Tebogo M. Mothiba
Full Text Available Background: Immunisation is the cornerstone of primary healthcare. Apart from the provision of safe water, immunisation remains the most cost-effective public health intervention currently available. Immunisation prevents infectious conditions that are debilitating, fatal and have the potential to cause huge public health burdens, both financially and socially, in South Africa. Aim: To determine the challenges faced by professional nurses when implementing the Expanded Programme on Immunisation (EPI at rural clinics in Capricorn District, Limpopo Province, South Africa. Setting: The study was conducted in selected primary healthcare clinics of Capricorn District, Limpopo Province. Methods: A qualitative explorative descriptive contextual research design was used to gather data related to the challenges faced by professional nurses when implementing EPI at rural clinics in Capricorn District. Results: The findings revealed that professional nurses had knowledge of the programme, but that they experienced several challenges during implementation of EPI that included staff shortages and problems related to maintenance of the vaccines’ potency. Conclusions: The Department of Health as well as the nursing administration should monitor policies and guidelines, and especially maintenance of a cold chain for vaccines, to ensure that they are practised throughout Limpopo Province. The problem of staff shortages also needs to be addressed so that the EPI can achieve its targeted objectives. Keywords: Professional nurse, knowledge, EPI-SA, immunisation
Mafune, Rhudzani V; Lebese, Rachel T; Nemathaga, Livhuwani H
Children depend solely on caregivers who can be either parents or guardians for drug administration to enhance adherence to antiretroviral treatment (ART), which might pose any number of challenges. The purpose of this study was to explore and describe the challenges faced by caregivers of children on ART at Mutale Municipality, Vhembe District, Limpopo Province. The research design was qualitative, explorative, descriptive and contextual in nature. The population consisted of 16 caregivers who were 18 years of age and above, and mentally capable, irrespective of educational qualifications, caring for children aged between 0 and 15 years who were on ART between April 2013 and October 2014. Non-probability, purposive sampling was used to select the 16 caregivers. Required permission, approval and ethical clearance were obtained from the University of Venda Higher Degree Committee, Limpopo Provincial Health Department and relevant institutions. An in-depth, individual, unstructured interview method was used to collect data. One central question was asked: 'What are the challenges you experience when caring for a child on antiretroviral treatment?' Subsequent questions were based on the participants' responses to the central question. Qualitative data were analysed by means of Tesch's open-coding method. The findings of this study revealed that participants, that is, caregivers of children on ART, experienced financial burdens because of transport costs needed to comply with follow-up dates and insufficient of money for food, clothing the child in need of care, pocket money for lunch boxes during school hours and time lost while waiting for consultations. Participants reported some level of stigmatisation against children on ART by family members, especially the husbands or in-laws of the secondary caregivers. Many primary and secondary caregivers seemed to have given up seeking support from government and community structures. The conclusions drawn from this research
Eton, Marus; Mwirumubi, Richard; Edaku, Charles
Entrepreneurship is defined as the process where an individual discovers, evaluates and exploit opportunities independently. Most countries have embraced entrepreneurship development as ways of creating employment and economic growth and development. The objective of the study was to examine the challenges faced by commercial enterprises in Lira…
Pordes, Ruth; /Fermilab
Today's global communities of users expect quality of service from distributed Grid systems equivalent to that their local data centers. This must be coupled to ubiquitous access to the ensemble of processing and storage resources across multiple Grid infrastructures. We are still facing significant challenges in meeting these expectations, especially in the underlying security, a sustainable and successful economic model, and smoothing the boundaries between administrative and technical domains. Using the Open Science Grid as an example, I examine the status and challenges of Grids operating in production today.
Dass, Pradeep Maxwell
Nation-wide dissemination of the Iowa Chautauqua Model for inservice professional development of K-12 science teachers has led to new professional development programs in many states. The Collier Chautauqua Program (CCP) implemented the Iowa Chautauqua model at the district level in Collier County, Florida. A formative evaluation of the…
China's rise signifies a gradual transformation of the international system from unipolarity to a non-unipolar world. ,4s an organization of small and middle powers, ASEAN faces strategic uncertainties brought about by the power transition in the system. Deepening economic interdependence between...... Summit (EAS), the Regional Comprehensive Economic Partnership (RCEP), and the ASEAN Community, to constrain and shape China's behaviour in the region in the post-Cold War era. It argues that due to globalization and economic interdependence, the power transition in the 21st century is different from...... the previous ones. ASEAN can potentially make a great contribution to a peaceful transformation of the international system. How to resolve the South China Sea disputes peacefully will be a critical task for both the ASEAN and Chinese leaders in the next decade or two....
In this talk, we will discuss the future of storage systems. In particular, we will focus on several big challenges which we are facing in storage, such as being able to build, manage and backup really massive storage systems, being able to find information of interest, being able to do long-term archival of data, and so on. We also present ideas and research being done to address these challenges, and provide a perspective on how we expect these challenges to be resolved as we go forward.
Gilmar P Henz
morango do DF mais eficiente e seletivo.In this article, I had highlighted the results of a survey carried out in 2009 on the situation and difficulties faced by strawberry growers, characterized as smallholders, in the Federal District (DF, Brazil. In addition, I discuss some alternatives to mitigate these problems. The most cited challenges identified by smallholders were, in order of importance: (1 incidence of pests and diseases; (2 strawberry plantlet acquisition; (3 packing costs; (4 need of intensive labor; and (5 high production costs. Based on these information, some possible measures to improve the social and economic status of the smallholders involved in the strawberry production in DF are: (a local production of plantlets, with sanitary quality and affordable costs, to reduce the dependence on other Brazilian States; (b a more intensive use of the several public and private universities, science and technology institutions and rural extension services available in DF to support the sector; (c creation of an association or cooperative to scale up production, access distinct market niches and strengthen the political influence of the sector; (d improve the postharvest handling system by adopting modern packing materials and refrigeration; (e adopt modern traceability tools, so as to increase the local strawberry added value and, therefore, access more demanding markets; (f implement and join the "Strawberry Integrated Production Program (PIMo", officially launched by the Brazilian Ministry of Agriculture, Livestock and Food Supply in 2006; (g survey the local strawberry market and consumer demands to develop a strategic marketing plan to serve the distinct market segments. The increasing consumers' demand for fruit quality and certified and residue free products will surely push the strawberry production system in DF into a scenario of efficiency and excellence.
In 2007, the U.S. Geological Survey (USGS) developed a science strategy outlining the major natural-science issues facing the Nation in the next decade. The science strategy consists of six science directions of critical importance, focusing on areas where natural science can make a substantial contribution to the well-being of the Nation and the world. This fact sheet is an overview of the science strategy and describes how USGS research can strengthen the Nation with information needed to meet the challenges of the 21st century.
Cárdenas, P; Pérez, T; Boury-Esnault, N
Systematics is nowadays facing new challenges with the introduction of new concepts and new techniques. Compared to most other phyla, phylogenetic relationships among sponges are still largely unresolved. In the past 10 years, the classical taxonomy has been completely overturned and a review of the state of the art appears necessary. The field of taxonomy remains a prominent discipline of sponge research and studies related to sponge systematics were in greater number in the Eighth World Sponge Conference (Girona, Spain, September 2010) than in any previous world sponge conferences. To understand the state of this rapidly growing field, this chapter proposes to review studies, mainly from the past decade, in sponge taxonomy, nomenclature and phylogeny. In a first part, we analyse the reasons of the current success of this field. In a second part, we establish the current sponge systematics theoretical framework, with the use of (1) cladistics, (2) different codes of nomenclature (PhyloCode vs. Linnaean system) and (3) integrative taxonomy. Sponges are infamous for their lack of characters. However, by listing and discussing in a third part all characters available to taxonomists, we show how diverse characters are and that new ones are being used and tested, while old ones should be revisited. We then review the systematics of the four main classes of sponges (Hexactinellida, Calcispongiae, Homoscleromorpha and Demospongiae), each time focusing on current issues and case studies. We present a review of the taxonomic changes since the publication of the Systema Porifera (2002), and point to problems a sponge taxonomist is still faced with nowadays. To conclude, we make a series of proposals for the future of sponge systematics. In the light of recent studies, we establish a series of taxonomic changes that the sponge community may be ready to accept. We also propose a series of sponge new names and definitions following the PhyloCode. The issue of phantom species
Chang, Bo; Kang, Haijun
Online group work can be complicated because of its asynchronous characteristics and lack of physical presence, and its requirements for skills in handling technology, human relationships, and content-related tasks. This study focuses on the administrative, logistical and relationship-related challenges in online group work. Challenges in areas…
Security Management Challenges Facing Federal Leadership 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT...including attention to management practices and key success factors. HOMELAND SECURITY Management Challenges Facing Federal Leadership www.gao.gov/cgi...significant management and coordination challenges if it is to provide this leadership and be successful in preventing and responding to any future
de Oliveira, Sandi Michele; Hernández-Flores, Nieves
In current research on face analysis questions of who and what should be interpreted, as well as how, are of central interest. In English language research, this question has led to a debate on the concepts of P1 (laypersons, representing the “emic” perspective) and P2 (researchers, representing...... in Spanish and address forms in European Portuguese, we view P1 and P2 as being far more complex than the literature suggests, with subgroups (different types of laypersons and researchers, respectively). At the micro-level we will describe the roles each subgroup plays in the interpretative process...
... with facebook share with twitter share with linkedin Gender-Specific Health Challenges Facing Women Global Research Global ... adverse reactions to the drugs. Women also suffer gender-specific consequences of HIV, including recurrent vaginal yeast ...
Matore, Mohd Effendi @ Ewan Mohd; Khairani, Ahmad Zamri
This study aims to identify other challenges besides those already faced by students, in seven polytechnics in Malaysia as a continuation to the previous research that had identified 52 main challenges faced by students using the Rasch Model. The explorative study focuses on the challenges that are not included in the Mooney Problem Checklist (MPCL). A total of 121 polytechnic students submitted 183 written responses through the open questions provided. Two hundred fifty two students had responded from a students' perspective on the dichotomous questions regarding their view on the challenges faced. The data was analysed qualitatively using the NVivo 8.0. The findings showed that students from Politeknik Seberang Perai (PSP) gave the highest response, which was 56 (30.6%) and Politeknik Metro Kuala Lumpur (PMKL) had the lowest response of 2 (1.09%). Five dominant challenges were identified, which were the English language (32, 17.5%), learning (14, 7.7%), vehicles (13, 7.1%), information technology and communication (ICT) (13, 7.1%), and peers (11, 6.0%). This article, however, focus on three apparent challenges, namely, English language, vehicles, as well as computer and ICT, as the challenges of learning and peers had been analysed in the previous MPCL. The challenge of English language that had been raised was regarding the weakness in commanding the aspects of speech and fluency. The computer and ICT challenge covered the weakness in mastering ICT and computers, as well as computer breakdowns and low-performance computers. The challenge of vehicles emphasized the unavailability of vehicles to attend lectures and go elsewhere, lack of transportation service in the polytechnic and not having a valid driving license. These challenges are very relevant and need to be discussed in an effort to prepare polytechnics in facing the transformational process of polytechnics.
The cotton industry is in the midst of an exciting time with increased domestic consumption, but also facing pressure from other crops and the global marketplace. In order to ensure the US cotton crop remains the fiber of choice for the world it is important to keep an eye on the challenges to fibe...
This paper discusses the challenges facing distance students in Geography field Practical projects (GFPs) at The Open University of Tanzania (OUT). A random sample size of 19 students who participated in GFP1 in 2009 and 2010 were selected from randomly sampled regional centres of Singida, Dodoma, Njombe, and ...
British Energy is one of the world's largest nuclear generating companies. This paper describes the business environment in which the company competes, its strategic responses to the challenges it faces, and gives some conclusions regarding the priorities for the nuclear generation industry if it is to thrive as a mainstream source of energy. (author)
Varis, O.; Vakkilainen, P.
The amount of water per person in northern China is less than half of that in Egypt, a country with very scarce water resources. Clearly, then, China is one of the regions on our planet that is going to have to face severe problems of water supply in the future. Rapid urbanisation and industrialisation growing agricultural output, environmental degradation, climatic instability, a large population density and worsening regional disparities are all factors that will challenge the management and utilisation of China's water resources in the years to come. (orig.)
Full Text Available While gaining centrality within the sport field, media accelerated its commodification process and facilitated sport actors becoming competitive on the celebrity market. The aim of this paper is to discuss the reconfiguration that the celebrity logic brought in terms of the mere condition of the sport actor and the face management challenges and remedial strategies that he has to cope with. I will thus focus on two main dimensions that I find to be constitutive for the celebrity status: one related to the augmented media exposure that sport stars are subject to and to the corollary symbolic reconfiguration of the boundaries between his public and his private life, and the second one related to the vulnerability that comes along with the new visibility of the complex repertoire of identities and social roles performed by the sport actors. Within this last dimension of the sport-related celebrity cycle of promotion, I will lay stress not only on the face threatening aspects for the sport stars, but also on the vulnerability transfer within the affinal branding network and the challenges it could bring for the brands that chose to associate their image with a sport celebrity. Thus, I argue that the kaleidoscopic public figures of sport celebrities requires high impression management involvement on their part, as well as more caution on the marketeers part.
Full Text Available Global health networks, webs of individuals and organizations with a shared concern for a particular condition, have proliferated over the past quarter century. They differ in their effectiveness, a factor that may help explain why resource allocations vary across health conditions and do not correspond closely with disease burden. Drawing on findings from recently concluded studies of eight global health networks—addressing alcohol harm, early childhood development (ECD, maternal mortality, neonatal mortality, pneumonia, surgically-treatable conditions, tobacco use, and tuberculosis—I identify four challenges that networks face in generating attention and resources for the conditions that concern them. The first is problem definition: generating consensus on what the problem is and how it should be addressed. The second is positioning: portraying the issue in ways that inspire external audiences to act. The third is coalition-building: forging alliances with these external actors, particularly ones outside the health sector. The fourth is governance: establishing institutions to facilitate collective action. Research indicates that global health networks that effectively tackle these challenges are more likely to garner support to address the conditions that concern them. In addition to the effectiveness of networks, I also consider their legitimacy, identifying reasons both to affirm and to question their right to exert power.
Individual medical physicists have presented many challenges which have greatly inhibited their input in patient care and management. To improve the role and recognition of medical physicists in Africa, FAMPO was established. This is the Federation of African Medical Physics Organisations. Its main role is to bridge the gap between individual medical physicists, existing medical physicist bodies and the International Organisation of Medical Physics (IOMP). It is a non profit making organisation. A qualified medical physicist is an individual who is competent to practice independently one or more of the sub fields of medical physics. i.e. therapeutic radiological, diagnostic radiological, medical nuclear and medical health. Their time should on average be distributed equally among three areas, clinical service and consultation, research and development, and teaching. All diagnostic and radiotherapy centres should have a well established comprehensive quality assurance programme in place, which should involve machine installation and calibration, source delivery and safety, operational procedures, clinical dosimetry and the whole treatment planning process. This should be followed according to national and international recommendations. A study was carried out to identify the challenges faced by medical physicists in Africa and the objectives of the study were; To identify the number of qualified medical physicists and their working experience in hospitals in African countries. To identify the level of involvement of medical physicists in the three areas of Nuclear medicine, Radiology and Radiotherapy in hospitals in African countries.To identify countries with recognised professional bodies governing medical physicists in African countries.To identify the challenges faced by medical physicists in African countries Methods and materials The study was conducted on thirteen medical physicists from seven African countries. i.e. Nigeria, Kenya, Libya, Tanzania, Zambia
Walach, T. [Canadian District Energy Association, Vaughan, ON (Canada)
A summary of how the Northwind Windsor plant operates was presented along with reasons why it is advantageous to get connected to a district heating system. The plant is a joint venture between Exelon Thermal Technologies and Ontario Power Generation. The plant produces and sells hot water, chilled water, steam and electricity to the Windsor Utilities Commission. Energy is then piped out to buildings in the area, including the Art Gallery of Windsor, the Royal Bank Business Centre, the Windsor Justice Facility, the Windsor Casino, and Northwind Windsor. The energy, which is transferred through heat exchangers, is used for space heating, domestic hot water heating, and air conditioning. The plant offers less management costs, lower energy costs, a lower level of risk management, stable energy rates, better use of building space, reliable service, and a cleaner environment. However, operators face significant challenges in terms of plant operation. They must be knowledgeable in the operation and maintenance of innovative equipment, and must have detailed information regarding operating efficiencies. District Energy requires more complex plants that use various energy saving technologies that deliver a broad range of energy types.
The 1992 Constitution of the Republic of Ghana and the various legislations on decentralisation articulate the explicit objectives of the policy which includes responsiveness to community needs. The rationale behind Ghana's decentralisation programme and the functions of the District Assemblies (DAs) therefore provide a ...
Full Text Available Mia Beck Lichtenstein,1 Cecilie Juul Hinze,2 Bolette Emborg,3 Freja Thomsen,2 Simone Daugaard Hemmingsen4 1Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, 2Research Unit for Telepsychiatry and E-mental Health, Mental Health Services in the Region of Southern Denmark, Odense, 3Department of Public Health, Aarhus University, Aarhus, 4Research Unit, Child and Adolescent Psychiatry, Mental Health Services in the Region of Southern Denmark, Odense, Denmark Abstract: Compulsive exercise is a condition described since 1970s. It is characterized by a craving for physical training, resulting in uncontrollable excessive exercise behavior with harmful consequences, such as injuries and impaired social relations. It has not been accepted as a mental disorder in either International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders. The aim of this literature review was to critically examine the research on links (comorbidity, risks (negative consequences, and challenges faced (problems in a treatment context. This review found that compulsive exercise is associated with eating disorder pathology, perfectionism, neuroticism, narcissism, and obsessive compulsive traits. The most prominent negative consequences were injuries, social impairment, and depression, but more research is needed to uncover the potential dysfunction resulting from compulsive exercise. As the condition is not recognized as a psychiatric disorder, studies on treatment interventions are sparse. Problems with compliance have been reported; therefore, motivational interviewing has been proposed as a treatment approach, in combination with cognitive behavioral therapy. This review summarizes and discusses findings on links/comorbidity, risks/negative consequences, and treatment challenges. We suggest that future studies should pay attention to both prevention and counseling in sports settings, where compulsive exercise
Among the numerous challenges facing our modern world, perhaps the most urgent and dominant are energy related. From the perspective of developing countries they are, in order of priorities, development, energy security and environment. Oil covers above 38% of the global commercial energy needs and gas about 20%. In some commanding sectors of the economy, like transport, oil is for now virtually the irreplaceable source of energy. In addition, oil and gas are two valuable primary materials of the chemical industry. It also happens that oil consumption is one of the sources of environmental pollution through the emission of CO 2 . Utilisation of the world's finite fossil energy resources (88% of total commercial energy) in the service of development reflects all the negative attributes of the mismanagement of the global economy, exemplified by waste, inefficiency, unfair terms of trade, market instability and short-sighted policies. These serious inequities have been further compounded by the growing menace of environmental and climatic degradation. In dealing with the interactions between these three complex systems, i.e., energy, environment and development, it is important for oil producers to delineate their priorities clearly, if they are to disentangle credible common goals for an international convention. (author)
This presentation relates to the changing business climate of the petroleum industry worldwide. The author gives a touch on the changes of what the industry is facing and the response together with the keys to long-term shareholder value
This presentation relates to the changing business climate of the petroleum industry worldwide. The author gives a touch on the changes of what the industry is facing and the response together with the keys to long-term shareholder value
Arnetz, B B
Fundamental changes in the organization, financing, and delivery of health care have added new stressors or opportunities to the medical profession. These new potential stressors are in addition to previously recognized external and internal ones. The work environment of physicians poses both psychosocial, ergonomic, and physico-chemical threats. The psychosocial work environment has, if anything, worsened. Demands at work increase at the same time as influence over one's work and intellectual stimulation from work decrease. In addition, violence and the threat of violence is another major occupational health problem physicians increasingly face. Financial constraint, managed care and consumerism in health care are other factors that fundamentally change the role of physicians. The rapid deployment of new information technologies will also change the role of the physician towards being more of an advisor and information provider. Many of the minor health problems will increasingly be managed by patients themselves and by non-physician professionals and practitioners of complementary medicine. Finally, the economic and social status of physicians are challenged which is reflected in a slower salary increase compared to many other professional groups. The picture painted above may be seen as uniformly gloomy. In reality, that is not the case. There is growing interest in and awareness of the importance of the psychosocial work environment for the delivery of high quality care. Physicians under stress are more likely to treat patients poorly, both medically and psychologically. They are also more prone to make errors of judgment. Studies where physicians' work environment in entire hospitals has been assessed, results fed-back, and physicians and management have worked with focused improvement processes, have demonstrated measurable improvements in the ratings of the psychosocial work environment. However, it becomes clear from such studies that quality of the
The need of the accounting profession to effectively and continuously meet new challenges confronting it and adapt its services to changing conditions and circumstances has become a necessity to the survival of the profession and the society. The challenges confronting the accountant on his role to the society at large in a ...
These are: the undervaluation of groundwater importance and significance; the need for expertise and information at all scales; the centralisation of power; and the disregard of ecosystems and the associated goods and services. As a means to tackle these challenges, it has been assumed that the concept of adaptive water ...
This study aimed at identifying the challenges that young African scientists face in their career development. Methods ... The research profile of Africans is relatively new, and the .... outside the country because it will support my original ideas.”.
ESOL) learners identified by educators as having language disorders and being referred for Speech-Language Therapy. We describe challenges faced by Grade 1, 2 and 3 educators at government schools in the Cape Metropolitan area who ...
Rural teachers' views: What are gender-based challenges facing. Free Primary Education in Lesotho .... resulted in high levels of poverty amongst women, particularly in rural areas. Women ...... Lesotho demographics profile 2010. Available at ...
Members of the World Forum community were invited to respond to the question: "What is the most urgent challenge facing young children in your country?" Here are some of their responses. Jamils Richard Achunji Anguaseh mentions that in Cameroon, young children face lots of insecurity, both from health hazards and poor parenting practices. There…
Albistur, F. X.
The Chairman of the Senate Commission for Industry. Tourism and Commerce emphasises the legitimate ambition felt by the citizens of all democratic States with respect to safety and underlines his trust in the regulatory body. He analyses the interesting example of the Spanish Nuclear Safety Council, true reflection of the democracy achieved in the country, from the standpoint of its history, the functions that have been added to its realm of competence in recent years environmental radiological surveillance, intervention in emergencies and activities at non-regulated facilities- and the need for it to adapt, within a framework of overall consensus, to improve its response to future challenges and to the goal of promoting credibility and forging a closer relationship with the public. (Author)
The path of society evolution has long been associated with a growing demand for natural resources and continuous environmental degradation. During the last decades, this pace has accelerated considerably, despite the general concern with the legacy being left for the next generations. Looking ahead, the predicted growth of the world population, and the improvement of life conditions in most regions, point to an increasing demand for energy generation, resulting in additional pressure on the Earth's sustainability. Materials have had a key role in decreasing the use of natural resources, by either improving efficiency of existing technologies or enabling the development of radical new ones. The greenhouse effect (CO2 emissions) and the energy crisis are global challenges that can benefit from the development of new materials for the successful implementation of promising technologies and for the imperative replacement of fossil fuels by renewable sources.
This article examines some of the fundamental challenges facing the district nurse in delivery of the managerial aspects of her role in contemporary practice. It discusses the personal attributes that are essential for this role to ensure safe, effective and compassionate leadership and management. The communication skills and ethos underpinning collaborative multidiscilplinary team work and person-centred care are discussed. Issues that compromise positive and productive team working are identified, and strategies dealing with conflict and also change management are debated. These factors are interrelated with the everyday demands of caseload management, the development of educational needs to meet the demands of increased complexity in care needs, and the place of technology in modern health care. It is evidenced that sustained organisational support for this role is more important than ever, due to increasing demand and decreasing capacity. Potential solutions to these challenges are offered to assist the contemporary district nurse.
Suleman, Qaiser; Gul, Rizwana
The current study explores the challenges faced by public secondary schools in successful implementation of total quality management (TQM) in Kohat District. A sample of 25 heads and 75 secondary school teachers selected from 25 public secondary schools through simple random sampling technique was used. Descriptive research designed was used and a…
This article presents the challenges that scientific research institutions face in terms of their marketing, which have been divided into two groups of those associated with internal marketing and those linked to external marketing. The most significant and important determinants that constitute challenges to both internal and external marketing were described. The key aspects of each of the identified challenges were indicated, as was their impact on the implementation of the marketing polic...
Full Text Available This article presents the challenges that scientific research institutions face in terms of their marketing, which have been divided into two groups of those associated with internal marketing and those linked to external marketing. The most significant and important determinants that constitute challenges to both internal and external marketing were described. The key aspects of each of the identified challenges were indicated, as was their impact on the implementation of the marketing policy at institutions.
Martins, Meghan G.
This research developed a survey that measures the degree to which challenges are experienced by school and district leaders, and teachers, when attempting to implement legislatively required District Improvement Plans (DIPs). The data indicate that there are certainly challenges when implementing DIPs and that teachers report experiencing a…
Full Text Available The European Union is currently affected by the financial crisis that spread internationally. The member states face difficulties such as price volatility, uncertainties, liquidity issues, cases of bankruptcy, increased unemployment rate, and decreasing GDP. The present paper analyses the challenges faced under these new circumstances by the European companies and their stakeholders. By taking into consideration the threats and weaknesses faced by firms and other interested parties, we emphasize the importance that transparency and communication among companies and their stakeholder have in overcoming financial difficulties.
M. J. Naude
Full Text Available Purpose and Objective: The South African automotive component industry faces huge challenges in a very competitive global market. The primary focus of this research article is to determine the challenges facing exporters within this industry with special reference to selected sub-sectors. The challenges are approached from a supply chain perspective only. Problem Investigated: The research problem of this study was to identify these unique challenges and ascertain whether the implementation of a 'philosophy of continuous improvement' could be used as a strategic tool to address the challenges they face in the market. Methodology: This study included a combination of literature review, interviews with managers in the selected sub-groups and questionnaires sent out to determine the challenges facing automotive component exporters. In order to test the content validity and the reliability of the questionnaire, a pilot study was conducted at two organisations that are the main suppliers of automotive filters for passenger vehicles. The non-probability convenience sample technique was used to select the sample and consisted of selected sub-sectors that contribute 64,1% of the total value of automotive component exports in South Africa. Out of twenty-seven questionnaires sent out, twenty (74% response rate were duly completed by the respondents and returned to the researcher. Findings: South Africa faces unique challenges and these are listed and ranked according to priority from most to least important as follows: 1. The reduction of production costs; 2. R/US$ exchange rate effect on the respondent's export sales and profit margin; 3. Exchange rate fluctuations; 4. Threats to the local automotive component market; and 5. Increased competition by way of manufactured imports being sold in the South African market. Value of Research: The study provides recommendations that can be used within the automotive component industry.
Lee, Lung-Sheng Steven
The technology education in Taiwan is prescribed in the national curriculum and provided to all students in grades 1-12. However, it faces the following challenges: (1) Lack of worthy image, (2) Inadequate teachers in elementary schools, (3) Deficient teaching vitality in secondary schools, and (4) Diluted technology teacher education programs. In…
First page Back Continue Last page Overview Graphics. Strategies being followed in India to face challenge of drug resistance in tuberculosis. Increasing the coverage with DOTS. Operational research to monitor the trends in drug resistance. Research in methods for rapid detection of drug resistance. Improving methods/ ...
The paper established that communication, supervisorstudent relationship, access to literature, plagiarism, and poor writing skills among some students are some of the key challenges facing students and supervisors in writing dissertations/theses at OUT. The paper recommends that communication between students and ...
Background: Africa accounts for 14% of world's population, and the economies of most African countries are considered to be growing, but this is not reflected in the amount of research published by Africans. This study aimed at identifying the challenges that young African scientists face in their career development.
This study examined the challenges facing commercial motorcycle occupation in Edo State, Nigeria. A descriptive survey design was adopted. Data were collected through questionnaires and in-depth interviews (IDIs) among selected motorcyclists, police officers and road safety officials in Etsako West Local Government ...
The effects of secularisation on society demand a rethinking of the identity and mission of Catholic schools in France. In 2013, the French bishops published a new directory which offers new approaches, described here, based on the three challenges facing Catholic education in France: linking social responsibility and evangelisation, setting up…
This paper gives prominence to rural teachers' accounts of gender-based challenges facing Free Primary Education in Lesotho. It draws on feminist interpretations of social constructionism to discuss factors within the Basotho communities that affect gender equality in the schools. The inductive analysis offered makes use ...
Challenges new entrant countries face in establishing a nuclear programme are distilled into four major categories: human resource development, financing, infrastructure and process. In implementing a successful nuclear programme role of the government is key to success. It requires clear and sustained policy support, international and bilateral agreements, developing the depth required of technical skills and infrastructure, proven delivery programme, management of radioactive waste and spent fuel, decommissioning and electricity market regulation.
Islam, Nurul; Beer, Martin; Slack, Frances
E-learning has become a necessity in higher education institutions and is being deployed in educational establishments throughout the world. Researchers have made much emphasis on its benefits but not much is discussed on the disadvantages of e-learning technology. This paper references some of the research work on the limitations of e-learning technology, categorises it in five challenges that teachers are faced with and suggestions for a successful e-learning outcome. This paper also discus...
Carter, Pam; Martin, Graham
This article engages with debates about the conceptualisation and practical challenges of patient and public involvement (PPI) in health and social care services. Policy in this area in England has shifted numerous times but increasingly a consumerist discourse seems to override more democratic ideas concerning the relationship between citizens and public services. Recent policy change in England has seen the creation of new consumer champion bodies in the form of local Healthwatch. The article describes these new organisational structures for PPI and shows how those who seek to influence planning and delivery of services or comment or complain about aspects of their care face considerable complexity. This is due, in part, to the ambiguous remit set out for newly instigated Healthwatch organisations by government. Drawing on governance theory, we show that it can also be understood as a function of an increasingly polycentric governance arena. Challenges that flow from this include problems of specifying jurisdictional responsibility, accountability, and legitimacy. We review Healthwatch progress to date, then we set out four challenges facing local Healthwatch organisations before discussing the implications of these for patients and the public. The first challenge relates to non-coterminous boundaries and jurisdictional integrity. Secondly, establishing the unique features of Healthwatch is problematic in the crowded PPI arena. The third challenge arises from limited resources as well as the fact that resources flow to Healthwatch from the local authorities that Healthwatch are expected to hold to account. The fourth challenge we identify is how local Healthwatch organisations negotiate the complexity of being a partner to statutory and other organisations, while at the same time being expected to champion local people's views. © 2016 by Kerman University of Medical Sciences.
Adrián Cuevas Jiménez
Full Text Available Higher education refers to the subsequent training to high school education; that is undergraduate and graduate; whose mission is to preserve; develop and disseminate culture. Throughout the history of higher education it has undergone a process of transformation; mainly due to the development of knowledge and the transformation of society. In the process they highlighted two great moments; in the first; which culminated in the mid-twentieth century; it conceived the higher education institution encompassing all knowledge of society; and who graduated was ready to perform professionally throughout life; the second time; after those dates; it is conceivable that knowledge is no longer exclusive to the institution of higher education; and there can be no efficient performance without continuous training and continuous updating of knowledge. The objective of this work is to point out the general goals and some strategies of the students’ formation of superior education; to confront the big challenges that it faces today the society. To define this goals and strategies four challenge levels are considered: a physical; structural and politicalideological challenges; b challenges around the scientifictechnician and of the knowledge advances; c challenges of the internal structure of the formative process and the access to the superior education; and d challenges in the formation of values in the students.
Yettick, Holly; Baker, Robin; Wickersham, Mary; Hupfeld, Kelly
The purpose of this study was to inform the upcoming and overdue reauthorization of the Elementary and Secondary Education Act (ESEA) by exploring whether rural school districts face disadvantages as they attempt to follow the law's provisions and, if so, if the law's rural-specific section ameliorates these disadvantages. The research drew upon…
Dey, Eric L.
First among the many important challenges facing American higher education is the need to improve the effectiveness of our educational programs. Public concern has heightened the sense of urgency for colleges and universities to make progress on improving and measuring educational outcomes, which is made more challenging by the varieties of diversity facing us. Diversity is not just an issue related to student recruitment or experience, but rather it is one that also relates to institutions and their faculties. New educational methods must address such diversity to be effective, and one possible example can be found in ongoing research at the University of Michigan that explores the educational implications of implementing a web-based lecture capture system in large lecture courses. Student use of and reactions to such systems is important, as is the potential to influence course performance for students in general, but also for underrepresented and at-risk student subpopulations. In addition to helping bring our current landscape into focus, this paper will identify effective practices as well as continuing challenges to improving educational practice for undergraduate students.
Full Text Available Ahmed Hashim Gastroenterology Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK Introduction: International medical graduates (IMGs in the UK constitute approximately one-quarter of the total number of doctors registered in the General Medical Council (GMC. The transition of IMGs into the health care system in the UK is accompanied by significant sociocultural and educational challenges. This study aims to explore the views of IMGs in medical training on the educational challenges they face.Methods: This study was conducted in the Kent, Surrey and Sussex region in 2015. All IMGs who work in medical (physicianly training programs were included. Data were collected through a questionnaire and semi-structured interviews. Thematic approach was used to analyze the qualitative data.Results: Of the total 61 IMGs included, 17 responded to the survey and 3 were interviewed. The common educational barriers faced by IMGs were related to lack of appreciation of the values and structure of the National Health Service (NHS, ethical and medicolegal issues, receiving feedback from colleagues and the different learning strategies in the UK. IMGs suggested introduction of a mandatory dedicated induction program in the form of formal teaching sessions. They also believed that a supervised shadowing period prior in the first job in the UK would be beneficial. Further assessment areas should be incorporated into the prequalifying examinations to address specific educational needs such as NHS structure and hospital policies. Other measures such as buddying schemes with senior IMGs and educating NHS staff on different needs of IMGs should also be considered.Conclusion: This study highlighted important educational challenges faced by IMGs and generated relevant solutions. However, the opinions of the supervisors and other health care professionals need to be explored. Keywords: international medical graduates, IMG, educational barriers
Sri Budi Utami
Technical and scientific support organizations (TSOs) dedicated to supporting national regulatory authorities. At present BAPETEN has internal TSOs. Pertaining to the regulatory control of nuclear safety, security, and safeguards for nuclear power plants (NPPs), independent TSOs providing support to the safety regulatory bodies are facing a number of technical challenges to ensuring the safety of NPPs. It is essential that BAPETEN need independent TSOs in order to warrant a sufficient level of safety, security and non proliferation in building and operating of first NPP. It is essential that BAPETEN need independent TSOs in order to warrant a sufficient level of safety, security and non proliferation in building and operating of first NPPs. (author)
Begault, Durand R.; Null, Cynthia H. (Technical Monitor)
The challenges facing successful multimedia presentation depend largely on the expectations of the designer and end user for a given application. Perceptual limitations in distance, elevation and azimuth sound source simulation differ significantly between headphone and cross-talk cancellation loudspeaker listening and therefore must be considered. Simulation of an environmental context is desirable but the quality depends on processing resources and lack of interaction with the host acoustical environment. While techniques such as data reduction of head-related transfer functions have been used widely to improve simulation fidelity, another approach involves determining thresholds for environmental acoustic events. Psychoacoustic studies relevant to this approach are reviewed in consideration of multimedia applications
Kampra, Matina; Tzerakis, Nikolas; Thomsen, Louise Lund Holm
, parents/caregivers found that they needed more education about the existing sources of psychosocial and emotional support to cope with their child's epilepsy personally and as a family. Finally, the parents/caregivers who let their child know about the epilepsy and discussed the implications......Objective This qualitative study explored the challenges that Greek parents/caregivers of children with controlled epilepsy (CwE) face regarding the disorder. Methods Interviews were conducted based on open-ended questions guided by a review of the literature. A total of 91 parents/caregivers were...... recruited by neurologists at the neurology clinics of two Athens public hospitals. A hermeneutic phenomenological approach was used to explore parent/caregiver experiences. The data were grouped and analyzed through a textual interpretation. Results Two key challenges were identified for parents of Cw...
Growing demand for science teachers in the Kingdom of Saudi Arabia, fed by increasing numbers of public school students, is forcing the Saudi government to attract, recruit and retain well-qualified science teachers. Beginning science teachers enter the educational profession with a massive fullfilment and satisfaction in their roles and positions as teachers to educating children in a science classroom. Nevertheless, teachers, over their early years of practice, encounter numerous challenges to provide the most effective science instruction. Therefore, the current study was aimed to identify academic and behavioral classroom challenges faced by science teachers in their first three years of teaching in the Kingdom of Saudi Arabia. In addition, new science teacher gender, school level and years of teaching experience differences in perceptions of the challenges that they encountered at work were analyzed. The present study also investigated various types of support that new science teachers may need to overcome academic and behavioral classroom challenges. In order to gain insights about ways to adequately support novice science teachers, it was important to examine new science teachers' beliefs, ideas and perceptions about effective science teaching. Three survey questionnaires were developed and distributed to teachers of both sexes who have been teaching science subjects, for less than three years, to elementary, middle and high school students in Al Jouf public schools. A total of 49 novice science teachers responded to the survey and 9 of them agreed to participate voluntarily in a face-to-face interview. Different statistical procedures and multiple qualitative methodologies were used to analyze the collected data. Findings suggested that the top three academic challenges faced by new science teachers were: poor quality of teacher preparation programs, absence of appropriate school equipment and facilities and lack of classroom materials and instructional
Li, Hongwei; Wang, Stephen Jia
Previous research and development shows that low temperature district heating (LTDH) system is economic feasible for low energy buildings and buildings at sparse areas. Coupling with reduced network temperature and well-designed district heating (DH) networks, LTDH can reduce network heat loss by...
Mortensen, Kristine Køhler; Brotherton, Chloe
for the face the be put into action. Based on an ethnographic study of Danish teenagers’ use of SnapChat we demonstrate how the face is used as a central medium for interaction with peers. Through the analysis of visual SnapChat messages we investigate how SnapChat requires the sender to put an ‘ugly’ face...... already secured their popular status on the heterosexual marketplace in the broad context of the school. Thus SnapChat functions both as a challenge to beauty norms of ‘flawless faces’ and as a reinscription of these same norms by further manifesting the exclusive status of the popular girl...
Florini, Ann; Sovacool, Benjamin K.
This article conceptualizes the energy problems facing society from a global governance perspective. It argues that a notion of 'global energy governance,' taken to mean international collective action efforts undertaken to manage and distribute energy resources and provide energy services, offers a meaningful and useful framework for assessing energy-related challenges. The article begins by exploring the concepts of governance, global governance, and global energy governance. It then examines some of the existing institutions in place to establish and carry out rules and norms governing global energy problems and describes the range of institutional design options available to policymakers. It briefly traces the role of a selection of these institutions, from inter-governmental organizations to summit processes to multilateral development banks to global action networks, in responding to energy issues, and points out their strengths and weaknesses. The article concludes by analyzing how the various approaches to global governance differ in their applicability to addressing the conundrums of global energy problems.
Nuclear power represents a major portion of Ontario Power Generation's generation mix and it will be the bedrock upon which we build a successful, competitive company. Our nuclear units offer many environmental and economic benefits, the one most relevant to this meeting is their significant contribution to the relatively low carbon intensity of Ontario's and Canada's electricity supply. In recent weeks, we have listened with great interest to the endorsement by our federal Minister of the Environment of nuclear technology as a means of reducing global warming. But endorsements of this type alone are not sufficient to ensure that nuclear remains an acceptable option for managing greenhouse gas emissions. Without public acceptance and support, the entire nuclear investment is endangered. At OPG we face three challenges to building this public support: we must continue to improve our safety margins and operating performance; we must continue to improve the environmental performance at our stations; and we must increase our community outreach. Today I would like to focus on the last two challenges and the actions that we are taking to maintain our social and environmental 'licence to operate.' But before I describe these initiatives, I will tell you about: the new company - Ontario Power Generation; the changes in store for Ontario's electricity sector; and our greenhouse gas emissions - the legacy from Ontario Hydro. (author)
Water management in the Western United States relies significantly upon a fleet of small to very large engineered dams to store water during times of runoff and distribute that water during times of need. Much of this infrastructure is Federally owned and/or operated, and was designed and funded during the first half of the twentieth century through a complex set of repayment contracts for Federally authorized purposes addressing water supply, recreation, and hydropower, and other water management objectives. With environmental laws, namely the Endangered Species Act, and other environmental concerns taking a more active role in water resources in the mid to latter half of the twentieth century, this infrastructure is being stressed even greater than anticipated to provide authorized purposes. Additionally, weather and climate norms being experienced are certainly near the edges, if not outside, of anticipated variability in the climate and hydrology scenarios for which the infrastructure was designed. And, finally, these dams, economically designed for a lifespan of 50 - 100 years, are experiencing maintenance challenges from routine to significant. This presentation will focus on identifying some of the history and challenges facing the water infrastructure in the Western United States. Additionally, some perspectives on future paths to meet the needs of western irrigation and hydropower production will be provided.
Agno, Christina Farala; Guo, Kristina L
The purpose of this article is to discuss specific challenges faced by hospitals adopting the use of electronic medical records and implementing electronic health record (EHR) systems. Challenges include user and information technology support; ease of technical use and software interface capabilities; compliance; and financial, legal, workforce training, and development issues. Electronic health records are essential to preventing medical errors, increasing consumer trust and use of the health system, and improving quality and overall efficiency. Government efforts are focused on ways to accelerate the adoption and use of EHRs as a means of facilitating data sharing, protecting health information privacy and security, quickly identifying emerging public health threats, and reducing medical errors and health care costs and increasing quality of care. This article will discuss physician and nonphysician staff training before, during, and after implementation; the effective use of EHR systems' technical features; the selection of a capable and secure EHR system; and the development of collaborative system implementation. Strategies that are necessary to help health care providers achieve successful implementation of EHR systems will be addressed.
Full Text Available The present study was carried out to analyse the constraints faced by the dairy farmers in Nagpur district. This study was conducted in 15 villages from 3 talukas of Nagpur district by personally interviewing 225 dairy farmers. Here, majority of the respondents (72.44% stated their constraint as low milk production from the local breeds, 45.33% as shortage of green fodder and 41.33% as lack of clean water while 25.33% stated lack of preservation facility as their constraint. Referring to the financial constraints, 78.22% respondents stated their constraint as delay in milk payment,63.11% as inadequate money and lack of loan facility whereas high cost of concentrates as the constraint by 56.44% of the respondents. As regards technical constraints, majority of the respondents (68.00% have stated their constraint as inadequate knowledge of diseases, their prevention and control while 56.89% have referred their constraint as non-availability of veterinary services. [Vet. World 2009; 2(3.000: 111-112
Goldie, T. [Hydro One Networks Inc., Toronto, ON (Canada); Hodder, S. [GE Digital Energy, Toronto, ON (Canada)
The challenges facing electric utilities regarding a shortage of highly qualified labour to maintain, refurbish and expand electrical infrastructure can be attributed to a wave of retirements in skilled employees, a shortage of entry-level workers and a rapidly increasing workload caused by investment in electricity infrastructure. Two solutions were presented for finding and sustaining an adequate personnel base. The first involved developing local talent, both entry-level and mid-career staff to ensure that work continuity and workplace safety are maintained. The second involved the implementation of technological solutions to help optimize the use of existing and future labour resources. This paper presented the human resource programs developed by Hydro One, the largest electrical transmission and distribution utility in the province of Ontario. Their initiatives include raising the profile of the utility work environment through strategic partnerships with educational institutions and developing in house offerings to supplement existing academic programs. This paper also presented a technical solution to address the resources challenges specifically associated with power system protection and control. The solution targets professional and skilled trades involved in the design, installation and maintenance of automated substations and protection and control systems. It is based on the premise that resource optimization can be achieved by reducing inconsistent design and construction practices and replacing these designs with highly standardized materials with digital communications using IEC 61850. This new technology should attract young professionals to the power engineering field while still maintaining a high comfort level with the established professional workforce. 5 refs., 4 figs.
Technological Horizons in Education, 1983
Elmhurst Community Unit School District 205 (Illinois) is currently using a Digital PDP-11/70 computer system and administrative software to handle administrative functions with ease and efficiency. These functions include production of reports and payroll, student scheduling, reporting grades and student progress, and maintaining student…
Schnable, P. S.
To overcome some of the myriad challenges facing sustainable crop production we are seeking to develop statistical models that will predict crop performance in diverse agronomic environments. Crop phenotypes such as yield and drought tolerance are controlled by genotype, environment (considered broadly) and their interaction (GxE). As a consequence of the next generation sequencing revolution genotyping data are now available for a wide diversity of accessions in each of the major crops. The necessary volumes of phenotypic data, however, remain limiting and our understanding of molecular basis of GxE is minimal. To address this limitation, we are collaborating with engineers to construct new sensors and robots to automatically collect large volumes of phenotypic data. Two types of high-throughput, high-resolution, field-based phenotyping systems and new sensors will be described. Some of these technologies will be introduced within the context of the Genomes to Fields Initiative. Progress towards developing predictive models will be briefly summarized. An administrative structure that fosters transdisciplinary collaborations will be briefly described.
Mazul, I.V., E-mail: email@example.com [Efremov Institute, 196641 St. Petersburg (Russian Federation); Belyakov, V.A.; Gervash, A.A.; Giniyatulin, R.N.; Guryeva, T.M.; Kuznetsov, V.E.; Makhankov, A.N.; Okunev, A.A. [Efremov Institute, 196641 St. Petersburg (Russian Federation); Sevryukov, O.N. [MEPhI, 115409 Moscow (Russian Federation)
Highlights: • Technological aspects of ITER PFC manufacturing in Russia are presented. • Range of technologies to be used during manufacturing of ITER PFC at Efremov Institute has been, in general, defined and their complexity, originality and difficulty are described. • Some features and challenges of welding, brazing and various tests are discussed. - Abstract: Major part of ITER plasma facing components will be manufactured in the Russian Federation (RF). Operational conditions and other requirements to these components, as well as the scale of production, are quite unique. These unique features and related technological solutions found in the frame of the project are discussed. Procedure breakdown and results of qualification for the proposed technologies and potential producers are presented, based on mockups production and testing. Design of qualification mockups and prototypes, testing programs and results are described. Basic quantitative and qualitative parameters of manufactured components and methods of quality control are presented. Critical manufacturing issues and prospects for unique production for future fusion needs are discussed.
Davis, P.B. [Department of Energy (United States); Sutton, R. [Argonne National Lab. (United States); Wagner, F.W. [Energetics Incorporated (United States)
The U.S. Department of Energy (DOE) and the U.S. automotive industry are working cooperatively under the auspices of the Partnership for a New Generation of Vehicles (PNGV) to develop a six-passenger automobile that can achieve up to 80 mpg. while meeting customer needs and all safety and emission requirements. These partners are continuing to invest heavily in the research and development of polymer electrolyte membrane (PEM) fuel cells as a clean and efficient energy conversion system for the PNGV. A critical challenge facing fuel cell systems for the PNGV is the development of efficient, compact, cost-effective air management systems. The U.S. Department of Energy has been exploring several compressor/expander options for pressurized fuel cell systems, including scroll, toroidal intersecting vane, turbine, twin screw, and piston technologies. Each of these technologies has strengths and weaknesses regarding efficiency, pressure ratio over turndown, size and weight, and cost. This paper will present data from the U.S. Department of Energy's research and development efforts on air management systems and will discusses recent program developments resulting from an independent peer review evaluation. (author)
Florini, Ann; Sovacool, Benjamin K. [Centre on Asia and Globalisation, Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore 259772 (Singapore)
This article conceptualizes the energy problems facing society from a global governance perspective. It argues that a notion of 'global energy governance,' taken to mean international collective action efforts undertaken to manage and distribute energy resources and provide energy services, offers a meaningful and useful framework for assessing energy-related challenges. The article begins by exploring the concepts of governance, global governance, and global energy governance. It then examines some of the existing institutions in place to establish and carry out rules and norms governing global energy problems and describes the range of institutional design options available to policymakers. It briefly traces the role of a selection of these institutions, from inter-governmental organizations to summit processes to multilateral development banks to global action networks, in responding to energy issues, and points out their strengths and weaknesses. The article concludes by analyzing how the various approaches to global governance differ in their applicability to addressing the conundrums of global energy problems. (author)
Linke, J; Pintsuk, G.; Rödig, M.
Increasing attention is directed towards thermonuclear fusion as a possible future energy source. Major advantages of this energy conversion technology are the almost inexhaustible resources and the option to produce energy without CO2-emissions. However, in the most advanced field of magnetic plasma confinement a number of technological challenges have to be met. In particular high-temperature resistant and plasma compatible materials have to be developed and qualified which are able to withstand the extreme environments in a commercial thermonuclear power reactor. The plasma facing materials (PFMs) and components (PFCs) in such fusion devices, i.e. the first wall (FW), the limiters and the divertor, are strongly affected by the plasma wall interaction processes and the applied intense thermal loads during plasma operation. On the one hand, these mechanisms have a strong influence on the plasma performance; on the other hand, they have major impact on the lifetime of the plasma facing armour. In present-day and next step devices the resulting thermal steady state heat loads to the first wall remain below 1 MWm-2; the limiters and the divertor are expected to be exposed to power densities being at least one order of magnitude above the FW-level, i.e. up to 20 MWm-2 for next step tokamaks such as ITER or DEMO. These requirements are responsible for high demands on the selection of qualified PFMs and heat sink materials as well as reliable fabrication processes for actively cooled plasma facing components. The technical solutions which are considered today are mainly based on the PFMs beryllium, carbon or tungsten joined to copper alloys or stainless steel heat sinks. In addition to the above mentioned quasi-stationary heat loads, short transient thermal pulses with deposited energy densities up to several tens of MJm-2 are a serious concern for next step tokamak devices. The most frequent events are so-called Edge Localized Modes (type I ELMs) and plasma disruptions
Subki, I.R.; Soentono, S.
Nuclear research centres in Indonesia are mainly owned and operated by the National Nuclear Energy Agency, covering basically various research and development facilities for non-energy and energy related activities. The research and development activities cover a broad spectrum of basic, applied, and developmental research involving nuclear science and technology in supporting various fields ranging from basic human needs, e.g. food and health; natural resources and nuclear and environmental safety; as well as industry. Recent economic crisis, triggered by monetary turmoil, has dictated the IAEA to face new challenges and to give more efforts on the application of the so called 'instant technology' i.e. the technology which has been developed and is ready for implementation, especially on food and health, to be better utilized to overcome various problems in the society. Various short and medium term programmes on the application of isotopes, radiation, and nuclear techniques for non-energy related activities have emerged in accord with these efforts. In this regard, besides the intensification of the instant technology implementation on food and health, the nuclear research and development on food plant mutation, fertilizers, radio-vaccines, production of meat and milk, production processes of various radiopharmaceuticals, and radioisotopes as well as radiation processing related to agro-industry have to be intensified using the available laboratories processing facilities. The possibility of the construction of irradiators for post harvesting processes in some provinces is being studied, while the designing and manufacturing of various prototypes of devices, equipment, and instruments for nuclear techniques in health and industry are continued. Considering the wide applications of accelerators for non-energy and energy related research and development, construction of accelerator-based laboratories is being studied. In energy related research the feasibility of
Gender equality has been a topic of discussion throughout my long (now three decade) career. This alone illustrates the complex nature of the issue, and the lack of a simple solution, particularly as many of the daily challenges that women face are institution or discipline-specific. For this reason, I will summarize some of the issues that appear to me to be more general, and therefore ones that may have general solutions. The first and foremost relates to demands on women's time. One way that academic institutions have sought to overcome gender bias has been to require that every university committee have a female member; in departments, schools and faculties where women represent a minority, this necessarily means that women shoulder an inequitable share of the service duties. I have experienced this myself, seen it in promotion files at all levels, and observed it with regard to my female colleagues. Clearly time spent doing service is time not spent doing science. There is also an easy solution to this problem, which is to re-think the underlying assumption that men are necessarily gender-biased if they don't have a woman sitting in the room! Additional time demands can come from informal mentoring of both students and younger colleagues, particularly in cases where senior male colleagues are viewed as too important, or too intimidating, to be consulted on personal issues. Although I suspect that this problem may also be widespread, it is more difficult to quantify, and is therefore more difficult to factor into time allotments of departmental duties. A final thought relates to hiring practices. I have now worked in both the US and UK educational systems, which have very different interview and hiring protocols. I will review both, highlighting components that I think are most likely to promote equitable hiring practices.
Mengiste, Shegaw Anagaw
This paper has analyzed the challenges of sustainability and scalability of HIS. The empirical analysis was conducted in a backward and disadvantaged region of Ethiopia. An ongoing process of HISP (Health Information System Program) was addressed and the main challenges in the implementation...... of sustainable and scalable district-based health information system in the context of Primary Health Care (PHC) sector in Ethiopia were identified. Human resource, infrastructure, and HIS related problems are the main challenges hindering the implementation of sustainable and scalable district-based health...... information systems in the region....
Miller, Peter; Pavlakis, Alexandra; Bourgeois, Alexis
This case was developed for use in a variety of leadership courses from contemporary issues to policy analysis or school-community relations. A narrative is presented about a superintendent, Kenny, who is faced with two new cases of student homelessness in his affluent suburban community. Students must consider the federal policy context (the…
Poputoaia, Diana; Bouzarovski, Stefan
Many states in Eastern and Central Europe (ECE) possess extensive district heating (DH) networks that were constructed during the days of communist rule in order to provide a universally accessible energy service that supported Soviet development policies. But the post-communist transition was marked by the exacerbation of the sector's numerous technical, economic, regulatory and environmental problems, accompanied by its abandonment in favour of alternative methods of domestic heating. Recent efforts to increase the use of DH in ECE as a result of environmental and energy security concerns have taken place in an absence of critical, context-sensitive research. The purpose of this paper is to explore the legal aspects of post-communist DH reforms in Romania, with the aim of identifying some of the governance challenges faced by state authorities in managing the sector. In broader terms, we seek to explore the extent to which the Romanian legislative framework is in a position to promote energy efficiency in DH. This has been achieved via an analysis of formal policy documents, government decrees, strategic documents and laws pertaining to this sector, as published and subsequently amended in the Official Gazette. The conclusions of the paper identify the key regulatory issues in the sector-especially with respect to the tariff setting process and the division of competences among different organisations in it-while suggesting a set of policy steps and general restructuring approaches that could help overcome the current situation.
Frumence, Gasto; Nyamhanga, Tumaini; Mwangu, Mughwira; Hurtig, Anna-Karin
Background During the 1990s, the government of Tanzania introduced the decentralization by devolution (D by D) approach involving the transfer of functions, power and authority from the centre to the local government authorities (LGAs) to improve the delivery of public goods and services, including health services. Objective This article examines and documents the experiences facing the implementation of decentralization of health services from the perspective of national and district officials. Design The study adopted a qualitative approach, and data were collected using semi-structured interviews and were analysed for themes and patterns. Results The results showed several benefits of decentralization, including increased autonomy in local resource mobilization and utilization, an enhanced bottom-up planning approach, increased health workers’ accountability and reduction of bureaucratic procedures in decision making. The findings also revealed several challenges which hinder the effective functioning of decentralization. These include inadequate funding, untimely disbursement of funds from the central government, insufficient and unqualified personnel, lack of community participation in planning and political interference. Conclusion The article concludes that the central government needs to adhere to the principles that established the local authorities and grant more autonomy to them, offer special incentives to staff working in the rural areas and create the capacity for local key actors to participate effectively in the planning process. PMID:23993021
Hojjati, Hossein; Davani, Sam Zeraatian Nejad; Johari, Hamed Ghoddusi
In the neck or face, there are different causes for subcutaneous emphysema such as injury to the sinuses, the hypopharynx, the laryngotracheal complex, the pulmonary parenchyma, the esophagus or the presence of gas-forming organisms. However, factitious subcutaneous emphysema, a rare cause, must be considered in the differential diagnosis. In this clinical report, we discuss a 20-year-old girl who was under follow-up because of recurrent subcutaneous emphysema of the face and periorbital area. After 2 years of work-ups, including a period of close observation in the intensive care unit, self air injection by syringe was found as the cause of recurrent subcutaneous emphysema of the face, and the patient was labeled as having factitious recurrent subcutaneous emphysema. Therefore, when a patient presents with unexplained recurrent subcutaneous emphysema, one should suspect self-infliction and examine for puncture marks.
Sandford, Adam; Burton, A Mike
Face recognition is widely held to rely on 'configural processing', an analysis of spatial relations between facial features. We present three experiments in which viewers were shown distorted faces, and asked to resize these to their correct shape. Based on configural theories appealing to metric distances between features, we reason that this should be an easier task for familiar than unfamiliar faces (whose subtle arrangements of features are unknown). In fact, participants were inaccurate at this task, making between 8% and 13% errors across experiments. Importantly, we observed no advantage for familiar faces: in one experiment participants were more accurate with unfamiliars, and in two experiments there was no difference. These findings were not due to general task difficulty - participants were able to resize blocks of colour to target shapes (squares) more accurately. We also found an advantage of familiarity for resizing other stimuli (brand logos). If configural processing does underlie face recognition, these results place constraints on the definition of 'configural'. Alternatively, familiar face recognition might rely on more complex criteria - based on tolerance to within-person variation rather than highly specific measurement. Copyright © 2014 Elsevier B.V. All rights reserved.
Full Text Available A large number of semi-domesticated reindeer is lost every year. Predators are the single most important factor for these losses, whereas restrictions on food availability some years also may cause high mortality. In the past, reindeer herding was challenged by severe infectious diseases, killing hundreds and thousands of animals, and having huge economic and social impact on reindeer herding in Fennoscandia. The general zoo-sanitary situation in Fennoscandia is very favourable for the time being, but reindeer herding is sometimes challenged by disease outbreaks, and diseases play an important role for survival and fitness of reindeer. Reindeer herding is also facing changes and challenges, which also may impact reindeer health and the disease status. Introduction of infectious agents not commonly present in the reindeer population may take place through import of animals, as well as by contact between reindeer, livestock and wildlife. Further, changes in the herding, such as increased feeding, transport, size of herds, animal density and stress load on the animals, may affect the animals ability to cope with infectious diseases. Also changes in weather conditions and climate, such as increased precipitation and mean temperature, may over time lead to restricted availability of pastures, changes in vegetation and changed conditions for parasites and insect vectors. These changes might be especially important for the reproductive success, including fitness of the calves during their first winter. To be able to cope with these changes and their potential impact on reindeer health, increased efforts should be made to gather reference data on health and disease parameters from the different reindeer herding districts, along with epidemiological risk factor analysis. This would increase the ability for the reindeer herding to cope with changes and to continue to produce quality meat products for the market.
Data relating to socio-demographic characteristics, such as continuity with ethnic food culture and the problems faced by Sub-Saharan immigrants with regard to them retaining their traditional food culture was collected. All the respondents indicated that they treasured and maintained their traditional food culture, albeit to ...
In popular imagination, the oak tree stands for strength, endurance, and longevity. But in the coastal lowlands and central valleys of British Columbia, Washington, Oregon, and California, oaks face a battery of natural and human-induced threats. Sudden oak death, caused by a virulent pathogen identified in 2000, has killed millions of tanoaks, California black oaks,...
This research attempted to provide an insight into major barriers facing adult learners pursuing a diploma in adult and continuing education programme through Blended Distance Learning. Participants included the adult learners, staff from the Department of Open and Distance Learning who are also the facilitators of the ...
Finon, Dominique; Johnsen, Tor Arnt; Midttun, Atle
Deregulation of electricity industry in Europe has tended to start with a grace period of energy surplus inherited from the previously expansive coordinated economies and further amplified by better resource utilisation from extended international trade. The regulatory challenge has therefore primarily been to allocate existing generation to consumers in an efficient way. However, as energy demand increases, due to economic growth, the challenge of providing new capacity surfaces. The Nordic region, which has been a pioneer in internationalising and deregulating electricity, is now approaching this stage, ahead of most of the rest of Europe. While the Nordic case is characterised by specificities related to hydropower it also raises the more general challenge of capacity expansion under a deregulated market economy. The article therefore discusses how the Nordic investment challenges of today shed light on more generic challenges that may become more general European challenges of tomorrow. In a final section, the article discusses policy options available to address the investment/price-hike challenge. The argument is put forward that recursion to some degree of coordinated governance might seem necessary if solutions are confined within large-scale technical systems. However, within the context of a small-scale decentralised technological development, one may be more confident of competitive solutions. (Author)
Luitel, Nagendra P; Jordans, Mark Jd; Adhikari, Anup; Upadhaya, Nawaraj; Hanlon, Charlotte; Lund, Crick; Komproe, Ivan H
of Health and Population (MoHP). Strategies to overcome these challenges included involvement of MoHP in the process, especially by providing psychotropic medicines and appointing a senior level officer to facilitate project activities, and collaboration with National Health Training Centers (NHTC) in training programs. This study describes many challenges facing mental health care in Nepal. Most of these challenges are not new, yet this study contributes to our understanding of these difficulties by outlining the national and district level factors that have a direct influence on the development of a district level mental health care plan.
In an effort to assist with the first Presidential administration transition of the Department of Homeland Security, the Homeland Security Advisory Council has identified ten key challenges that will...
Gimena Castro Pérez
Full Text Available Dermatofibrosarcoma protuberans (DFSP is a malignant fibrohistiocytic tumor that appears exclusively on the skin. It is a low-grade malignant soft tissue tumor of subcutaneous tissues that has a propensity for local recurrence but seldom metastasizes. It may rarely occur on the head and neck accounting for less than one percent of total head and neck malignancies. We present a man with a giant DFSP on the face. Oncological, functional, and aesthetic aspects are set forth.
Full Text Available Background: There are many challenges women face to be able to give birth in health facilities in many parts of Indonesia. This study explores the roles and observations of close-to-community maternal health providers and other community members on potential barriers faced by women to deliver in health facilities in two districts within The Archipelago. Methods: Employing an explorative qualitative approach, 110 semi-structured interviews and 7 focus group discussions were conducted in 8 villages in Southwest Sumba, in the East Nusa Tenggara province, and in 8 villages in Cianjur, in the West Java province. The participants included village midwives, Posyandu kader (village health volunteers, traditional birth attendants (TBAs, mothers, men, village heads and district health officials. Results: The main findings were mostly similar in the two study areas. However, there were some key differences. Preference for TBA care, traditional beliefs, a lack of responsiveness of health providers to local traditions, distance, cost of travel and indirect costs of accompanying family members were all barriers to patients attending health facilities for the birth of their child. TBAs were the preferred health providers in most cases due to their close proximity at the time of childbirth and their adherence to traditional practices during pregnancy and delivery. Conclusions: Improving collaborations between midwives and TBAs, and responsiveness to traditional practices within health facilities and effective health promotion campaigns about the benefits of giving birth in health facilities may increase the use of health facilities in both study areas.
New Jersey's urban--or "Abbott"--schools have improved at the preschool and elementary school level, but lag when it comes to middle and high school performance. These are the key findings of an Abbott Indicators Project report entitled, "The Abbott Districts in 2005-06: Progress and Challenges." The report was prepared by…
AlHagbani, Eman Saad; Khan, Muhammad Badruddin
The future information systems are expected to be more intelligent and will take human queries in natural language as input and answer them promptly. To develop a chatbot or a computer program that can chat with humans in realistic manner to extent that human get impressions that he/she is talking with other human is a challenging task. To make such chatbots, different technologies will work together ranging from artificial intelligence to development of semantic resources. Sophisticated chatbots are developed to perform conversation in number of languages. Arabic chatbots can be helpful in automating many operations and serve people who only know Arabic language. However, the technology for Arabic language is still in its infancy stage due to some challenges surrounding the Arabic language. This paper offers an overview of the chatbot application and the several obstacles and challenges that need to be resolved to develop an effective Arabic chatbot.
Grossmann, Igor; Gerlach, Tanja M.; Denissen, J.J.A.
How stable vs. dynamic is wisdom in daily life? We conducted a daily diary study of wise reasoning (WR) by recording people's reflections on daily challenges in terms of three facets: intellectual humility, self-transcendence, and consideration of others' perspectives/compromise. We observed
This paper explains the concept of nation-state and sports. It critically examines some of the challenges characterizing Nigerian nation state such as ethnicity, corruption, politics of godfatherisms, tribalism, language differences, and religious crises among others. It emphasizes the use of sports for creating of friendship ...
Sinkford, Jeanne C.
The status of minority women dentists is reviewed, and initiatives to improve it are noted. Issues and challenges for African-American female dentists are outlined, including negative racial/gender stereotypes, lack of advancement opportunities, difficulties in starting practices and securing professional and social support systems, lack of…
Lent, ReLeah Cossett
ReLeah Cossett Lent provides practical advice for ensuring that books are kept on shelves and in classrooms for students to read. She outlines steps for creating professional learning communities that engage with censorship issues and prepare schools to deal with book challenges in thoughtful, supportive ways. (Contains 4 figures.)
T. N. Samsonova
Full Text Available Political leadership is a concept central to understanding political processes and outcomes, yet its definition is elusive. The study of political leadership has a long history. Many disciplines have contributed to this study, including history, philosophy, political theory, psychology etc. Leadership is a process in which leaders and followers interact dynamically in a particular situation or context. Leaders must be able to connect with followers to understand their mood and their initiative. There are essential and operational differences between a leader and a manager. Managerial effectiveness is related to an emphasis on rationality and organizational structure. Leadership effectiveness is linked to symbols and culture. The interactive nature of leader-followers-situation can help us better understand the changing nature of the leaderfollower relationship and the increasingly greater complexity of situations leaders and followers face in contemporary world. Good leadership makes a difference, and it can be enhanced through greater awareness of the important factors influencing the leadership process. The changes we are facing in today’s world demand a new breed of political leaders, new forms and mechanisms of leader-follower interaction that provide effective leadership.
Shreve, Marilou; Scott, Allison; Vowell Johnson, Kelly
To assess the challenges primary care providers encounter when providing counseling for pediatric patients identified as obese. A survey assessed the current challenges and barriers to the screening and treatment of pediatric obesity for providers in northwest Arkansas who provide care to families. The survey consisted of 15 Likert scale questions and 4 open-ended questions. Time, resources, comfort, and cultural issues were reported by providers as the biggest barriers in screening and the treatment of pediatric obesity. All providers reported lack of time as a barrier to providing the care needed for obese children. Cultural barriers of both the provider and client were identified as factors, which negatively affect the care and treatment of obese children. Primary care providers continue to experience challenges when addressing pediatric obesity. In this study, a lack of adequate time to address obesity was identified as the most significant current barrier and may likely be tied to physician resources. Although reimbursement for obesity is increasing, the level of reimbursement does not support the time or the resources needed to treat patients. Many providers reported their patients' cultural view of obesity influenced how they counsel their patients. Increasing providers' knowledge concerning differences in how weight is viewed or valued may assist them in the assessment and care of obese pediatric patients. The challenges identified in previous research continue to limit providers when addressing obesity. Although progress has been made regarding knowledge of guidelines, continuing effort is needed to tackle the remaining challenges. This will allow for earlier identification and intervention, resulting in improved outcomes in pediatric obesity.
Hansen, Lars Kristian
Abstract. Increasing the organizational benefits from IT projects is a key concern in most organizations. The use of Project Portfolio Management (PPM) is generally recommended by consultants (e.g. Kaplan 2005) and researchers (e.g. De Reyck et al 2005) as one way of increasing the organizational...... benefits from IT investments. This article reports from an action research project aiming at understanding and improving IT PPM practices in Danish municipalities, thereby contributing to the general body of knowledge concerning PPM of IT projects. Our findings suggest that the participating organizations...... might benefit from a structured approach as suggested by the literature (e.g. Kaplan 2005), but also that the prescriptive PPM literature in some areas is too simplistic when compared to the reality faced by the participating practitioners. Especially, our research suggests that different PPM elements...
Angelier, J.P.; Hadjsaid, N.; Sabonnadiere, J.C.
The introduction of liberalization, the increasing share of decentralized electricity generation, the aging of electrical infrastructures, ambitious generation objectives and technological evolution are the key drivers that require substantial investments in the distribution grid. The most urgent challenges are to adapt the network architecture and operation, modernize and improve metering equipment, renovate existing facilities. The Energy Regulatory Commission sets the price to be paid by users of the distribution grid; this price is set rather low, in order to encourage the system operator to make productivity gains. But resultant low income may deprive the operator of the financial resources needed to adapt the system to the new conditions. (authors)
Challenges faced by young persons living with HIV: The case of children on the ... Journal of Social Development in Africa ... to 34 randomly selected children who were beneficiaries of an initiative called the Community Outreach Programme.
Patil, Arun; Patil, Vaishali; Shin, Dong Wook; Choi, Ji-Won; Paik, Dong-Soo; Yoon, Seok-Jin
New materials hold the key to fundamental advances in energy conversion and storage, both of which are vital in order to meet the challenge of global warming and the finite nature of fossil fuels. Nanomaterials in particular offer unique properties or combinations of properties as electrodes and electrolytes in a range of energy devices. Technological improvements in rechargeable solid-state batteries are being driven by an ever-increasing demand for portable electronic devices. Lithium batteries are the systems of choice, offering high energy density, flexible, lightweight design and longer lifespan than comparable battery technologies. We present a brief historical review of the development of lithium-based thin film rechargeable batteries highlight ongoing research strategies and discuss the challenges that remain regarding the discovery of nanomaterials as electrolytes and electrodes for lithium batteries also this article describes the possible evolution of lithium technology and evaluates the expected improvements, arising from new materials to cell technology. New active materials under investigation and electrode process improvements may allow an ultimate final energy density of more than 500 Wh/L and 200 Wh/kg, in the next 5-6 years, while maintaining sufficient power densities. A new rechargeable battery technology cannot be foreseen today that surpasses this. This report will provide key performance results for thin film batteries and highlight recent advances in their development
Reyes, David J; Bekemeier, Betty; Issel, L Michele
This study discusses the challenges and characteristics of effective public health nursing leaders in local health departments and barriers to effective leadership during the hyperturbulent conditions of 2008-2010. Participants were drawn from a purposive sample of seven directors of nursing (DON) in six county LHDs in two states for this qualitative study using inductive methods. Semistructured telephone interviews were conducted, using open-ended questions. Data analysis consisted of coding, pattern identification, and theme development, assisted by the use of ATLAS.ti™. Credibility was achieved through intercoder agreement and resonance of the findings with participants. Two underlying challenges emerged: leadership dissonance and leading through ambiguity. Three key effective leadership attributes identified were as follows: collaborative change management, life-long learning, and being visionary. DONs identified extrinsic and intrinsic barriers to leadership effectiveness and leading change in public health systems and PHN practice. Results suggest ways to support PHN leaders in order to overcome barriers to effective leadership such as defined leadership competencies, continuing education, and mentorship opportunities. © 2013 Wiley Periodicals, Inc.
Moon, Sidney M.
One rationale for failure to address the needs of high-ability students in schools is that high-ability students do not need special services because they do not face any special problems or challenges. A more extreme corollary of this attitude is the notion that high ability is so protective that students with high ability do not face problems or…
Machuca, Ana; Torres, Karin; Morris, Pamela; Whitley, William
This paper will summarize some of challenges faced by military students enrolled in an associate and bachelors online program at American Public University System (APUS). The survey results on which the study is based exposed the following problems faced by military personnel: 48.7% had difficulties working around military obligations, 33.3%…
Alberto Vallejo Peña
Full Text Available Young people Spain classed as belonging Generation Y are facing the transition to employment under even more adverse conditions than the previous generation (X, as a result of the economic crisis (2008-2015 prevailing as they reach working age. This paper aims to address the generational traits that are attributed to these young people in Spain, and contrast them with the data offered (Labour Force Survey, LFS, and Organization for Economic Co-operation and Development, OECD, mainly. This aims to achieve a better understanding of the phenomenon to distinguish their true features and generational experiences from the testimony of somewhat unreliable sources. To this end, we analyse the main social types attributed to this generation (Not in Education, Employment, or Training, NEETs, mileuristas and boomerangs, technological changes that determine their profile (digital society, new migration trends, the influence of social stratification and the contribution of the family. The conclusions look in particular at the influence of certain factors (education, social class to improve their employability, and the prevalence of the family as a key institution in supporting these young people, given the lack of other social actors.
Goldman, G. T.; Carter, J. M.; Licker, R.
Climate scientists have long faced politicization of their work, especially those working within the US federal government. However, political interference in federal government climate change science has escalated in the current political era with efforts by political actors to undermine and disrupt infrastructure supporting climate science. This has included funding changes, decreased access to climate science information on federal agency websites, restrictions on media access to scientific experts within the government, and rolling back of science-based policies designed to incorporate and respond to climate science findings. What are the impacts of such changes for both the climate science community and the broader public? What can be done to ensure that access to and application of climate change-related research to policy decisions continues? We will summarize and analyze the state of climate change research and application in the US government. The impacts of political interference in climate change science as well as opportunities the scientific community has to support climate science in the US government, will be discussed.
Lupi, F.; Borri, C.; Harte, R.; Krätzig, W. B.; Niemann, H.-J.
The Solar Updraft Power Plant technology addresses a very challenging idea of combining two kinds of renewable energy: wind and solar. The working principle is simple: a Solar Updraft Power Plant (SUPP) consists of a collector area to heat the air due to the wide-banded ultra-violet solar radiation, the high-rise solar tower to updraft the heated air to the atmosphere, and in between the power conversion unit, where a system of coupled turbines and generators transforms the stream of heated air into electric power. A good efficiency of the power plant can only be reached with extra-large dimensions of the tower and/or the collector area. The paper presents an up-to-date review of the SUPP technology, focusing on the multi-physics modeling of the power plant, on the structural behavior of the tower and, last but not least, on the modeling of the stochastic wind loading process.
Van Vliet, Geert; Magrin, Geraud; Dittgen, Romain; Tavares, Marie-Adeline; Doudjidingao, Antoine; Maoundonodji, Gilbert; Liang, Guohuang; Wang, Fan; Yang, Weiyong; Lin, Yiran
This book analyses the factors that influence environmental management in the CNPC when operating outside of China, in the outer margins of the world oil system, specifically in Chad, a Least Developed Country. Within a sector marked by the regulations inherited from the Exxon project in Doba (implemented since 2000 with initial World Bank support), the 2007 CNPC Ronier project aims at refining part of the extracted oil and exporting the remainder, most probably through the pipeline built under the Exxon Doba project. The question of the compatibility between the systems of reference and practices in both firms thus arises. Through the prism of social and environmental responsibility, this text analyses the challenges in the interaction between Chinese oil firms, host countries and OCDE-based firms. (authors)
Zhang, B N; Chen, W Q; Zhang, X; Qiao, Y L
The incidence and mortality of breast cancer is in an increasing trend. In contrast to the global breast cancer situation, the prevention and control is challenging in China. Some suggestions are presented to the project of breast cancer prevention and control in China. Combining the global screening experiences with the epidemiological features of Chinese female breast cancer, aims to improve the population screening and early detection rate. Standardizing clinical diagnosis and treatment practice, aims to increase the efficacy and decrease the mortality. Intervening lifestyle and dietary behaviors, and intends to reduce risk exposure and incidence. Building national breast cancer registry provides preventive strategies. Great efforts should be made to carry out large sample multicenter clinical trails and translational research on the prevention and cotrol of breast cancer coordiated by health care service and science and technology administrations. Breast cancer prevention and control has a long way to go in China.
Ernstoff, Marc S; Gandhi, Shipra; Pandey, Manu; Puzanov, Igor; Grivas, Petros; Montero, Alberto; Velcheti, Vamsidhar; Turk, Mary Jo; Diaz-Montero, Claudia Marcela; Lewis, Lionel D; Morrison, Carl
In 1996, Jim Allison demonstrated that blocking the immune regulatory molecule CTLA-4 with anit-CTLA4 antibody led to enhance tumor responses in mice. It would take an additional 15 years for human studies to confirm the potency and clinical efficacy of anti-CTLA4, ultimately leading to US FDA approval of the first checkpoint inhibitor, ipilimumab. Now with a plethora of immune-modulating agents demonstrating single agent safety and benefit across many tumor types, investigation on the optimal combination of immune-based therapies has begun in earnest. While there are many challenges, a central one is how to select which combination for which patient is the best. Here we review the current approaches that a practitioner can use to achieve this therapeutic goal.
Thiago Pierobom de Avila
Full Text Available This article aims to offer a critical overview of the Brazilian legal framework for confronting domestic violence against women. Intimate partner homicides are epidemic in Brazil: there are four deaths of women per day. In 2006, the Maria da Penha Law (MPL introduced integrated polices and transformed criminal procedures to deal with the complexities of gender violence. Reforms included the establishment of The House of Brazilian Women, women-only police stations, specialised courts, intervention orders, interdisciplinary experts, and perpetrator programs. In 2015, a new law created the crime of femicide, designed to prevent ‘honor killings’ defenses in cases of intimate partner homicide and to avoid impunity. Despite law reform, structuring and articulating the network of services remains a challenge. The MPL led to great social change in Brazil regarding awareness of the violence against women, facilitating a broader discussion about gender equality.
Dupre, Bruno; )
On 19 April 2012, the United Nation Security Council congratulated the European Union for its initiative on centres of excellence in the nuclear, radiological, biological, and chemical fields. The time for glowing reports is over. Three years after its creation, the support of EU Member Sates, the Security Council, the G8, the IEAE, the WHO, the USA, Interpol, the ICRC, has been obtained. Other diplomatic, organisational, and communicative challenges have now arisen regarding implementation. The manifest challenges include: 1/Political exploitation of the centres. Following a recent round table in Algiers, the Algerian press ran headlines such as 'terrorism, the Malian crisis arrives in Algiers' CBRN centres of excellence' and 'Bouteflika, the centres of excellence slight'. 2/Communication errors. A unanimously approved expert in South East Asia became a persona non grata over the last six months despite not making any fundamental mistake, aside from his inability to evaluate the degree of a country's sensitivity and pride. The countries in the region went so far as to threaten to pull out of the Manila centre as a result of this ultimately minor error in communication. 3/The scope of the centres' role complicates the grasp of its objectives. To date, the focus has essentially been on non-proliferation and the fight against CBRN terrorism, under the well-established theme of Resolution 1540. The shift of CBRN focus, at the behest of certain regions, on to real natural risks (pandemics) or industrial risks (protection of crucial infrastructure following an earthquake, flooding, or a tsunami) fundamentally changes the teams' make-up and the mobilization of resources. The emergency services culture is different to that of nonproliferation. However, they both very much address CBRN risks and threats. 4/The limits of the 'bottom-up' approach. To date, the centres' success has been due to the lack of restrictive rules. The policy is to enlist willing third-party States
Roland W. Scholz
Full Text Available This paper identifies and discusses the benefits, threats, and vulnerabilities related to the digital revolution. It aims to motivate research and its funding regarding digital threats and vulnerabilities related, in particular, to anticipating unintended, undesirable rebound effects, tipping points, critically fast evolutionary change rates, trade-offs, etc. A brief analysis of the history of the mind and technology reveals slow technological development over tens of thousands of years (including the invention of a place-value digital number system. Then, a small series of groundbreaking ideas (e.g., binary logic, Shannon’s symbolic analysis of relay and switching circuits, architectures of computing enabled the industry-driven invention of programmable computing machines. Ultimately, the mastery of electron and semiconductor physics allowed for economical and seemingly unlimited storage capacity that made digital tools available to all domains of society. Based on the historical analysis, a coupled human-environment systems perspective (that includes a hierarchy assumption ranging from the human cell to the human species enables the identification of several potential challenges to society and science. First, digital nano-engineering promotes genetic modifications (i.e., directed evolution, and synthetic biology enables a new level of the appropriation of nature. The understanding of cell-based biocomputers may call for new forms of logic. These and other challenges require thorough sustainability research in order to anticipate major changes on all levels of human systems. Second, the human individual is exposed to new forms of vulnerability. In particular, the potential epigenetic effects resulting from the excessive use of digital information of historically unknown speed, density, and contents and the loss of (the Western common-law right to privacy resulting from big data (whose ownership is often unknown should become subjects of
Full Text Available Network access technologies have evolved significantly in the last years. They deploy novel mechanisms like reactive capacity allocation and time-slotted operation to optimize overall network capacity. From a single node's perspective, such optimizations decrease network determinism and measurement repeatability. Evolving application fields like machine to machine (M2M communications or real-time gaming often have strict real-time requirements to operate correctly. Highly accurate delay measurements are necessary to monitor network compliance with application demands or to detect deviations of normal network behavior, which may be caused by network failures, misconfigurations or attacks. This paper analyzes factors that challenge active delay measurements in modern networks. It introduces the Representative Delay Measurement tool (RDM that addresses these factors and proposes solutions that conform to requirements of the recently published RFC7312. Delay measurement results acquired using RDM in live networks confirm that advanced measurement methods can significantly improve the quality of measurement samples by isolating systematic network behavior. The resulting high-quality samples are one prerequisite for accurate statistics that support proper operation of subsequent algorithms and applications.
Eida, Abdul Aziz
The general inaccessibility of soil phosphorous (P) to plants in combination with the depletion of global P reserves provides an incentive for researchers to find sustainable solutions to sustain food security for the ever-increasing world population. Bio-fertilizers based on bacteria and fungi able to solubilize endogenous P in soils have a high potential for increasing nutrient availability in agriculture. However, the inconsistency of bio-fertilizer performance in the field poses a major challenge for farmers. This discrepancy is thought to stem from the complexity of the interactions between crop plants, microbes, and their soil environments, as well as our lack of understanding of the processes involved. For farmers, a clear beneficial effect across different soil types, crop species, environmental conditions, and microbial communities will be required to make it worth to adopt bio-fertilizer technology based on phosphate-solubilizing microbes (PSMs). Here, we attempt to review the current knowledge of the complexity of the P-solubilization mechanisms used by PSMs and how they may be affected by interactions in the field. We also identify possible explanations for the inconsistent performance of P-solubilizing bacteria in the field and ways to solve these obstacles.
Visher, Christy A; Bakken, Nicholas W
Women entering the correctional system represent a population at high risk for mental health and the body of research on the mental health needs of women offenders is growing. These mental health problems pose challenges for women at every stage of the criminal justice process, from arrest to incarceration to community reentry and reintegration. In this article, we examined mental health status among a sample of 142 women leaving confinement and the role that mental health problems played in shaping their reentry outcomes using data collected between 2002 and 2005 in Houston, Texas. In the year after leaving prison, women with mental health problems reported poorer health, more hospitalizations, more suicidal thoughts, greater difficulties securing housing and employment, more involvement in criminal behavior, and less financial support from family than women with no indication of mental health problems. However, mental health status did not increase the likelihood of substance use relapse or reincarceration. The article concludes with a discussion of recommendations for improved policy and practice.
Although the outlook for most segments of the contract drilling business is now more optimistic than in the past decade, the increased activity has brought several problems: the availability of fully trained crews, the need for new capital, and the limited number of quality drillstrings. These problems will grow in importance if natural gas deliverability begins to decline visibly and once the scramble to correct this decline begins. As the drilling recovery unfolds, the most important lesson to remember, based on worldwide activity in the past year, is how rapidly conditions can change and how quickly excess capacity can turn into chronic shortages. The various segments of the world wide contract drilling industry's prospects have changed dramatically during the past 12 months, and oddly, some market sectors have improved while others have become worse. These quick changes highlight the unpredictable and volatile nature of the markets for contract drilling and other services needed to drill and complete oil and gas wells. The paper describes the business of well drilling onshore and offshore in the US, drilling activities in Canada, international markets, capacity, the supplies of natural gas, Gulf of Mexico activities, drill pipe shortages, manpower shortages, and challenges offshore
Lyman, Edwin S.
In January 2006 the Department of Energy (DOE) announced the creation of the Global Nuclear Energy Partnership (GNEP), an ambitious plan to reshape the nuclear energy production sector both in the United States and worldwide. If fully realized in the United States, GNEP would entail the construction of a large number of sodium-cooled fast reactors utilizing actinide-based fuels, multiple commercial-scale reprocessing plants for both light-water and fast reactors, and fast reactor fuel fabrication plants. It appears likely that the first commercial-scale GNEP facilities, as well as a future full-scale GNEP complex, would fall under the licensing jurisdiction of the Nuclear Regulatory Commission (NRC). This will be a challenging endeavor for the NRC, primarily because the proposed GNEP facilities will in large part be based on novel and untested designs and processes that have not been developed on a commercial scale. In order to effectively regulate the GNEP complex, the NRC will have to quickly address the many technical and policy questions that will arise in any GNEP licensing scheme. This paper identifies some difficult issues that will be encountered in GNEP licensing by examining the potential implications of NRC's current policies and regulatory requirements, and analyzing the impacts of some emerging post-9/11 security issues. (author)
On-line hemodiafiltration (on-line HDF) is the result of a vision that triggered multifarious changes in very different areas. Driven by the idea to offer better medical treatment for renal patients, technological innovations were developed and established that also constituted new challenges in the field of regulatory affairs. The existing regulations predominantly addressed the quality and safety of those products needed to perform dialysis treatment which were supplied by industrial manufacturers. However, the complexity of treatment system required for the provision of on-line fluids demanded a holistic approach encompassing all components involved. Hence, focus was placed not only on single products, but much more on their interfacing, and the clinical infrastructure, in particular, had to undergo substantial changes. The overall understanding of the interaction between such factors, quite different in their nature, was crucial to overcome the arising regulatory obstacles. This essay describes the evolution of the on-line HDF procedure from the regulatory point of view. A simplified diagram demonstrates the path taken from the former regulatory understanding to the realization of necessary changes. That achievement was only possible through 'management of preview' and consequent promotion of technical and medical innovations as well as regulatory re-evaluations. Copyright © 2011 S. Karger AG, Basel.
Eida, Abdul Aziz; Hirt, Heribert; Saad, Maged
The general inaccessibility of soil phosphorous (P) to plants in combination with the depletion of global P reserves provides an incentive for researchers to find sustainable solutions to sustain food security for the ever-increasing world population. Bio-fertilizers based on bacteria and fungi able to solubilize endogenous P in soils have a high potential for increasing nutrient availability in agriculture. However, the inconsistency of bio-fertilizer performance in the field poses a major challenge for farmers. This discrepancy is thought to stem from the complexity of the interactions between crop plants, microbes, and their soil environments, as well as our lack of understanding of the processes involved. For farmers, a clear beneficial effect across different soil types, crop species, environmental conditions, and microbial communities will be required to make it worth to adopt bio-fertilizer technology based on phosphate-solubilizing microbes (PSMs). Here, we attempt to review the current knowledge of the complexity of the P-solubilization mechanisms used by PSMs and how they may be affected by interactions in the field. We also identify possible explanations for the inconsistent performance of P-solubilizing bacteria in the field and ways to solve these obstacles.
María Elena Villafuerte-Castrejón
Full Text Available The search for electroceramic materials with enhanced ferro-pyro-piezoelectric properties and revealing the perovskite type structure has been the objective of a significant number of manuscripts reported in the literature. This has been usually carried out by proposing the synthesis and processing of new compounds and solid solution series. In this work, several methods to obtain ferro-pyro-piezoelectric families of materials featuring the well-known ABO3 perovskite structure (or related such as BaTiO3, Ba1–xCaxTi1–yZryO3, (Bi0.5Na0.5TiO3, (K0.5Na0.5NbO3 and their solid solutions with different cations either in the A or B positions, are presented. For this kind of materials, the challenge for obtaining a single phase compound with a specific grain size and morphology and, most importantly, with the adequate stoichiometry, will also be discussed. The results reviewed herein will be discussed in terms of the tendency of working with softer conditions, i.e., lower temperature and shorter reaction times, also referred to as soft-chemistry.
Teachers of students with low-incidence disabilities, such as students who are deaf or hard of hearing, face unique challenges in putting education policy into practice. The present article presents professional development findings from the Third Annual National Survey of Accommodations and Assessment for Students Who Are Deaf or Hard of Hearing (Cawthon, Hersh, Kim, & Online Research Lab, in press). A total of 391 participants described professional development they had experienced related to assessment of students who are deaf or hard of hearing. Teachers reported greater exposure to topics in school/district sessions and discussion with their colleagues than in their preparation programs. Teaching at a school for the deaf or teaching students in high school were significant predictors of an increased prevalence of professional development opportunities on assessment-related topics for students who are deaf or hard of hearing.
Full Text Available Susan M Carr1,2, Pauline Pearson1, Lesley Young-Murphy3, Barbara Cleghorn41Centre for Community Health & Education Studies Research & Enterprise, Northumbria University, Newcastle upon Tyne, UK; 2School of Health, University of New England, Armidale, New South Wales, Australia; 3NHS North of Tyne, Newcastle upon Tyne, UK, 4Newcastle PCT, Newcastle upon Tyne, UKAbstract: This paper presents an overview of the challenges and potential of lean implementation for the health visiting service in England and examines the rhetoric and the reality of the situation. It is coauthored by academic researchers and senior service providers so as to embrace the multidimensional issues impacting on this subject. If lean thinking is to be implemented in relation to health visiting, it is important to understand how it is likely to be viewed by practitioners and line managers in settings where it is used. In order to contextualize the discussion, an introduction to the roles, systems, and structures of health visiting are provided. The literature on what lean implementation is, what it means, and in particular the application and potential of the approach to primary care and public health services is reviewed. The process and findings from a focus group convened within a large primary care organization in the National Health Service during their lean implementation is reported. The paper concludes that it is important for staff at all levels to see a clear link between strategic aims and objectives and the planning processes operated by providers and commissioners. It appears that the successful introduction of lean thinking should focus more on productive working and thereby reducing waste. This has the potential to refresh workforce models to ensure that health visiting and other practitioners liberate the use of their specialist knowledge and skills. In a context of enhanced partnership working, the stage is then set for providers to add value to the whole
The purpose of this research is to analyze the studies concerning challenges faced by novice teachers in terms of various aspects and compare challenges according to location of the studies conducted in Turkey and abroad. A total of 30 research studies were included in detailed analysis. This is a descriptive study based on qualitative research…
competitiveness, measured in terms of scientific yield and citations, primarily affects fields where articles and citations are not the traditional outputs, such as the humanities and social sciences in general and planning-related disciplines in particular. When discussing planning, it has to be stressed out that research has a merely societal value and is not aimed at developing products that can foster economic growth or delivering scientific articles that profoundly change the theoretical perspectives. Simply put, research in planning aims at increasing the safety and welfare of people. As a consequence, planning research topics have shifted from providing scientific grounds to regional development policies, to addressing research quality and social responsibility or producing research guidelines. This article looks at the particular case of Romanian planning research based on SCImago data, in an attempt to assess whether this field is able to meet these global challenges, especially after the consistent, albeit uneven, in terms of goal and pace, application of new research policies designed after joining the European Union, which were aimed at increasing its article output and its international visibility. The findings indicate that the numerical growth of articles and publications is spectacular in Romania for most fields, and even more so within the humanities, the social sciences and planning. However, the question remains whether this impressive growth is supported by an increase in quality. We have therefore left aside matters such as the globalization of authors, topics or citations. These aspects require a more in-depth research effort.
Mann, Matthew James
Rural and small schools have almost one-third of all public school enrollment in America, yet typically have the fewest financial and research based resources. Educational models have been developed with either the urban or suburban school in mind, and the rural school is often left with no other alternative except this paradigm. Rural based educational resources are rare and the ability to access these resources for rural school districts almost non-existent. Federal and state based education agencies provide some rural educational based programs, but have had virtually no success in answering rural school issues. With federal and state interest in science initiatives, the challenge that rural schools face weigh in. To align with that focus, this study examined Texas middle school student achievement in science and its relationship with school district enrollment size. This study involved a sequential transformative mixed methodology with the quantitative phase driving the second qualitative portion. The quantitative research was a non-experimental causal-comparative study conducted to determine whether there is a significant difference between student achievement on the 2010 Texas Assessment of Knowledge and Skills 8 th grade science results and school district enrollment size. The school districts were distributed into four categories by size including: a) small districts (32-550); b) medium districts (551-1500); c) large districts (1501-6000); and d) mega-sized districts (6001-202,773). A one-way analysis of variance (ANOVA) was conducted to compare the district averages from the 2010 TAKS 8th grade science assessment results and the four district enrollment groups. The second phase of the study was qualitative utilizing constructivism and critical theory to identify the issues facing rural and small school administrators concerning science based curriculum and development. These themes and issues were sought through a case study method and through use of semi
Tappis, Hannah; Koblinsky, Marge; Winch, Peter J; Turkmani, Sabera; Bartlett, Linda
Reducing preventable maternal mortality and achieving Sustainable Development Goal targets for 2030 will require increased investment in improving access to quality health services in fragile and conflict-affected states. This study explores the conditions that affect availability and utilisation of intrapartum care services in four districts of Afghanistan where mortality studies were conducted in 2002 and 2011. Information on changes in each district was collected through interviews with community members; service providers; and district, provincial and national officials. This information was then triangulated with programme and policy documentation to identify factors that affect the coverage of safe delivery and emergency obstetric care services. Comparison of barriers to maternal health service coverage across the four districts highlights the complexities of national health policy planning and resource allocation in Afghanistan, and provides examples of the types of challenges that must be addressed to extend the reach of life-saving maternal health interventions to women in fragile and conflict-affected states. Findings suggest that improvements in service coverage must be measured at a sub-national level, and context-specific service delivery models may be needed to effectively scale up intrapartum care services in extremely remote or insecure settings.
Full Text Available Little is known about how to tailor implementation of mental health services in low- and middle-income countries (LMICs to the diverse settings encountered within and between countries. In this paper we compare the baseline context, challenges and opportunities in districts in five LMICs (Ethiopia, India, Nepal, South Africa and Uganda participating in the PRogramme for Improving Mental health carE (PRIME. The purpose was to inform development and implementation of a comprehensive district plan to integrate mental health into primary care.A situation analysis tool was developed for the study, drawing on existing tools and expert consensus. Cross-sectional information obtained was largely in the public domain in all five districts.The PRIME study districts face substantial contextual and health system challenges many of which are common across sites. Reliable information on existing treatment coverage for mental disorders was unavailable. Particularly in the low-income countries, many health service organisational requirements for mental health care were absent, including specialist mental health professionals to support the service and reliable supplies of medication. Across all sites, community mental health literacy was low and there were no models of multi-sectoral working or collaborations with traditional or religious healers. Nonetheless health system opportunities were apparent. In each district there was potential to apply existing models of care for tuberculosis and HIV or non-communicable disorders, which have established mechanisms for detection of drop-out from care, outreach and adherence support. The extensive networks of community-based health workers and volunteers in most districts provide further opportunities to expand mental health care.The low level of baseline health system preparedness across sites underlines that interventions at the levels of health care organisation, health facility and community will all be essential
Villela, Wilza Vieira; Araújo, Eliane Cardoso de; Ribeiro, Sandra Aparecida; Cuginotti, Aloísio Punhagui; Hayana, Eliana Tiemi; Brito, Francisco Carlos de; Ramos, Luiz Roberto
This article presents the results of a case study aimed at identifying challenges for the delivery of primary health care in a health district in the city of São Paulo, Brazil, considering comprehensiveness as a central device for organizing work at this level of care. Five units in the district's primary care network were studied. We collected the data by observing work routines and flows, conducting interviews with managers and health professionals from different backgrounds, and through focus groups with family health teams. The analysis shows a mismatch between users' characteristics and their presumed needs and the heterogeneity of the health professionals' perceptions concerning their work. Lack of staff and time and difficulties with referrals were the main problems identified by interviewees.
Kho, Boon Phiaw; Hassali, Mohamed Azmi; Lim, Ching Jou; Saleem, Fahad
The aims of this research were to determine extra-organisational challenges (e.g. market competition, governing policies) faced by community pharmacies in Sarawak, the coping strategies employed to deal with these challenges and explore potential legislative changes that can attenuate the intensity of these challenges. Survey questionnaires (n = 184) were posted to all eligible community pharmacies in Sarawak, Malaysia. The questionnaire included sections on participants' demographic data, extra-organisational challenges faced, coping strategies employed and proposals to improve community pharmacy legislations. Items were constructed based on the findings of a prior qualitative research supplemented with relevant literature about these issues. High levels of homogeneity in responses were recorded on various extra-organisational challenges faced, particularly those economy-oriented. Strategic changes to counter these challenges were focused on pricing and product stocked, rather than services provision. Highly rated strategies included increasing discounts for customers (n = 54; 68%) and finding cheaper suppliers (n = 70; 88%). Legislative changes proposed that might increase their share of the pharmaceutical market were strongly supported by respondents, particularly about making it compulsory for general practitioners to provide patients the option to have their medicines dispensed in community pharmacies (n = 72; 90%). Current legislative conditions and Malaysian consumer mindset may have constrained the strategic choices of community pharmacies to deal with the strong extra-organisational challenges. A long-term multipronged approach to address these issues and increased involvement of community pharmacists themselves in this agenda are required to influence practice change. © 2018 Royal Pharmaceutical Society.
Raden Aswin Rahadi
This research is a part of a continuous study to analyze the opportunities and challenges for micro-small and medium business in Indonesia when facing ASEAN Economic Community (AEC) in 2016. It has its own uniqueness, as it will combine the point of view between current business owners and current literature study synthesis on business perception towards AEC. Ten business owners have been interviewed. The results suggested AEC provides challenges for the business owners, particularly in terms...
Al Ajlouni, Ahmed
Developing Strategies for Islamic Banks to Face the Future Challenges of Financial Globalization Ahmed Al-Ajlouni Abstract This study aims at forming strategic response to assess the ability of Islamic banks in benefiting from the opportunities that may be provided by financial globalization and limits its threats, through assessing the capability of Islamic banks to meet the requirements and challenges of financial globalization, then suggests the suitable strategies that may be ...
Aljadhey, Hisham; Mahmoud, Mansour A; Alshammari, Thamir M; Al-Dhaeefi, Mohammed; Le Louet, Herve; Perez-Gutthann, Susana; Pitts, Peter J
To explore the challenges facing pharmacovigilance in Saudi Arabia and formulate recommendations to improve it from the perspective of healthcare professionals in Saudi Arabia. This was a qualitative study of 4 focus group discussions with pharmacists, physicians, and academicians held under the auspices of the King Saud University School of Pharmacy and the Center for Medicine in the Public Interest, Riyadh, Saudi Arabia. A total of 29 eligible healthcare professionals were invited to participate in the discussion. The predefined themes of the study were the current practice and major challenges facing pharmacovigilance in regulatory bodies, hospitals, the community, and academia, as well as recommendations to improve pharmacovigilance practice. Of the 29 participants invited, 27 attended the discussion. Challenges facing regulatory bodies included complicated adverse drug reactions (ADR) reporting forms, lack of feedback on ADRs submitted to the Saudi Food and Drug Authority, lack of decisions from the local authority to withdraw medications, and lack of data on pharmacovigilance. The challenges to pharmacovigilance in hospitals included the lack of knowledge of the significance of ADR reporting, workload, blaming culture, and lack of collaboration between regulatory bodies and hospitals. However, challenges facing pharmaceutical industries included the lack of drug manufacturers in Saudi Arabia and lack of interest in pharmacovigilance. Recommendations to improve pharmacovigilance included the need for communication, stronger regulatory requirements, the need for research, the need for unified ADRs reporting, and continuous education and training. The study has identified the challenges facing pharmacovigilance in Saudi Arabia and made certain recommendations to overcome them. These recommendations might be helpful for regulatory bodies to enhance spontaneous reporting and promote pharmacovigilance.
Subramanyam, K.; Haridharan, M. K.
Developing countries like India require a huge infrastructure to facilitate needs of the people. Construction industry provides several opportunities to the individuals. Construction manager work is to supervise and organize the construction activities in construction projects. Now a day construction manager facing challenges. This paper aimed to study the challenges facing by the construction manager in the perception of construction professionals. 39 variables were taken from the literature review which found to be severe impact on construction managers’ performance. Construction manager, project manager and site engineers are the respondents for this survey. Using SPSS, regression analysis was done and recognized significant challenges. These challenges were classified into 5 domains. In management challenges, resource availability and allocation, risks and uncertainties existing in the project onsite, top management support and cost constraints are the most significant variables. In skills requirement of a construction manager challenges, technical skills required to learn and adapt new technology in the project, decision making and planning according to the situation in site are the most significant variables. In performance challenges, implementation of tasks according to the plan is the important variable whereas in onsite challenges, manage project risks, develop project policies and procedures are the most important.
Magalhães-Sant'Ana, M.; More, S. J.; Morton, D. B.; Hanlon, A.
Ethics is key to the integrity of the veterinary profession. Despite its importance, there is a lack of applied research on the range of ethical challenges faced by veterinarians. A three round Policy Delphi with vignette methodology was used to record the diversity of views on ethical challenges faced by veterinary professionals in Ireland. Forty experts, comprising veterinary practitioners, inspectors and nurses, accepted to participate. In round 1, twenty vignettes describing a variety of ethically challenging veterinary scenarios were ranked in terms of ethical acceptability, reputational risk and perceived standards of practice. Round 2 aimed at characterising challenges where future policy development or professional guidance was deemed to be needed. In round 3, possible solutions to key challenges were explored. Results suggest that current rules and regulations are insufficient to ensure best veterinary practices and that a collective approach is needed to harness workable solutions for the identified ethical challenges. Challenges pertaining mostly to the food chain seem to require enforcement measures whereas softer measures that promote professional discretion were preferred to address challenges dealing with veterinary clinical services. These findings can support veterinary representative bodies, advisory committees and regulatory authorities in their decision making, policy and regulation. PMID:27613779
Enugu, Ramya; Hokayem, Hayat
This study examined the challenges that pre-service teachers faced when implementing inquiry and their perspective on how to overcome them. The data sample was 55 pre-service teachers (PSTs) enrolled into two sections of a science methods course in a private university in North Texas. The data sources consisted of inquiry-based lesson plans, PST…
This paper gives prominence to rural teachers' accounts of gender-based challenges facing Free Primary Education in Lesotho. It draws on feminist interpretations of social constructionism to discuss factors within the Basotho communities that affect gender equality in the schools. The inductive analysis offered makes use of the data generated from…
recruitment and retention of blacks and women in senior posts is still the major challenge facing .... classed social space in order to gain trust and to succeed in their careers. ... In this paper, we examine how participants in one particular ADP experience the .... they didn't want a new way of doing things and they believed the.
Transition program for special needs students is known to open opportunities for students with learning disabilities to gain work experience in actual work environment. The program provides training activities and also an opportunity to go for internship to gain work experience. Therefore, this study is to identify the challenges faced by special…
de Lange, Paul; Watty, Kim
Of the various reports released in 2010, two purport to examine the state of accounting education in Australia. These are "Accounting Education at a Crossroad in 2010" and "Challenges Facing Accounting Education in Australia". Both were released as collaborations of the leading academic organisation, the Accounting and Finance…
Horton-Deutsch, Sara; Young, Patricia K; Nelson, Kristine A
The aim of the present study was to explore the experience of becoming a nurse faculty leader. In a recent interpretation of 23 interviews conducted with nurse faculty leaders from across the United States about their experiences of becoming a leader three themes were identified: being thrust into leadership, taking risks and facing challenges. This interpretive phenomenological study further explicates three aspects of how nurse educators faced challenges in becoming and serving as a leader. Facing challenges meant reflecting, persevering through difficulties and learning to relate to others in new ways. Exemplars of participant experiences are provided for concreteness, to assist readers in determining how findings resonate with their own experience and how they can actualize this resonance in their own leadership practice. In the present study, reflecting, persevering through difficulties and learning to relate with others in a new way was how leaders faced challenges. Leadership development opportunities that facilitate self-exploration, caring and thoughtful interactions with others and values clarification serve as the foundation for becoming a nurse faculty leader who is, in turn, able to build leadership capacity in other individuals and organizations.
Mahfoodh, Omer Hassan Ali
This paper reports a qualitative study which examines the challenges faced by six international undergraduate students in their socialisation of oral academic discourse in a Malaysian public university. Data were collected employing interviews. Students' presentations were also collected. Semi-structured interviews were transcribed verbatim and…
This paper explores some new challenges facing universities in a global multimediated Internet-based environment, as they seek alternative paradigms and options to remain true to their core business. At a time of rapid technological change, and contested, complex concepts associated with globalisation, knowledge is becoming a primary factor of…
Al-Jaradat, Mahmoud Khaled Mohammad
This study aimed at identifying the challenges facing women academic leadership in secondary schools of Irbid Educational Area. A random sample of 187 female leaders were chosen. They responded to a 49-item questionnaire prepared by the researcher. The items were distributed into four domains: organizational, personal, social and physical…
As the twentieth anniversary of the 1994 genocide in Rwanda approaches, Mark Gudgel argues that we should face the challenges posed by teaching about Rwanda. Drawing on his experience as a history teacher in the US, his experience researching and supporting others' classrooms in the US and UK, his training in Holocaust education and his knowledge…
Bernardes, Margarida Maria Rocha; Lopes, Gertrudes Teixeira
This historic-sociologic study aims to analyse the challenges faced by the Brazilian Expeditionary Force's Air Transportation Nurses of the Army with the Theatre of Operations on the course of World War II. The primary source was comprised of a photograph from this time period and oral testimonies of those who participated in the conflict. Ideas by sociologist Pierre Bourdieu support the discussion. Results suggest that Brazilian nurses were challenged to transport the wounded without medical advice. We conclude that the challenge to fulfill the task imposed, which led to independent decision-making, gave confidence and autonomy to the ones already responsible for the transportation of the wounded.
Biswas, Animesh; Dalal, Koustuv; Abdullah, Abu Sayeed Md; Gifford, Mervyn; Halim, M A
Background: Maternal complications contribute to maternal deaths in developing countries. Bangladesh still has a high prevalence of maternal mortality, which is often preventable. There are some geographically challenging and hard to reach rural districts in Bangladesh and it is difficult to get information about maternal complications in these areas. In this study, we examined the community lay knowledge of possible pregnancy complications. We also examined the common practices associated with complications and we discuss the challenges for the community. Methods: The study was conducted in Moulvibazar of north east Bangladesh, a geographically challenged, difficult to reach district. Qualitative methods were used to collect the information. Pregnant women, mothers who had recently delivered, their guardians and traditional birth attendants participated in focus group discussions. Additionally, in-depth interviews were conducted with the family members. Thematic analyses were performed. Results: The study revealed that there is a lack of knowledge of maternal complications. In the majority of cases, the mothers did not receive proper treatment for maternal complications. There are significant challenges that these rural societies need to address: problems of ignorance, traditional myths and family restrictions on seeking better treatment. Moreover, traditional birth attendants and village doctors also have an important role in assuring appropriate, effective and timely treatment. Conclusions: The rural community lacks adequate knowledge on maternal complications. Reduction of the societal barriers including barriers within the family can improve overall practices. Moreover, dissemination of adequate information to the traditional birth attendant and village doctors may improve the overall situation, which would eventually help to reduce maternal deaths.
Many, Tom; King, Dennis
How do some school districts not only attain excellence but sustain it over time in the face of remarkable challenges? Two districts--Blue Valley School District in Overland Park, Kansas, and Kildeer Countryside Community Consolidated School District 96 in Buffalo Grove, Illinois--have managed to do just that by functioning as professional…
Full Text Available Automated person recognition (APR based on biometric signals addresses the process of automatically recognize a person according to his physiological traits (face, voice, iris, fingerprint, ear shape, body odor, electroencephalogram – EEG, electrocardiogram, or hand geometry, or behavioural patterns (gait, signature, hand-grip, lip movement. The paper aims at briefly presenting the current challenges for two specific non-cooperative biometric approaches, namely face and gait biometrics as well as approaches that consider combination of the two in the attempt of a more robust system for accurate APR, in the context of surveillance application. Open problems from both sides are also pointed out.
Tim Scott J
Full Text Available Abstract Background The study is designed to assess the organisational and human resource challenges faced by Primary Care Trusts (PCTs. Its objectives are to: specify the organisational and human resources challenges faced by PCTs in fulfilling the roles envisaged in government and local policy; examine how PCTs are addressing these challenges, in particular, to describe the organisational forms they have adopted, and the OD/HR strategies and initiatives they have planned or in place; assess how effective these structures, strategies and initiatives have been in enabling the PCTs to meet the organisational and human resources challenges they face; identify the factors, both internal to the PCT and in the wider health community, which have contributed to the success or failure of different structures, strategies and initiatives. Methods The study will be undertaken in three stages. In Stage 1 the key literature on public sector and NHS organisational development and human resources management will be reviewed, and discussions will be held with key researchers and policy makers working in this area. Stage 2 will focus on detailed case studies in six PCTs designed to examine the organisational and human resources challenges they face. Data will be collected using semi-structured interviews, group discussion, site visits, observation of key meetings and examination of local documentation. The findings from the case study PCTs will be cross checked with a Reference Group of up to 20 other PCG/Ts, and key officers working in organisational development or primary care at local, regional and national level. In Stage 3 analysis of findings from the preparatory work, the case studies and the feedback from the Reference Group will be used to identify practical lessons for PCTs, key messages for policy makers, and contributions to further theoretical development.
Malatzky, Christina; Bourke, Lisa
To examine the effects of dominant knowledge in rural health, including how they shape issues central to rural health. In particular, this article examines the roles of: (i) deficit knowledge of rural health workforce; (ii) dominant portrayals of generalism; and (iii) perceptions of inferiority about rural communities in maintaining health disparities between rural- and metropolitan-based Australians. A Foucauldian framework is applied to literature, evidence, case studies and key messages in rural health. Three scenarios are used to provide practical examples of specific knowledge that is prioritised or marginalised. The analysis of three areas in rural health identifies how deficit knowledge is privileged despite it undermining the purpose of rural health. First, deficit knowledge highlights the workforce shortage rather than the type of work in rural practice or the oversupply of workforce in metropolitan areas. Second, the construction of generalist practice as less skilled and more monotonous undermines other knowledge that it is diverse and challenging. Third, dominant negative stereotypes of rural communities discourage rural careers and highlight undesirable aspects of rural practice. The privileging of deficit knowledge pertaining to rural health workforce, broader dominant discourses of generalism and the nature of rural Australian communities reproduces many of the key challenges in rural health today, including persisting health disparities between rural- and metropolitan-based Australians. To disrupt the operations of power that highlight deficit knowledge and undermine other knowledge, we need to change the way in which rural health is currently constructed and understood. © 2018 National Rural Health Alliance Ltd.
Wijesinghe, Thushanthi S; Wijesinghe, Pushpa Ranjan
Sri Lanka took a policy decision to integrate leprosy services into the general health services (GHS) in 1999. This paper aims to summarize the emergence of new, specific challenges and how they were overcome during the integration of leprosy services to the GHS in a remote, leprosy endemic district in Sri Lanka. In this article, the regional epidemiologist as the team leader describes the principles used for transition to an effective integrated model of leprosy services from a centralized leprosy control model in the district. In addition, rationale for integration is viewed from the epidemiological and operational perspectives. National and district leprosy epidemiological data from secondary sources are also reviewed for corroborating the effectiveness of integration. Challenges surfaced were mainly related to the transfer of ownership of the programme, selection of appropriate service providing institutions easily accessible to clients, sustainability of leprosy services at the GHS, ensuring participation of all stakeholders in capacity building programmes and co-ordination of patient care in the absence of a dermatologist in the district. An empowered district team leader with specified roles and responsibilities, his sound technical and managerial know how and ability to translate 'team work' concept to practice were found to be essential for successful implementation of integration. Decision-making powers at the district level and flexibility to introduce new, area-specific changes to the centrally prepared core activities of integration were also vital to overcome locally surfaced challenges.
Taderera, Clever; Hall, Herna
Parenting children with learning disabilities requires a high level of knowledge and access to resources, information and services. In developing countries, however, these resources and services are not always available. Parents in Namibia, a developing country, therefore face challenges addressing children's learning and other developmental disabilities, including challenges related to preventative and supportive interventions. This research focuses on challenges faced by parents as they parent children with learning disabilities in Opuwo, Namibia. In-depth interviews were conducted with eight parents regarding the challenges they face in parenting their children with learning disabilities. Thematic analysis enabled the researchers to identify, analyse and report on themes that emerged from the qualitative interview data. Analysis of the interviews indicated that some participants had only a vague understanding of learning disabilities, as they did not have access to essential knowledge about this phenomenon. They also lacked an awareness of the availability of programmes, services and policies meant to benefit their children with learning disabilities. Participants voiced that they, their children with learning disabilities and community members have stereotypes and prejudices regarding learning disabilities. In this study, most of the children with learning disabilities were raised by single, unemployed parents who seemed to have access to less support from external sources than married couples parenting children with learning disabilities. These single parents are usually not married and because of lack of financial support from the other parent, the majority of them indicated that they struggle to meet the financial and material needs of their children. The researchers concluded that the participants in this study experience a range of challenges in parenting their children with learning disabilities. The main challenges emanate from financial instability, as
Full Text Available Museums are part of a wider cultural and entertainment environment, which is ruled by highly demanding visitors who seek immersive experiences (edutainment and time-saving arrangement. This has encouraged and, in some opinions, forced museums to turn their focus from collections to visitors. In addition, museums have faced competition and new technologies in the form of virtual museums and virtual reality. This has emphasized the need to accept marketing as a survival tool and to make it into a link between museums and visitors. This article attempts to give current insights into museum marketing as part of the arts marketing field. Its aim is also to identify and explain some of the major challenges and opportunities facing everyday museum business, in order to provide insight into the complex world of museum marketing. Former findings about the development of museum marketing and its biggest changes and challenges are presented, summarized and analyzed.
Elizabeth Chinomona; Eugine Tafadzwa Maziriri
In today’s post-modern era, the role of women entrepreneurs in economic development is inevitable and women are willing to take action in business and contribute to the nation’s growth. Women are stepping up to own and run businesses in numbers that would have been hard to imagine a mere few decades ago. However, women entrepreneurs face a wide variety of challenges both in starting and in growing their business ventures. The objective of this paper is to investigate the challenges women entr...
Fridah Muriungi Mwobobia
The study sought to identify the challenges facing small scale women entrepreneurs in Kenya and initiatives put in place to counter the challenges. The study employed desktop research. MSEs Baseline survey, recorded that 612,848 women in Micro and Small Enterprises (MSEs) in Kenya, accounting for 47.4 per cent of all those in MSEs. The study showed that women tended to operate enterprises associated with traditional women¡¯s roles, such as hairstyling. The small and micro enterprises (SMEs) p...
Klassen, Anne F; Gulati, Sonia; Watt, Lisa; Banerjee, Ananya T; Sung, Lillian; Klaassen, Robert J; Dix, David; Poureslami, Iraj M; Shaw, Nicola
Given the increasing numbers of immigrant families in Canada, it is imperative that healthcare providers (HCPs) understand the caregiving experiences of immigrant family caregivers. Our study aimed to explore any special challenges faced by immigrant parents of children with cancer and to identify supportive factors. A constructivist grounded theory approach was used. Participants included 50 first generation Chinese and South Asian parents of children with cancer who were at least six months post-diagnosis. Recruitment took place at six Canadian pediatric oncology centres. Interviews were conducted in English, Cantonese, Mandarin, Urdu, Punjabi or Hindi. Analysis involved coding and the use of the constant comparison method. Interviewing continued until no new themes emerged. While immigrant parents described many challenges faced by any parent of a child with cancer, the context of being an immigrant made certain experiences particularly challenging. Parents described challenges in the following areas: managing caregiving demand and financial strain, accessing support from others, and interfacing with the healthcare system. Parents described receiving a range of practical, emotional, social and informational support from extended family, their workplace, other cancer families, community organizations and HCPs. Our study addresses an important gap in the research literature by providing practical insight into the experiences of immigrant family caregivers. Our findings may help to inform the development of pediatric oncology policies and programs in ways that respond to the unique needs and challenges of culturally and linguistically diverse families. Copyright © 2011 John Wiley & Sons, Ltd.
Bredland, Ebba Langum; Söderström, Sylvia; Vik, Kjersti
Active ageing reflects the message from World Health Organisation about addressing the challenge faced by the rapidly ageing population. Knowledge about barriers and facilitators to an active lifestyle must be given more attention. In addition, men seem to participate less in cultural activities and less in fall-prevention groups than women do. When mostly women work with the elderly in primary care, one might question whether the activities offered to older men meet their activity preferences. The aim of this study is to provide new knowledge about challenges and motivators encountered by retired men in maintaining physical activity when ageing. Nine retired men, aged between 66 and 83, wrote a Time Geographic Diary for 7 days each. Two focus group discussions with the men were held. A Systemic Text Condensation was used to analyse the data. The analyses identified three categories to describe challenges in being physical active: differences between men and women; meaningful physical activity; and environmental - especially socio-cultural - constraints. Motivating conditions were seen as: new activities to get younger friends, and more information about how to cope. To achieve the aim of active ageing, service providers as well as local authorities need to have a better understanding of the challenges retired men encounter when ageing. This study highlights vital aspects of the challenges faced by retired men in maintaining their physical activity level.
Lassi, Zohra S; Salam, Rehana A; Bhutta, Zulfiqar A
The health challenges faced by young people are more complex than adults and can compromise their full growth and development. Attention must be paid to the health of this age group, yet adolescents and youth remain largely invisible and often disappear from the major global datasets. The aim of this paper is to discuss the global health challenges faced by adolescents and youth, global legislations and guidelines pertaining to this particular age group, recommendations to arrest these challenges, and research priorities. Major direct and indirect global health risks faced by adolescents include early pregnancy and childbirth, femicide, honor killing, female genital mutilation, nutritional habits and choices, social media, and peer pressure. There are no standard legal age cut-offs for adulthood; rather, the age varies for different activities, such as age of consent or the minimum age that young people can legally work, leave school, drive, buy alcohol, marry, be held accountable for criminal action, and make medical decisions. This reflects the fact that the existing systems and structures are focused on either children or adults, with very few investments and interventions directed specifically to young people. Existing legislation and guidelines need transformation to bring about a specific focus on adolescents in the domains of substance use and sexual behaviors, and the capacity for adolescent learning should be exploited through graduated legal and policy frameworks. Sustainable development goals provide an opportunity to target this neglected and vulnerable age group. A multisectoral approach is needed to bring about healthy change and address the challenges faced by adolescents and youth, from modifications at a broader legislative and policy level to ground-level (community-level) implementations. Copyright © 2017 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.
Approved for public release; distribution is unlimited As a result of the changing security environment in the Asia-Pacific, Japan is shifting to a more proactive defense policy, as outlined in the National Defense Program Guidelines (NDPG). This thesis investigates the challenges faced by Japan's industry, government, and society in meeting the NDPG objectives. To do this, this thesis probes the following problem areas: difficulties with indigenous production of weapons systems, inability...
The marketing and successful distribution of artificial-intelligence-based decision-support systems for nursing face special barriers and challenges. Issues that must be confronted arise particularly from the present culture of the nursing profession as well as the typical organizational structures in which nurses predominantly work. Generalizations in the literature based on the limited experience of physician-oriented artificial intelligence applications (predominantly in diagnosis and pharmacologic treatment) must be modified for applicability to other health professions.
549 Nanotechnology equivalent.17 In addition, nanotechnology -enabled water desalination and filtration systems may offer affordable...Senate NANOTECHNOLOGY Nanomaterials Are Widely Used in Commerce, but EPA Faces Challenges in Regulating Risk May 2010 GAO-10-549...2010 2. REPORT TYPE 3. DATES COVERED 00-00-2010 to 00-00-2010 4. TITLE AND SUBTITLE Nanotechnology : Nanomaterials Are Widely Used in Commerce
Roč. 14, č. 2 (2010), s. 67-78 ISSN 1842-5135 Institutional research plan: CEZ:AV0Z30860518 Keywords : classification * geographical research * identification method * landscape structure Subject RIV: DE - Earth Magnetism, Geodesy, Geography http://studiacrescent.com/images/02_2010/09_jaromir_kolejka_post_industrial_landscape_its_identification_and_classification_as_contemporary_challenges_faced_by_geographic_.pdf
Lopez, Paul; Wise, Donald
Rural school districts across the nation, with their limited resources, face daunting challenges posed by the implementation of the Common Core State Standards. This article presents a recent study of 13 rural school districts in the Central Valley of California and how these districts are responding to those challenges. A total of 352 teachers…
Ganle, John Kuumuori; Otupiri, Easmon; Obeng, Bernard; Edusie, Anthony Kwaku; Ankomah, Augustine; Adanu, Richard
Background While a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana. Methods and Findings A qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling’s thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers’ insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability. Conclusions Maternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and
Macherera, Margaret; Moyo, Lindani; Ncube, Mkhanyiseli; Gumbi, Angella
Objectives Despite the advent of antiretroviral therapy (ART), many children, particularly in the rural communities of Zimbabwe, remain vulnerable. The purpose of this study was to determine the factors and challenges facing children on antiretroviral therapy (ART) in Brunapeg area of Mangwe District, Zimbabwe. Methods A mixed-method approach involving interviewer-guided focus group discussions and piloted semi-structured questionnaires was utilized to collect data from different key population groups. The data obtained were analyzed through content coding procedures based on a set of predetermined themes of interest. Results A number of challenges emerged as barriers to the success of antiretroviral therapy for children. Primary care givers were less informed about HIV and AIDS issues for people having direct impact on the success of antiretroviral therapy in children whilst some were found to be taking the antiretroviral drugs meant for the children. It also emerged that some primary care givers were either too young or too old to care for the children while others had failed to disclose to the children why they frequently visited the Opportunistic Infections (OI) clinic. Most primary care givers were not the biological parents of the affected children. Other challenges included inadequate access to health services, inadequate food and nutrition and lack of access to clean water, good hygiene and sanitation. The lack of community support and stigma and discrimination affected their school attendance and hospital visits. All these factors contributed to non-adherence to antiretroviral drugs. Conclusions and Public Health Implications Children on ART in rural communities in Zimbabwe remain severely compromised and have unique problems that need multi-intervention strategies both at policy and programmatic levels. Effective mitigating measures must be fully established and implemented in rural communities of developing countries in the fight for universal
Margaret Macherera, MSc
Full Text Available Objectives:Despite the advent of antiretroviral therapy (ART, many children, particularly in the rural communities of Zimbabwe, remain vulnerable. The purpose of this study was to determine the factors and challenges facing children on antiretroviral therapy (ART in Brunapeg area of Mangwe District, Zimbabwe.Methods:A mixed-method approach involving interviewer-guided focus group discussions and piloted semi-structured questionnaires was utilized to collect data from different key population groups. The data obtained were analyzed through content coding procedures based on a set of predetermined themes of interest.Results:A number of challenges emerged as barriers to the success of antiretroviral therapy for children. Primary care givers were less informed about HIV and AIDS issues for people having direct impact on the success of antiretroviral therapy in children whilst some were found to be taking the antiretroviral drugs meant for the children. It also emerged that some primary care givers were either too young or too old to care for the children while others had failed to disclose to the children why they frequently visited the Opportunistic Infections (OI clinic. Most primary care givers were not the biological parents of the affected children. Other challenges included inadequate access to health services, inadequate food and nutrition and lack of access to clean water, good hygiene and sanitation. The lack of community support and stigma and discrimination affected their school attendance and hospital visits. All these factors contributed to non-adherence to antiretroviral drugs.Conclusions and Public Health Implications:Children on ART in rural communities in Zimbabwe remain severely compromised and have unique problems that need multi-intervention strategies both at policy and programmatic levels. Effective mitigating measures must be fully established and implemented in rural communities of developing countries in the fight for
Vindevogel, Sofie; De Schryver, Maarten; Broekaert, Eric; Derluyn, Ilse
Warfare takes a profound toll of all layers of society, creating multiple and multilevel challenges that impinge on the psychosocial well-being of affected individuals. This study aims to assess the scope and salience of challenges confronting former child soldiers and at identifying additional challenges they face compared to non-recruited young people in war-affected northern Uganda. The study was carried out with a stratified random sample of northern Ugandan adolescents (n = 1,008), of whom a third had formerly been recruited (n = 330). The mixed-method comparison design consisted of a constrained free listing task to determine the challenges; a free sorting task to categorize them into clusters; and statistical analysis of their prevalence among formerly recruited youth and of how they compare with those of nonrecruited youth. Altogether, 237 challenges were identified and clustered into 15 categories, showing that formerly recruited participants mainly identified "emotional" and "training and skills"-related challenges. Compared with nonrecruited counterparts, they reported significantly more "emotional" and fewer "social and relational" challenges, with the exception of stigmatization. Overall, there was similarity between the challenges reported by both groups. The challenges confronting formerly recruited youths reach well beyond the effects of direct war exposure and emerge mainly from multiple influence spheres surrounding them. These challenges are largely shared in common with nonrecruited youths. This multidimensional and collective character of challenges calls for comprehensive psychosocial interventions through which healing the psychological wounds of war is complemented by mending the war-affected surroundings at all levels and in all life areas. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Full Text Available Informal trade has grown at an alarming rate in South Africa because of lack of employment opportunities in both the private and public sectors. This has resulted in many unemployed members of the population joining the informal business sector. The majority of people in this sector do not have skills that are needed in the formal employment sector, others are semi-literate and a small percentage has some level of qualification. Nevertheless, this sector is plagued by a number of challenges which this article presents. The article reports on the study that was conducted at Greater Letaba Municipality in Limpopo Province. The aim of the study was to investigate the challenges that were faced by informal traders in Greater Letaba Municipality in Limpopo Province in South Africa. The area was chosen because of its accessibility to the researchers and its potential to provide relevant and accurate information for the research project. Thus, a qualitative research method was used to collect data through face to face interviews. The research discovered that some of the challenges experienced by the informal traders in the area ranged from lack of support from the local municipality to structural challenges like lack of ablution facilities and limited access to electricity. Furthermore, other challenges concerned safety and health issues that were also gender based. Most of the traders in the area were women; an element which attest to the fact that it is difficult to find employment in the country when one is less educated and is also a woman.
Full Text Available The study examined the challenges faced by cocoyam farmers in adapting to climate change in Southeast, Nigeria. Three hundred and eighty-four respondents selected through multi-stage sampling technique were used for the study. Data were collected using structured questionnaire and interview schedule and analysed using both descriptive and inferential statistical tools. Findings showed that majority were females (67%, married (92% and maintain average household size of 6 persons and a mean age of 51 years. They were mainly primary (32% and secondary (34% school certificate holders with farming (77% as their major occupation. The major cropping pattern practiced was mixed farming with cassava (63% and maize (58% as the major crops cultivated by the farmers. Majority of the farmers owned farms of one hectare and below accessed mainly through inheritance (76% and labour sourced mainly through hiring (50%. Most (81% of the farmers have spent more than ten years in farming. Climate change information was accessed mainly through their personal experience (64%, radio (42% and fellow villagers (39%. The study identified eight major challenges faced by cocoyam farmers in adapting to climate change namely Lack/high cost of farm inputs and low soil fertility (Factor 1, Land and labour constraints (Factor 2, Poor access to information and ineffectiveness of cooperatives (Factor 3, lack of/poor access to fund and credit facilities and poor government support (Factor 4, lack of improved varieties of cocoyam (factor 5, poor value attached to cocoyam (Factor 6, poor infrastructural capacity and technology know-how (Factor 7 and Transportation constraint (Factor 8. Analysis of variance identified significant variations in the challenges faced by cocoyam farmers in the study area. The study recommends enrollment in cooperatives and revitalizing existing cooperatives, re-orientation of farmers on the benefits of cocoyam and increased used of climate change
Musoke, David; Boynton, Petra; Butler, Ceri; Musoke, Miph Boses
The health seeking behaviour of a community determines how they use health services. Utilisation of health facilities can be influenced by the cost of services, distance to health facilities, cultural beliefs, level of education and health facility inadequacies such as stock-out of drugs. To assess the health seeking practices and challenges in utilising health facilities in a rural community in Wakiso district, Uganda. The study was a cross sectional survey that used a structured questionnaire to collect quantitative data among 234 participants. The sample size was obtained using the formula by Leslie Kish. While 89% of the participants were aware that mobile clinics existed in their community, only 28% had received such services in the past month. The majority of participants (84%) did not know whether community health workers existed in their community. The participants' health seeking behaviour the last time they were sick was associated with age (p = 0.028) and occupation (p = 0.009). The most significant challenges in utilising health services were regular stock-out of drugs, high cost of services and long distance to health facilities. There is potential to increase access to health care in rural areas by increasing the frequency of mobile clinic services and strengthening the community health worker strategy.
Madas, E; North, N
This article reports on a postal survey of 78 long-term care managers in one region of New Zealand, of whom 45 (58%) responded. Most long-term care managers (73.2%) were middle-aged females holding nursing but not management qualifications. Most long-term care facilities (69%) tended to be stand-alone facilities providing a single type of care (rest home or continuing care hospital). The most prominent issues facing managers were considered to be inadequate funding to match the growing costs of providing long-term care and occupancy levels. Managers believed that political/regulatory, economic and social factors influenced these issues. Despite a turbulent health care environment and the challenges facing managers, long-term care managers reported they were coping well and valued networking.
Full Text Available Among the processes cosmopolitan societies undergo at the present moment, is the unprecedented increase in mass migration across cultures. What challenges are faced by both immigrants, who have to settle in novel socio-cultural environments, and by the host populations accepting them? The current qualitative study investigates the nature of identity construction among Russian-speaking immigrants in New Zealand, applying thematic analysis for the interpretation of the data collected via 23 in-depth interviews. Among the most common themes articulated by the participants was the feeling of identity loss. A taken-for-granted sense of identity, brought by the participants from their culture of origin, was not validated by their new society of residence, mostly due to the lack of appropriate cultural resources. The participants were faced with a challenge of re-constructing their old identity, or constructing a new one, utilising the available resources in the community around them. At the same time, there was a sub-group for whom this challenge brought the realisation that the nature of their identity is cosmopolitan, rather than located within any particular culture or geographical space.
Davis, Sheila P; Davis, Danyetta D
Current trends in higher education in the United States demand that nursing take stock of how it is prepared or being prepared to face challenges and issues impacting on its future. The intense effort made to attract students to pursue advanced training in science and engineering in the United States pales in comparison to the numbers of science and engineering majors produced yearly in international schools. As a result, more and more jobs are being outsourced to international markets. Could international outsourcing become a method of nursing education? Authors submit that to remain competitive, the nursing profession must attract a younger cohort of technologically savvy students and faculty reflective of the growing diverse population in the United States. Additionally, nursing programs in research universities face even more daunting challenges as it relates to mandates for funded research programs of educational units. This article offers suggestions and recommendations for nursing programs in higher education institutions on ways to attract and retain ethnic minorities and of how to harness the power of research to address burgeoning societal health challenges.
Objectives: The purpose of this article was to examine the critical role played by the procurement function in business and to reveal the challenges faced by procurement professionals in developing economies as well as to suggest solutions to these challenges. Method: A sequential literary analysis was used, complemented by cross-country qualitative data gathered from one hundred diverse procurement practitioners from Botswana, Namibia and Zimbabwe. These were primarily participants in a series of procurement workshops run by the researchers from January to June 2014. Results: Findings suggested that limited recognition, increasing unethical behaviour, poor supplier service delivery, poor regulatory environment, varying supplier standards and poor corporate governance are the main challenges faced by the procurement profession in these countries. Conclusion: The study’s findings imply that there is limited understanding regarding the role procurement plays in both government and non-government institutions in developing economies. The article suggests solutions which procurement professionals and organisations can implement in order to unlock the potential value in the procurement function.
Pung, L-X; Goh, Y-S
Results from this literature review were used to identify the challenges faced by international nurses in their host countries following migration. The increasing strain of nursing shortages in the healthcare system has led to the recruitment of international nurses among many countries. However, following migration, international nurses are faced with challenges that may result in poor integration with their host countries. Using Cooper's five stages for integrative research reviews, a literature search was conducted across seven databases using a PRISMA search strategy. Additional manual searches were also conducted on the end-references of the retrieved articles. The authors then independently reviewed the selected articles using the Joanna Briggs Institute appraisal form to extract and generate the themes for the review. Twenty-four articles were selected for the review. The themes generated included: (i) difficulty orientating; (ii) a longing for what is missing; (iii) professional development and devaluing; (iv) communication barriers; (v) discrimination and marginalization; (vi) personal and professional differences; and (vii) a meaningful support system. By identifying the challenges faced by international nurses, interventions that ensure equal treatment (e.g. multifaceted transition programmes and culturally sensitive 'buddy' systems) can be implemented to help international nurses adapt to their new environments. Adequate communication can be achieved by encouraging international nurses to speak English and learn the colloquial language and non-verbal behaviours used by native nurses. With good integration international nurses may be able to reach their full career potential as professional nurses in their host countries. The adaptation process is a dynamic process that requires effort from both international and native nurses. Thus, any strategies that are developed and implemented must be multifaceted. © 2016 International Council of Nurses.
Some of the environmental challenges which the uranium production industry faces in the 21st century have been discussed in the paper. They are: the use of the linear non-threshold (LNT) model for radiation protection, the concept of 'controllable dose' as an alternative to the current International Commission on Radiological Protection (ICRP) system of dose limitation, the future of collective dose and the ALARA (As low As Reasonably Achievable) principle and the application of a risk-based framework for managing hazards. The author proposes that, the risk assessment/risk management framework could be used for managing the environmental, safety and decommissioning issues associated with the uranium fuel cycle. (author)
After twenty years serving its members, the Quebec Healthy Cities and Towns Network (QHCTN) faces several challenges. There are currently many changes being made in the local organization and the administration of services. The Network, through its capacity to mobilize the different municipalities, is the best placed to advocate and support a coordinated approach to government initiatives and also to encourage partnerships with other institutions (education, health, socio-economic) and communities. There is, nonetheless, a need to rethink its direct support to members, especially in terms of communication and networking among them.
An upgraded safety concept for CMS has been adapted to the size of the project and its organisational challenges under today's budgetary constraints, as well as to the increasing levels of risk. Strong magnetic fields and high radiation levels, including neutrons, pose additional hazards to materials, to operators, to maintenance and to ultimate deposit of activated materials. CMS also fits the insurer's risk-description for modern facilities, i.e. characterised by "higher energy density, more combustible materials and unattended operation". The regulatory environment, consisting essentially of CERN's autonomous regulations as well as of those of its host countries, also need to be satisfied with much attention. To face this challenge, seven distinct safety management tools have been identified, which are described in some detail, namely clear safety objectives, documented safety requirements, open items list, safety ( and design)reviews, safety risk analysis, enforcement of compliance and quality management....
Gopal Rao, MRS Web-Editor; Yury Gogotsi, Drexel University; Karen Swider-Lyons, Naval Research Laboratory
Symposium T: Nanomaterials for Polymer Electrolyte Membrane Fuel Cells Polymer electrolyte membrane (PEM) fuel cells are under intense investigation worldwide for applications ranging from transportation to portable power. The purpose of this seminar is to focus on the nanomaterials and nanostructures inherent to polymer fuel cells. Symposium topics will range from high-activity cathode and anode catalysts, to theory and new analytical methods. Symposium U: Materials Challenges Facing Electrical Energy Storage Electricity, which can be generated in a variety of ways, offers a great potential for meeting future energy demands as a clean and efficient energy source. However, the use of electricity generated from renewable sources, such as wind or sunlight, requires efficient electrical energy storage. This symposium will cover the latest material developments for batteries, advanced capacitors, and related technologies, with a focus on new or emerging materials science challenges.
Raden Aswin Rahadi
Full Text Available This research is a part of a continuous study to analyze the opportunities and challenges for micro-small and medium business in Indonesia when facing ASEAN Economic Community (AEC in 2016. It has its own uniqueness, as it will combine the point of view between current business owners and current literature study synthesis on business perception towards AEC. Ten business owners have been interviewed. The results suggested AEC provides challenges for the business owners, particularly in terms of capital; competitiveness; sales system; innovation; finance, bureaucracy; and government preparedness. AEC also provides opportunities, in terms of market potential; creativity; export opportunities; business owners’ resistances and sustainability; and knowledge of local market. From all of the keywords mentioned by the respondents, there are four main attributes considered as important: human resources; creativities; market share; and capital. Finally, most of the respondents suggested that AEC will bring more positive influences for the development of micro-small and medium business in Indonesia.
Touchton, Debra; Acker-Hocevar, Michele
Superintendents of small school districts describe how they give voice, involve and listen to others, and solicit various publics to build democratic communities. Superintendents make sense of leadership through their constructed role, leadership orientation, and district size. Findings suggest the following when superintendents involve, listen,…
Subramanian, Pathmawathi; Allcock, Nick; James, Veronica; Lathlean, Judith
To explore nurses' challenges in managing pain among ill patients in critical care. Pain can lead to many adverse medical consequences and providing pain relief is central to caring for ill patients. Effective pain management is vital since studies show patients admitted to critical care units still suffer from significant levels of acute pain. The effective delivery of care in clinical areas remains a challenge for nurses involved with care which is dynamic and constantly changing in critically ill. Qualitative prospective exploratory design. This study employed semi structured interviews with nurses, using critical incident technique. Twenty-one nurses were selected from critical care settings from a large acute teaching health care trust in the UK. A critical incident interview guide was constructed from the literature and used to elicit responses. Framework analysis showed that nurses perceived four main challenges in managing pain namely lack of clinical guidelines, lack of structured pain assessment tool, limited autonomy in decision making and the patient's condition itself. Nurses' decision making and pain management can influence the quality of care given to critically ill patients. It is important to overcome the clinical problems that are faced when dealing with pain experience. There is a need for nursing education on pain management. Providing up to date and practical strategies may help to reduce nurses' challenges in managing pain among critically ill patients. Broader autonomy and effective decision making can be seen as beneficial for the nurses besides having a clearer and structured pain management guidelines. © 2011 Blackwell Publishing Ltd.
Full Text Available We were prompted by the prevalence of English Second or Other Language (ESOL learners identified by educators as having language disorders and being referred for Speech-Language Therapy. We describe challenges faced by Grade 1, 2 and 3 educators at government schools in the Cape Metropolitan area who were working with such learners. Applying a mixed-methods descriptive design, a self-administered questionnaire and three focus groups were used for data collection. Educator perceptions and experiences regarding ESOL learners were described. Some participant educators at schools that were not former Model C schools had large classes, including large proportions of ESOL learners. Furthermore, there was a shortage of educators who were able to speak isiXhosa, the most frequently occurring first (or home language of the region's ESOL learners. Challenges faced by educators when teaching ESOL learners included learners' academic and socio-emotional difficulties and a lack of parent involvement in their children's education. Participant educators indicated a need for departmental, professional and parental support, and additional training and resources. Implications and recommendations for speech-language therapist and educator collaborations and speech-language therapists' participation in educator training were identified.
Full Text Available Although the maternal mortality ratio has descended in Bolivia from 416 (1989 to 229 deaths (DHS 2003 per one hundred thousand live births, it is one of the highest in the region. As a national average, the ratio conceals the rural-urban, socio-economics differences and the reality of the indigenous population. Maternal mortality is one of the major challenges at national level. Reduction of maternal mortality, in addition of technical-medical measures offering health services, requires to focus on socio-cultural aspects that hamper the access to health services. This article examines challenges faced by indigenous mothers accessing the health services. In addition to the geographic, economic and administrative barriers that generate delays in access to the health services, there are others that are presented in the context of multiculturalism resulting from discriminatory attitudes exercised in health centers. The testimonies of indigenous mothers show delays faced in health centers because of prejudice and discrimination suffered, threatening the lives of mothers and their babies. The study also suggests the need to deepen the concept of multiculturalism as a successful strategy in health, in order to promote equity and social justice on the horizon of more inclusive societies.
Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J
Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort.
Dickey, Lore M; Singh, Anneliese A
This article explores some of the challenges faced by trans and gender diverse (TGD) individuals who not only are attempting to access trans-affirmative care, but who are also members of the very profession from which they are seeking services. The authors explore challenges related to finding supervision, accessing care for assessment services, and finding a provider for personal counseling. With each example, the authors unpack the challenges and also address the implications for training for all involved. Based on these challenges that TGD psychologists and trainees face in attempting to access care, the authors provide recommendations related to trans-affirmative training for psychologists. © 2017 Wiley Periodicals, Inc.
Coye de Brunélis, T.; Bachellerie, E.; Sidaner, J.-F.
Operating experience from TMI and and more general experience from three decades of nuclear facility operations, have shown the value of safety culture’s contribution to nuclear risk management. More than ever, this particular aspect of human and organizational factors (HOF) is central to the AREVA group’s concerns as it faces new challenges. The first generation of operators commissioned the facilities and optimized their operation. This first phase gave them a better understanding of operations and related limits, particularly through testing and start-up operations and the responses that were found for all of the technical issues that arose. All of these interactions offered opportunities to make the safety challenges of processes and facilities tangible and directly perceptible. The young operators of those bygone years are now the ones who are “in the know” in the organizations, the ones with unique technical know-how and a multi-layered perception of the risks involved. Those first generations of operators, with their unique operational knowledge, are gradually leaving the industrial world. Replacing those skills creates a new set of challenges. Concomitantly, the French nuclear safety authority benefited from these facility start-ups to increase its skills by sharing in the learning process concerning the facilities’ operational realities and in the construction of a safety configuration program, and by gaining a concrete perception of risk. This fostered the mutual trust that is vital and integral to facility safety.
The colloquium organised by the Association of Energy Economists dealing with the theme 'Technical progress faced with the challenges of the energy sector in the future' takes place against a backdrop of ever-increasing initiatives in this field, for example at the World Energy Council or the International Energy Agency Faith in technical progress is widespread but should be supported by studies without any preconceived ideas. Research and development efforts must be fully supported, and in a climate of opening markets and liberalization the public authorities have a major role to pay. Historically, the markets have always been able to meet new needs thanks to technology, but the ambitious targets that the international community has set itself regarding the emission of greenhouse gases imply technical improvements and major investments. (authors)
Faudon, Valerie; Jouette, Isabelle; Le Ngoc, Boris
As the French nuclear industry is facing a major challenge (financial weakness, an electric power market in crisis, 15 years without building any reactor, delayed works), this report first outlines why innovation is necessary to guarantee a low carbon and competitive electricity, to comfort the leadership position of this sector in the world, and to respond to expectations of civil society. Then, it describes how the French nuclear industry is already implementing organisational, technological and social innovations, notably through the development of digital technologies. The third part identifies priorities of new public policies: to imagine a new business model for nuclear (a better visibility for investors, taking all induced costs in the power system into account in a diversified mix, reform of the carbon market, taking avoided atmospheric pollution into account), to rethink regulation in order to free innovation spirit, and to prepare the future by investing in research
Bhaskara P Shelley
Full Text Available Hansen's disease (HD looms still as a public health problem. Conventional wisdom and teaching largely view HD as a predominantly dermatologic disorder with much emphasis in the dermatology postgraduate curriculum. This review attempts to reorient this view and reemphasize that HD has primarily neurologic underpinnings since Mycobacterium leprae is an intracellular neurotropic bacterium. The main thrust of this article would, therefore, be a neurologist's perspective of HD. The cutaneous manifestations of HD are the sequelae of the neurobiology of M. leprae, its selective predilection to human Schwann cells, neurovascular bundle and its localization in the intracutaneous nerve plexus of the skin. We discuss the nuances of HD as a “great imitator,” the many faces of its neurodermatologic clinical presentation, the neurologic basis of HD clinical examination, and its diagnostic and therapeutic challenges.
Jeanblanc, Jérôme; Rolland, Benjamin; Gierski, Fabien; Martinetti, Margaret P; Naassila, Mickael
Binge drinking (BD), i.e., consuming a large amount of alcohol in a short period of time, is an increasing public health issue. Though no clear definition has been adopted worldwide the speed of drinking seems to be a keystone of this behavior. Developing relevant animal models of BD is a priority for gaining a better characterization of the neurobiological and psychobiological mechanisms underlying this dangerous and harmful behavior. Until recently, preclinical research on BD has been conducted mostly using forced administration of alcohol, but more recent studies used scheduled access to alcohol, to model more voluntary excessive intakes, and to achieve signs of intoxications that mimic the human behavior. The main challenges for future research are discussed regarding the need of good face validity, construct validity and predictive validity of animal models of BD. Copyright © 2018 Elsevier Ltd. All rights reserved.
Despite the significant effects of systems of oppression on health, nursing education tends not to include anti-racist pedagogy in its curricula, preferring instead to focus more narrowly on culture. This narrow focus allows nurses to depoliticize discussions of race and other social differences, largely ignoring the influence that systems of oppression, imperialism, and historical trauma have had on health in marginalized populations. In contrast, anti-racist pedagogy educates students in ways that make racialized power relations explicit, deconstruct the social construction of race, and analyze interlocking systems of oppression that serve to marginalize and exclude some groups while privileging others. This article describes anti-racist pedagogy from the perspective of a faculty member of color, drawing on personal experience and a review of the anti-racist pedagogical literature. Specifically, this article highlights some of the personal and professional challenges faced by faculty of color when engaged in anti-racist pedagogy in predominantly white schools of nursing.
WANNER, A. A.; KIRSCHMANN, M. A.
Summary Serial block‐face scanning electron microscopy (SBEM) is becoming increasingly popular for a wide range of applications in many disciplines from biology to material sciences. This review focuses on applications for circuit reconstruction in neuroscience, which is one of the major driving forces advancing SBEM. Neuronal circuit reconstruction poses exceptional challenges to volume EM in terms of resolution, field of view, acquisition time and sample preparation. Mapping the connections between neurons in the brain is crucial for understanding information flow and information processing in the brain. However, information on the connectivity between hundreds or even thousands of neurons densely packed in neuronal microcircuits is still largely missing. Volume EM techniques such as serial section TEM, automated tape‐collecting ultramicrotome, focused ion‐beam scanning electron microscopy and SBEM (microtome serial block‐face scanning electron microscopy) are the techniques that provide sufficient resolution to resolve ultrastructural details such as synapses and provides sufficient field of view for dense reconstruction of neuronal circuits. While volume EM techniques are advancing, they are generating large data sets on the terabyte scale that require new image processing workflows and analysis tools. In this review, we present the recent advances in SBEM for circuit reconstruction in neuroscience and an overview of existing image processing and analysis pipelines. PMID:25907464
Australia and Canada are benefiting from a global increase in coal consumption, but face challenges regarding coal and coal export capacity. Coal is Australia's biggest export commodity, accounting for over 50 percent of world coking coal exports, with almost 75 percent of those exports destined for Asian markets, primarily Japan. However, the number of ships delayed at Australian ports hit a record of 223 bulk carriers in early 2010. Compared to Canada, Australia faces greater logistical issues getting coal into port and onto ships at its 9 loading terminals. Two of Canada's 3 major shipping terminals, Westshore and Neptune, have some additional capacity. Its third terminal, Ridley Island, has considerable potential to carry more coal. With 98 percent of all coal moved by rail in Australia, rail issues also hinder growth. A national approach to planning freight transport on both roads and rail is being developed. While infrastructure issues remain the single greatest barrier to export growth for Australia's coal sector, Canada's most immediate issues pertain to mine permitting and mine-site expansion. In 2009, Canada exported 28 million tonnes of coal, 90 percent of it metallurgical. With approximately 70 million tonnes of annual production, mostly in British Columbia and Alberta, coal remains the number one commodity in Canada carried by rails and shipped from ports. 1 fig.
Kakyo, T A; Xiao, L D
The aim of this study was to understand nurse ward managers perceived challenges in the rural healthcare setting in Uganda. The health workforce, essential medicines and equipment and political unrest are the main factors affecting the international community in addressing the hefty disease burden in World Health Organization African regions. Nurse ward managers have an important role to play to mitigate these factors in health facilities in these regions through leadership, supervision and support for staff. This study utilized interpretive phenomenology based on Gadamer's hermeneutical principles. Eleven nurse managers from two rural public hospitals in Uganda were interviewed. Those with more than a 2-year experience in their management role were invited to participate in the study. Nurse managers pointed out four major challenges with staffing, while they worked in the rural healthcare settings. These are summarized into themes: 'Numbers do matter'; 'I cannot access them when I need them at work'; 'Challenges in dealing with negative attitudes'; and 'Questioning own ability to manage health services'. Health facilities in rural areas face extremely low staff-to-patient ratio, a high level of workload, lack of essential medicines and equipment, low salaries and delayed payment for staff. Nurse managers demonstrated situation-based performance to minimize the impact of these challenges on the quality and safety of patient care, but they had less influence on policy and resource development. It is imperative to mobilize education for nurse ward managers to enable them to improve leadership, management skills and to have a greater impact on policy and resource development. © 2018 International Council of Nurses.
Khalaf, Hatem; Derballa, Moataz; Elmasry, Mohammed; Khalil, Ahmed; Yakoob, Rafie; Almohannadi, Muneera; Almaslamani, Muna; Fadhil, Riadh; Al-Kaabi, Saad; Al-Ansari, Abdulla; Almaslamani, Yousuf
Beginning to do liver transplants in a developing country is challenging. We report on the first few liver transplants performed in Qatar and discuss future exceptions and challenges facing our program. The first liver transplant was performed in Qatar on December 6, 2011. Since starting the program, 4 deceased-donor liver transplants have been performed in Qatar. All recipients underwent a standard deceased-donor liver transplant procedure, which included a duct-to-duct biliary anastomosis without a veno-venous bypass. All liver transplants were performed at the Hamad Medical Corporation by a local team of surgeons without external assistance. The 4 patients were all men, with a median age of 56 years (age range, 46-63 y). Indications for liver transplant included hepatitis C cirrhosis in 2 patients, and 1 patient with hepatitis B cirrhosis with hepatocellular carcinoma, and the other patient with cryptogenic liver cirrhosis. Median amount of blood transfused was 6 units (range, 0-10 U); median time spent in the intensive care unit was 2 days (range, 2-5 d); median amount of time spent in the hospital was 10 days (range, 9-16 d). All 4 recipients have survived after a median follow-up of 438 days (range, 33-602 d) and are enjoying a healthy life, with no significant posttransplant complications. A deceased-donor liver transplant can be performed in Qatar with no external assistance. However, a severe organ shortage remains the biggest obstacle facing us. Efforts should be directed toward improving the number and quality of available deceased donors in Qatar. Meanwhile, live-donor liver transplant may be the only way for us, going forward, to prevent deaths on the waiting list.
Ingrid L. Potgieter
Full Text Available Orientation: South Africa has faced a number of discriminatory practices in the past. Most of these practices are still present today. Although a considerate amount of attention has been given to discrimination based on gender, race and religion, limited emphasis has been placed on discrimination based on disability, specifically within the workplace. Research purpose: The objective of the study was to explore the perceptions of individuals living with a disability with regards to career advancement challenges they face in the South African workplace. Motivation for study: The research literature shows that irrespective of employment equity legislation, employees with disabilities have restricted opportunities to advance in their careers. Research is needed to assist these employees with their career development. Research design, approach and method: A qualitative research design with an exploratory approach was followed. Probability, purposeful and snowballing sampling techniques were applied in this study on 15 employed individuals with declared disabilities. The data were collected by means of semi-structured interviews and the verbatim transcriptions were analysed by content analysis. Main findings/results: The findings indicated that people with disabilities generally experience career advancement challenges and reach career plateau. Managers and colleagues’ lack of knowledge about disability has an adverse impact on the careers of people living with a disability. The study found that human resource practices, especially promotion opportunities, discriminate against employees with disabilities. Furthermore, the study further indicated that there is prejudice against invisible disabilities, and as a result, employees are reluctant to declare their disability. Practical implications: Human resource practitioners and managers need to recognise the influence that disabilities have on the career advancement of individuals living with a
How do districts know if the resources they have allocated to support professional learning in their school district are actually improving the quality of teaching and impacting student performance? In an increasingly challenging financial environment, this is important to know. In this article, a Chicago-area district facing a budget deficit…
Updike, Randall G.; Ellis, Eugene G.; Page, William R.; Parker, Melanie J.; Hestbeck, Jay B.; Horak, William F.
Along the nearly 3,200 kilometers (almost 2,000 miles) of the United States–Mexican border, in an area known as the Borderlands, we are witnessing the expression of the challenges of the 21st century. This circular identifies several challenge themes and issues associated with life and the environment in the Borderlands, listed below. The challenges are not one-sided; they do not originate in one country only to become problems for the other. The issues and concerns of each challenge theme flow in both directions across the border, and both nations feel their effects throughout the Borderlands and beyond. The clear message is that our two nations, the United States and Mexico, face the issues in these challenge themes together, and the U.S. Geological Survey (USGS) understands it must work with its counterparts, partners, and customers in both countries.Though the mission of the USGS is not to serve as land manager, law enforcer, or code regulator, its innovation and creativity and the scientific and technical depth of its capabilities can be directly applied to monitoring the conditions of the landscape. The ability of USGS scientists to critically analyze the monitored data in search of signals and trends, whether they lead to negative or positive results, allows us to reach significant conclusions—from providing factual conclusions to decisionmakers, to estimating how much of a natural resource exists in a particular locale, to predicting how a natural hazard phenomenon will unfold, to forecasting on a scale from hours to millennia how ecosystems will behave.None of these challenge themes can be addressed strictly by one or two science disciplines; all require well-integrated, cross-discipline thinking, data collection, and analyses. The multidisciplinary science themes that have become the focus of the USGS mission parallel the major challenges in the border region between Mexico and the United States. Because of this multidisciplinary approach, the USGS
In 2015, a new Liberal Government came to power in Canada, elected on a platform that included legalization and regulation of cannabis for recreational purposes. Their legislation, based on recommendations from a Federal Task Force on Marijuana Legalization and Regulation, is due in early April 2017. This commentary utilizes Canadian Federal policy papers, previous literature, and internal and international agreements to examine two key areas critical to the development of a nationwide regulated market for cannabis in Canada; the need to overcome restrictions to legalizing cannabis in United Nations' drug control treaties, and the unique challenges that non-medical cannabis creates for navigating interprovincial trade policies in Canada. Irrespective of UN conventions that appear to prohibit legalization of cannabis the Government is preparing to bring forward legislation as this article goes to print. At the same time significant squabbles impede the selling of even beer and wine inter-provincially in Canada. This paper identifies the challenges facing Canadian legalization efforts, but also shows how the legalization legislation may provide opportunities to engender significant change beyond the simple legalization of a specific drug. This commentary does not argue for any specific course of action for Canada, but rather explores the nuance of legalization absent from the declaration in the Liberal party platform. The paper argues that Canada's efforts may hasten the dismantling of the UN drug control structure, and provide renewed opportunities for intern-provincial trade in Canada. Copyright © 2017 Elsevier B.V. All rights reserved.
Conceição de Maria Pinheiro Barros
Full Text Available The Professional Executive Secretary has been occupying space increasingly evident in the labor market and organizational structure, both because of market demand, the needs of dynamism in the modern administration that demonstrates the growth of the reference to it. It has sought in his field vision and attitude of performance excellence with fulfilling its role with its own characteristics. This study aims to investigate the general challenges for the Executive Secretariat professional male in contemporary organizations. We defined the following objectives: to analyze the insertion of the male in the profession of Executive Secretary and identify the challenges faced by the Executive Secretary of the males to their development and professional growth. To this end, we performed a literature search, followed by a field survey. It is a qualitative research because data collected, and then make a qualitative analysis of results from selected literature. The survey was conducted in organizations from the public and private, state of Ceará. The sample was represented by professional male graduates in the executive secretariat at the Federal University of Ceará and working in the area. After analyzing the data it was concluded that despite the obstacles to be overcome, the tendency is that these opportunities work for the professional male grow, requiring that all actors in the field to seek gender equity in the profession.
events illustrate some of the challenges facing the world of insurance following the modernisation of the international nuclear third party liability regime: - Will the insurance industry be able to find funds corresponding to the new amounts that have been set? - Do the additional damages covered by the revised conventions provide adequate cover for existing risks and will private insurance be able and willing to cover such risks? Nevertheless, the insurance world has changed a great deal since 2004 and there are many additional issues that have arisen since that time. For example, the economic crisis and the introduction of the European Solvency II Directive require insurers to take a more stringent line with their commitments. Moreover, after the Fukushima Daiichi accident, a number of questions have resurfaced: are the new insurance amounts sufficient? The age of 'nuclear renaissance' has long gone and some countries are distancing themselves from nuclear power in light of its questionable costs; are operators paying a fair price in light of the risks incurred? Finally, Europe is keen to play its part and impose its own rules; what will be the consequences of this development? This article reconsiders these challenges in light of the 2004 Protocol (which has not entered into force), by focusing in particular on the situation in Europe. Section I looks back at the history behind the conventions and the key principles they set down. Section II highlights the changes made to the Paris Convention as amended by the 2004 Protocol and the problems facing the insurance industry. Section III provides an overview of the various actors involved in the insurance industry and redefines the necessary insurance foundations to cover the challenges described in Section IV. Finally, Section IV covers all the challenges facing the insurance industry since the modernisation of the international nuclear third party liability regime. (author)
Lorenzino, Martina; Caminati, Martina; Caudek, Corrado
One of the most important questions in face perception research is to understand what information is extracted from a face in order to recognize its identity. Recognition of facial identity has been attributed to a special sensitivity to "configural" information. However, recent studies have challenged the configural account by showing that participants are poor in discriminating variations of metric distances among facial features, especially for familiar as opposed to unfamiliar faces, whereas a configural account predicts the opposite. We aimed to extend these previous results by examining classes of unfamiliar faces with which we have different levels of expertise. We hypothesized an inverse relation between sensitivity to configural information and expertise with a given class of faces, but only for neutral expressions. By first matching perceptual discriminability, we measured tolerance to subtle configural transformations with same-race (SR) versus other-race (OR) faces, and with upright versus upside-down faces. Consistently with our predictions, we found a lower sensitivity to at-threshold configural changes for SR compared to OR faces. We also found that, for our stimuli, the face inversion effect disappeared for neutral but not for emotional faces - a result that can also be attributed to a lower sensitivity to configural transformations for faces presented in a more familiar orientation. The present findings question a purely configural account of face processing and suggest that the role of spatial-relational information in face processing varies according to the functional demands of the task and to the characteristics of the stimuli. Copyright © 2018 Elsevier B.V. All rights reserved.
Rajanbir Kaur; Kanwaljit Kaur; Rajinder Kaur
Menstruation and menstrual practices still face many social, cultural, and religious restrictions which are a big barrier in the path of menstrual hygiene management. In many parts of the country especially in rural areas girls are not prepared and aware about menstruation so they face many difficulties and challenges at home, schools, and work places. While reviewing literature, we found that little, inaccurate, or incomplete knowledge about menstruation is a great hindrance in the path of p...
This article aims to "modernize" the current legal debate over inequitable public school funding at the state and local level. The 1973 Supreme Court case of "San Antonio Independent School District v. Rodriguez" established precedent, allowing for property-tax based education funding programs at the state-level--a major source…
Kampra, Matina; Tzerakis, Nikolaos; Lund Holm Thomsen, Louise; Katsarou, Efstathia; Voudris, Konstantinos; D Mastroyianni, Sotiria; Mouskou, Stella; Drossou, Kyriaki S; Siatouni, Anna; Gatzonis, Stylianos
This qualitative study explored the challenges that Greek parents/caregivers of children with controlled epilepsy (CwE) face regarding the disorder. Interviews were conducted based on open-ended questions guided by a review of the literature. A total of 91 parents/caregivers were recruited by neurologists at the neurology clinics of two Athens public hospitals. A hermeneutic phenomenological approach was used to explore parent/caregiver experiences. The data were grouped and analyzed through a textual interpretation. Two key challenges were identified for parents of CwE: the disclosure of epilepsy and the absence of adequate information about coping with epilepsy. Parents in Greece were hesitant to reveal their child's epilepsy to school staff and their wider social milieu. Also, although satisfied with the patient-centered approach they experienced with their hospital doctor, parents/caregivers found that they needed more education about the existing sources of psychosocial and emotional support to cope with their child's epilepsy personally and as a family. Finally, the parents/caregivers who let their child know about the epilepsy and discussed the implications with the child found that parent-child communication improved. This study provides valuable insight into the impact of epilepsy on parents of CwE, which might help hospital and school staff support families with greater understanding, sensitivity, and skill. The findings suggest that Greek authorities should staff hospitals and schools with experts and more systematically advertise sources of information about epilepsy and ways to cope with it. Copyright © 2017 Elsevier Inc. All rights reserved.
El-Shazly, A. K.
Small geoscience departments with 5 faculty members or less in undergraduate institutions are facing serious challenges that will have a profound impact on their future, as well as the future of geoscience education. In addition to past and future budget cuts that affect all departments, small departments are more vulnerable to such problems as (i) decreased enrollments in introductory level classes, (ii) small number of geology majors, (iii) small number of graduates per year (iv) lack or paucity of equipment necessary for faculty and student research, (v) limited opportunities for external funding, (vi) need to offer upper division classes on an alternate year basis, (vii) difficulty in recruiting and retaining students, (viii) high teaching loads for faculty, and (ix) designing rigorous curricula based on 120 credit hours with a significant component of liberal art classes. These problems pose new challenges for faculty, department chairs and administrators. Faculty need to design curricula tailored to the need of the job market, without compromising rigor or the quality of the program. New classes/ concentrations in environmental science, hydrogeology and geographical information systems should be offered, and traditional classes in petrology, geophysics and tectonics should be maintained. Classes in Physics, Chemistry and Math should be core requirements. Student involvement in research should be encouraged at an early stage (sophomore/ junior levels). Department chairs need to assign duties in their department carefully to capitalize on the strengths of their faculty: faculty with strong research backgrounds should be helped in their efforts to pursue external funding opportunities, whereas those with strong teaching abilities should be evaluated primarily on their performance in the classroom. Student credit hour production should not be used as a criterion for evaluating faculty. Administrators should evaluate programs and departments based on the success
Mburu, Grace; George, Gavin
Shortages of Human Resources for Health (HRH) in rural areas are often driven by poor working and living conditions, inadequate salaries and benefits, lack of training and career development opportunities amongst others. The South African government has adopted a human resource strategy for the health sector in 2011 aimed at addressing these challenges. This study reviews the challenges faced by health personnel against government strategies aimed at attracting and retaining health personnel in these underserved areas. The study was conducted in six primary health care service sites in the Hlabisa sub-district of Umkhanyakude, located in northern KwaZulu-Natal, South Africa. The study population comprised 25 health workers including 11 professional nurses, 4 staff nurses and 10 doctors (4 medical doctors, 3 foreign medical doctors and 3 doctors undertaking community service). Qualitative data were collected from semi-structured interviews and analysed using thematic analysis. Government initiatives including the rural allowance, deployment of foreign medical doctors and the presence of health personnel undertaking their community service in rural areas are positively viewed by health personnel working in rural health facilities. However, poor living and working conditions, together with inadequate personal development opportunities, remain unresolved challenges. It is these challenges that will continue to dissuade experienced health personnel from remaining in these underserved areas. South Africa's HRH strategy for the Health Sector 2012/13-2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised.
The challenges that face the forest industry in achieving sustainable development are reviewed. Sustainable development is not the same as sustained yield forest management. While sustained yield limits harvesting to an estimate of a forest's incremental annual growth, it is a policy which neither takes into account how improved forest management practices can increase future growth rates nor gives guidance on how multiple uses for the forest resource can be made compatible with periodic harvesting of that resource. Forests, in addition to meeting demands for timber production, must also meet demands for watershed management, recreation, preservation of wildlife and genetic diversity, moderation of climates, carbon sequestration, and land reclamation. Information is lacking from which to develop improved forest management programs that take these demands into account. Questions remain about such matters as the role of plantations in sustainable forestry and the maintenance of natural diversity. Some recent research being undertaken to generate better information for future forestry decision making is outlined, including work on gene pool maintenance, the interdependence of forest ecology and climate, the symbiotic role of mycorrhiza, forest fertilization, and the interdependence of sustainable forestry and sustainable fisheries. In the forest products industry, engineered wood products have been developed that meet tight specifications and require less raw material, and process changes have been introduced that greatly reduce pollutants from pulp manufacture
Drawing on an in-depth analysis of eight global health networks, a recent essay in this journal argued that global health networks face four challenges to their effectiveness: problem definition, positioning, coalition-building, and governance. While sharing the argument of the essay concerned, in this commentary, we argue that these analytical concepts can be used to explicate a concept that has implicitly been used in global health governance scholarship for quite a few years. While already prominent in the discussion of climate change governance, for instance, global health governance scholarship could make progress by looking at global health governance as being polycentric. Concisely, polycentric forms of governance mix scales, mechanisms, and actors. Drawing on the essay, we propose a polycentric approach to the study of global health governance that incorporates coalitionbuilding tactics, internal governance and global political priority as explanatory factors. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Full Text Available This study presents an empirical investigation to study the post-war tourism in sought west region of Iran. This region is the host of many Iranian who wish remember the events of War between Iran and Iraq. Many high school or university students travel to the region through cultural as well as religious communities. This paper tries to analyze the challenges facing these people when they travel to province of Khozestan, Iran. The study designs a questionnaire in Likert scale and distributes it among some randomly selected people who visited the region. The implementation of Pearson correlation test has determined that “Weakness of tourism infrastructure facilities and services” is to be blamed the most followed by “Underdevelopment of decision making centers”. Moreover, path analysis has been implemented to detect direct and indirect effects of different factors on development of tourism in the region. In our survey, marketing, culture and weakness in infrastructures have been determined the most important factors influencing on development of the region.
Full Text Available Selena R Levine,1 Jennifer L McNeer,2 Michael S Isakoff1 1Center for Cancer and Blood Disorders, Connecticut Children’s Medical Center and University of Connecticut School of Medicine, Hartford, CT, 2Section of Pediatric Hematology/Oncology, University of Chicago Comer Children's Hospital, Chicago, IL, USA Abstract: The survival rate for children with acute lymphoblastic leukemia (ALL has dramatically improved over the last 50 years. However, for those in the adolescent and young adult (AYA age-group of 15–30 years with ALL, there has not been the same degree of improvement. Historically, pediatric and adult providers have utilized different treatment approaches based on clinical trials. However, studies that have compared the outcome of AYA patients with ALL treated on pediatric or adult clinical trials have generally shown substantially better outcomes for this patient population treated with the pediatric trials. Additionally, hematopoietic stem cell transplantation has been considered as part of intensified therapy for AYA patients with ALL. Herein, we review the outcomes with chemotherapy alone and with hematopoietic stem cell transplantation, and explore the challenges faced in determining the ideal therapy for the AYA population of patients. Keywords: adolescent young adult oncology, leukemia, hematopoietic stem cell transplantation
Hassan-Bitar, Sahar; Narrainen, Sheila
to explore the challenges and barriers faced by Palestinian maternal health-care providers (HCPs) to the provision of quality maternal health-care services through a case study of a Palestinian public referral hospital in the Occupied Palestinian Territory. descriptive qualitative study. The data are from a broader study, conducted in 2005 at the same hospital as part of a baseline assessment of maternal health services. 31 maternal HCPs; nine midwives and 14 nurses and eight doctors. the quality of care provided for women and infants at this Palestinian public hospital is substandard. The maternal HCPs work within a difficult and resource-constrained environment. ISSUES INCLUDE: high workload, poor compensation, humiliation in the workplace, suboptimal supervision and the absence of professional support and guidance. Midwives are perceived to be at the bottom of the health professional hierarchy. there is a need for managers and policy makers to enable maternal HCPs to provide better quality care for women and infants during childbirth, through facilitating the roles of midwives and nurses and creating a more positive and resourceful environment. Palestinian midwives need to increase their knowledge and use evidence-based practices during childbirth. They need to unite and create their own circle of professional support in the form of a Palestinian midwifery professional body. Copyright © 2009 Elsevier Ltd. All rights reserved.
Professional guidelines have addressed ethical dilemmas posed by a few types of nontraditional procreative arrangements (e.g., gamete donations between family members), but many questions arise regarding how providers view and make decisions about these and other such arrangements. Thirty-seven ART providers and 10 patients were interviewed in-depth for approximately 1 h each. Interviews were systematically analyzed. Providers faced a range of challenges and ethical dilemmas concerning both the content and the process of decisions about requests for unconventional interfamilial and other reproductive combinations. Providers vary in how they respond - what they decide, who exactly decides (e.g., an ethics committee or not), and how - often undergoing complex decision-making processes. These combinations can involve creating or raising the child, and can shift over time - from initial ART treatment through to the child's birth. Patients' requests can vary from fully established to mere possibilities. Arrangements may also be unstable, fluid, or unexpected, posing challenges. Difficulties emerge concerning not only familial but social, combinations (e.g., between friends). These arrangements can involve blurry and confusing roles, questions about the welfare of the unborn child, and unanticipated and unfamiliar questions about how to weigh competing moral and scientific concerns - e.g., the autonomy of the individuals involved, and the potential risks and benefits. Clinicians may feel that these requests do not "smell right"; and at first respond with feelings of "yuck," and only later, carefully and explicitly consider the ethical principles involved. Proposed arrangements may, for instance, initially be felt to involve consanguineous individuals, but not in fact do so. Obtaining and verifying full and appropriate informed consent can be difficult, given implicit familial and/or cultural expectations and senses of duty. Social attitudes are changing, yet patients
Mphemelang J. Ketlhoilwe
Full Text Available Access to energy is a challenge to rural communities, especially among women who are the prime household energy users. This article is based on research carried out in the Tswapong villages in Botswana where energy sources particularly wood, are slowly getting depleted while electricity connection costs remain unaffordable for the poor. The article provides constructivist analysis of experiences in real-life situations among women. Data were generated through observations, documents analysis, interviews and focus group discussions. It has emerged from the research that majority of the respondents use firewood as energy source. Firewood and gas are mainly used for cooking while electricity is mainly used for lighting. The demand for firewood has led to firewood commercialisation, the depletion of preferred firewood tree species and increase in the impact of climate change. The article recommends economic diversification and subsidies to empower the majority of the rural poor to connect to the national electric grid and reduce on firewood dependence. These could be complemented by harnessing of solar energy and low-cost, energy-saving technologies. Subsidies to enable women access to energy services would contribute immensely to the decade of Sustainable Energy for All and to the attainment of the post 2015 sustainable development goal on energy.
Magalhães-Sant'Ana, Manuel; More, Simon J; Morton, David B; Hanlon, Alison J
Veterinarians are faced with significant conflicts of interest when issuing certificates for the transport and slaughter of acutely injured and casualty livestock. In a recent Policy Delphi study, emergency and casualty slaughter certification was a key concern identified by veterinary professionals in Ireland. In this case study (the third in a series of three resulting from a research workshop exploring challenges facing the veterinary profession in Ireland; the other two case studies investigate clinical veterinary services and the on-farm use of veterinary antimicrobials), we aim to provide a value-based reflection on the constraints and opportunities for best practice in emergency and casualty slaughter certification in Ireland. Using a qualitative focus group approach, this study gathered evidence from relevant stakeholders, namely a representative from the regulatory body, local authority veterinarians with research experience in emergency slaughter, an animal welfare research scientist, official veterinarians from the competent authority, a private veterinary practitioner, and a member of a farming organisation. Results revealed a conflict between the responsibility of private veterinary practitioners (PVPs) to safeguard the welfare of acutely injured bovines on-farm and the client's commercial concerns. As a consequence, some PVPs may feel under pressure to certify, for example, an acutely injured animal for casualty slaughter instead of recommending either on-farm emergency slaughter or disposal by the knackery service. Among Official Veterinarians, there are concerns about the pressure within processing plants to accept acutely injured livestock as casualty animals. Confusion pertaining to legislation and definition of fitness to travel also contribute to these dilemmas. Conflicts of interest arise due to the gap between governance and provision to facilitate on-farm emergency slaughter of livestock. Increased availability and acceptance of on
In this article I highlight the challenges facing a law lecturer in a multicultural society in transformation where the student is being prepared to serve society in different occupational fields as a professional person. I indicate that the law itself cannot effect change. For this we need properly trained lawyers. For an effective transformation…
Conclusion: The government, in partnership with other stakeholders, should address challenges faced by women with disabilities when accessing sexual and reproductive health services. Non-government, private hospitals and profit-making organisations should join hands with government in funding health requirements for women with disabilities.
Morake, Nnior Machomi; Monobe, Ratau John; Dingwe, Stephonia
The purpose of this study was to examine the challenges facing managers in managing conflict in schools of South and South Central Regions of Botswana. In this study, the schedule of interview was used to collect empirical data. A random sample of 50 school managers and deputy school managers was selected for interviews. Major findings of the…
De Lisle, Jerome; Seunarinesingh, Krishna; Mohammed, Rhoda; Lee-Piggott, Rinnelle
In this study, methodology and theory were linked to explicate the nature of education practice within schools facing exceptionally challenging circumstances (SFECC) in Trinidad and Tobago. The research design was an iterative quan>QUAL-quan>qual multi-method research programme, consisting of 3 independent projects linked together by overall…
Victoire Lejzerzon; Sauron, Claire; Villot, Marie; Ratzbor, Guenter; Tausch, Christian; Cagneaux, Bertrand; Jouneau, Agathe; Stemmer, Boris; Huebner, Gundula; Orozco-Souel, Paola; Lhermitte, Charles; Ferus, Elisabeth; Benezech, Philippe; Gunzelmann, Thomas
The French-German office for Renewable energies (OFAEnR) organised a conference on n wind power development in the face of landscape and local project acceptability challenges. In the framework of this French-German exchange of experience, participants addressed the following points: the conciliation between landscape protection and wind power development, the definition of landscape environmental quality criteria, the needs and usages of the departments in charge of the treatment of landscape studies in France, the socio-psychological approach of the local acceptability of wind farm projects, the re-powering tool for the improvement of the wind farm integration in the landscape, and the conciliation between the monuments maintenance and wind power development. This document brings together the available presentations (slides) made during this event: 1 - Conciliating landscape protection and wind power development goals in France (Marie Villot); 2 - Wind turbines: Conflicts between development goals, landscape and acceptance - Perception and criteria (Guenter Ratzbor); 3 - Bayern's wind power atlas: a planning tool which takes into account the landscape aspects (Christian Tausch); 4 - Landscape assessment in wind farms projects: what and how to do in French administrative procedures? (Bertrand Cagneaux); 5 - Methods for evaluation of landscape for wind farms projects - A French project developer's feedback (Agathe Jouneau); 6 - Landscape Assessment: Methods from German Landscape Practice (Boris Stemmer); 7 - Acceptance of Wind Turbines - Social Psychological Research (Gundula Huebner); 8 - Local consultation: who to involve, when and how? (Paola Orozco-Souel); 9 - Local acceptability: what dialogue concepts and strategies, and how to manage wind energy objection (Charles Lhermitte); 10 - Re-powering and landscape: chances and limits (Elisabeth Ferus); 11 - Wind power and cultural heritage: consultation and dialogue to succeed (Philippe Benezech); 12
Full Text Available According to the 2010 UNAIDS Report, an estimated 320 000 (or 20% fewer people died of AIDS-related causes in 2009 when compared to figures in 2004 in sub-Saharan Africa, when antiretroviral therapy was markedly expanded (UNAIDS, 2010. This decreased mortality rate offers hope for HIV-infected people to plan a future, part of which will include dating and sexual relationships. The Report cites KwaZulu-Natal in South Africa as being at the heart of the HIV/AIDS epidemic; this article is based on research on dating and sexuality among HIV-positive people in KwaZulu-Natal. Dating and sexuality are an integral part of living. Yet HIV-positive persons are denied intimacy at a time when this is most needed (Kasiram in Kasiram, Partab & Dano, 2006. Little is known about the full range of sexual adaptations that HIV-infected individuals choose (Schiltz & Sandfort, 2000. Kasiram, Partab, Dano and Van Greunen (2003:9 cite interaction and intimacy among HIV-positive persons as a neglected research focus, while Painter (2001 adds that insufficient attention is afforded to couple relationships for infected people. An important reason that motivated this study on dating and sexual challenges faced by HIV-positive people was the first author’s (the main researcher’s personal experience of being HIV positive and counselling and life coaching HIV-positive people. She is confronted regularly with variations of the question “Will I be normal?”, which often translates to: “Will I be able to date and have sex.
Full Text Available Eliminating child labour is one of the biggest challenges that the world is facing. Child labour not only causes damage to a child’s physical and mental health but also keeps him deprived of his basic rights to education, development, and freedom. Children of lower socio-economic class are known to be inducted as child labour. The main causes of child labour include poverty, unemployment, excess population and urbanization. The construction sector is one of the most hazardous working environments especially for children. Children are exposed to dangerous machinery causing fatal and non-fatal injuries, while operating or working near them. Children are exposed to strenuous labour, which can affect the musculo-skeletal development of the children. In industries, child workers are exposed to various physical, mental, social occupational hazards resulting in lower growth and poor health status. Working long hours, child labourers are often denied a basic school education, normal social interaction, personal development and emotional support from their family. The Child Labour Act was implemented in India in 1986 that outlaws child labour in certain areas and sets the minimum age of employment at fourteen. Eradicating poverty is only the first step on the road for eliminating child labour. There is an urgent need for intensive focus and research along with political and practical decisions to improve the conditions of working children for the betterment of their health and development. Proper education of the children and banning child labor will help in boosting the success of the country.
Temtime, Zelealem T.; Mmereki, Rebana N.
Purpose: The purpose of this paper is to examine the degree of satisfaction and perceived relevance of the Graduate Business Education (GBE) programme at the University of Botswana. Design/methodology/approach: A self-administered questionnaire and face to face interviews were used to collect data from Master of Business Administration (MBA)…
Amenu, Kebede; Markemann, André; Roessler, Regina; Siegmund-Schultze, Marianna; Abebe, Girma; Valle Zárate, Anne
Compared to the total water use in livestock production systems, water for livestock drinking is small in amount but is an important requirement for health and productivity of animals. This study was carried out to assess constraints and challenges of meeting drinking water requirements of livestock in rural mixed smallholder crop-livestock farming districts in the Ethiopian Rift Valley area. Data was collected by individual interviews with randomly selected respondents and farmer group discussions. Farmers ranked feed and water scarcity as the two most important constraints for livestock husbandry, although the ranking order differed between districts and villages. Poor quality water was a concern for the communities in proximity to urban settlements or industrial establishments. Water provision for livestock was challenging during the dry season, since alternative water sources dried up or were polluted. Though rainwater harvesting by dugout constructions was practiced to cope with water scarcity, farmers indicated that mismanagement of the harvested water was posing health risks on both livestock and people. A sustainable water provision for livestock in the area, thus, depends on use of different water sources (intermittent or perennial) that should be properly managed. Industrial establishments should adopt an environment-friendly production to minimize pollution of water resources used for livestock consumption. Technical support to farmers is required in proper design and use of existing rainwater harvesting systems. Further investigations are recommended on effect of poor quality water (perceived by farmers) on performance of livestock.
Acosta, Gabriela M.; Arnaud, Marta I.; Cesario, Pablo A.
The Nuclear Regulatory Authority of Argentina (ARN) is an autonomous body reporting to the Presidency of Argentina, empowered to regulate and control the nuclear activity with regards to radiation and nuclear safety, physical protection and nuclear non-proliferation issues. Under the executive decree 1172/2003, which makes reference to the accessibility of public information to increase transparency of government actions and specially to promote public involvement, ARN has the legal obligation to inform of its activities in an accurate, comprehensive and understandable manner. The re-launching of the nuclear plan in 2006 and the repercussions this provoked on society highlighted the need to reinforce the legitimacy of the regulatory role and the promotion of confidence on its works to ensure the safety of the people. Therefore it was considered necessary to involve the society further in this programme by achieving greater public understanding and awareness of the nuclear regulatory activities. The more the public is conscious of the role of the regulator, conceiving it as a trustworthy and autonomous authority, the easier it is for the regulator to fulfil its obligations. As ARN has a strong commitment with society and considering that communication with the general public, as an external stakeholder, is a means to establishing and maintaining public trust and confidence, the implementation of a new communication programme became a key issue. In this scenario, ARN faced a challenge it was not prepared to handle and thus created a Division to deal with institutional communication and allow and ease the interaction with society. Within this Division, one of the methods chosen to achieve a better interaction with society was the use of a technological tool to attend possible inquiries, increasing and facilitating a greater involvement of the stakeholders. With this in mind a 'Mail-Info' was established because it allows a fast, accessible, easy and informal way of
Acosta, Gabriela M.; Arnaud, Marta I.; Cesario, Pablo A. [Nuclear Affairs and Institutional Communication Department, Autoridad Regulatoria Nuclear, Av. del Libertador 8250, C1429BNP (Argentina)
The Nuclear Regulatory Authority of Argentina (ARN) is an autonomous body reporting to the Presidency of Argentina, empowered to regulate and control the nuclear activity with regards to radiation and nuclear safety, physical protection and nuclear non-proliferation issues. Under the executive decree 1172/2003, which makes reference to the accessibility of public information to increase transparency of government actions and specially to promote public involvement, ARN has the legal obligation to inform of its activities in an accurate, comprehensive and understandable manner. The re-launching of the nuclear plan in 2006 and the repercussions this provoked on society highlighted the need to reinforce the legitimacy of the regulatory role and the promotion of confidence on its works to ensure the safety of the people. Therefore it was considered necessary to involve the society further in this programme by achieving greater public understanding and awareness of the nuclear regulatory activities. The more the public is conscious of the role of the regulator, conceiving it as a trustworthy and autonomous authority, the easier it is for the regulator to fulfil its obligations. As ARN has a strong commitment with society and considering that communication with the general public, as an external stakeholder, is a means to establishing and maintaining public trust and confidence, the implementation of a new communication programme became a key issue. In this scenario, ARN faced a challenge it was not prepared to handle and thus created a Division to deal with institutional communication and allow and ease the interaction with society. Within this Division, one of the methods chosen to achieve a better interaction with society was the use of a technological tool to attend possible inquiries, increasing and facilitating a greater involvement of the stakeholders. With this in mind a 'Mail-Info' was established because it allows a fast, accessible, easy and informal
Abd El Aziz Mohi El Din, Ehab Mohamed Farouk
Securing energy demand for next generations is one of the most challenges aspects facing any sustained development plans, due to the growing electric energy demand and Egypt as a country of limited fossil fuel resources has to diversify its energy portfolio by utilization of its renewable energy resources, mainly wind due to its economic potential and solar as proved by Egypt's wind and solar atlases. In the year 2009/2010, the total installed capacity in Egypt was 24726 MW with electricity generation 139,000 GWh, of which 89 % was delivered by thermal plants and about 10% from Hydro power with total installed 2800 MW and electricity generated is about 12863 GWh and 1% from Wind energy with total installed 550 MW and electricity generated 1542 GWh. In the solar energy field, the first solar thermal power plant of 140 MW with a solar share of 20 MW using parabolic trough technology was started the initial work since the 1 st of July with estimated total energy generated of 852GWh/year. Recently, Egypt has adopted an ambitious plan to cover 20% of the generated electricity by renewable energy by 2020, including a 12% contribution from wind energy, translating more than 7200 MW grid-connected wind farms. Such plan gives a room enough to the private investment to play the major role in realizing this goal. The plan includes also a 100 MW Solar thermal energy CSP with parabolic trough technology in Kom Ombo city, and also two PV plants in Hurgada and Kom Ombo with a total installed capacity 20 MW each. Due to the high investment cost of solar energy technologies, still limited in spread all over the world on the other hand wind energy has an economic potential and becomes a commercial technology but the future potential for solar energy due to the limited land for wind energy. Current study will evaluate the Egyptian strategy for renewable energy up to 2020 and find how much the planned projects from the Egyptian government will fulfill its target, the economic study
Full Text Available shown very little interest in the increasingly severe freight transport problems facing urban areas, there is now growing interest in the logistics of collection and delivery services in towns and city centres....
Tomola M Obamuyi
Full Text Available This paper examines the Nigerian economy and the tendency for its growth in the face of several socio-political challenges facing the country, which have hampered the rate of economic development in spite of the tremendous human and material resources inherent. The paper identifies the socio-political challenges to include corruption, poverty, unemployment, insecurity, politics and governance, among others. The central argument of the paper is that steady economic growth can be achieved and financial crisis mitigated in Nigeria, if the effects of socio-political challenges, which are the key factors that have contributed to the high poverty, unemployment and economic instability in the country, are minimised. To ensure economic growth and move the country forward politically and economically, government must be more accountable in managing the nation’s resources in order to avoid wastage, poverty and unemployment. Close attention should be given to those socio-political challenges in the formulation of policies that aimed at maintaining economic growth at a level commensurate with the country’s growth rate. This study put forward that government must be proactive in all issues relating to the socio-political challenges to prevent resource mismanagement, poverty, unemployment, insecurity and slow economic growth in future.
Rozenveld, Marc; Heinonen, Tapio
Date: June 7th of 2013 Level: Master thesis in marketing, 15 ECTS Institution: School of Business, Society and Engineering, Mälardalen University Authors: Tapio Heinonen & Marc Rozenveld 18 thof November 1988 & 16th of June 1990 Title: Challenges facing the advertising world in the digital era. Subtitle: A comparison between Dutch and Swedish advertising agencies. Tutor: Peter Selegård Keywords: media logic, advertising industry, advertising agencies, advertising and digital ma...
The proceedings of the IGT national conference on meeting the challenges of the New Energy Industry: The driving forces facing Electric Power Generators and the Natural Gas Industry are presented. The conference was held June 19-21, 1995 at the Ambassador West Hotel in Downtown Chicago, Illinois. A separate abstract and indexing for each of the 18 papers presented for inclusion in the Energy Science and Technology Database.
The proceedings of the IGT national conference on meeting the challenges of the New Energy Industry: The driving forces facing Electric Power Generators and the Natural Gas Industry are presented. The conference was held June 19-21, 1995 at the Ambassador West Hotel in Downtown Chicago, Illinois. A separate abstract and indexing for each of the 18 papers presented for inclusion in the Energy Science and Technology Database
Sanders, Jet Gabrielle; Ueda, Yoshiyuki; Minemoto, Kazusa; Noyes, Eilidh; Yoshikawa, Sakiko; Jenkins, Rob
We often identify people using face images. This is true in occupational settings such as passport control as well as in everyday social environments. Mapping between images and identities assumes that facial appearance is stable within certain bounds. For example, a person's apparent age, gender and ethnicity change slowly, if at all. It also assumes that deliberate changes beyond these bounds (i.e., disguises) would be easy to spot. Hyper-realistic face masks overturn these assumptions by allowing the wearer to look like an entirely different person. If unnoticed, these masks break the link between facial appearance and personal identity, with clear implications for applied face recognition. However, to date, no one has assessed the realism of these masks, or specified conditions under which they may be accepted as real faces. Herein, we examined incidental detection of unexpected but attended hyper-realistic masks in both photographic and live presentations. Experiment 1 (UK; n = 60) revealed no evidence for overt detection of hyper-realistic masks among real face photos, and little evidence of covert detection. Experiment 2 (Japan; n = 60) extended these findings to different masks, mask-wearers and participant pools. In Experiment 3 (UK and Japan; n = 407), passers-by failed to notice that a live confederate was wearing a hyper-realistic mask and showed limited evidence of covert detection, even at close viewing distance (5 vs. 20 m). Across all of these studies, viewers accepted hyper-realistic masks as real faces. Specific countermeasures will be required if detection rates are to be improved.
Denvil, Sébastien; Dufresne, Jean-Louis; Salas, David; Meurdesoif, Yann; Valcke, Sophie; Caubel, Arnaud; Foujols, Marie-Alice; Servonnat, Jérôme; Sénési, Stéphane; Derouillat, Julien; Voury, Pascal
The presentation will introduce a french national project : CONVERGENCE that has been funded for four years. This project will tackle big data and computational challenges faced by climate modeling community in HPC context. Model simulations are central to the study of complex mechanisms and feedbacks in the climate system and to provide estimates of future and past climate changes. Recent trends in climate modelling are to add more physical components in the modelled system, increasing the resolution of each individual component and the more systematic use of large suites of simulations to address many scientific questions. Climate simulations may therefore differ in their initial state, parameter values, representation of physical processes, spatial resolution, model complexity, and degree of realism or degree of idealisation. In addition, there is a strong need for evaluating, improving and monitoring the performance of climate models using a large ensemble of diagnostics and better integration of model outputs and observational data. High performance computing is currently reaching the exascale and has the potential to produce this exponential increase of size and numbers of simulations. However, post-processing, analysis, and exploration of the generated data have stalled and there is a strong need for new tools to cope with the growing size and complexity of the underlying simulations and datasets. Exascale simulations require new scalable software tools to generate, manage and mine those simulations ,and data to extract the relevant information and to take the correct decision. The primary purpose of this project is to develop a platform capable of running large ensembles of simulations with a suite of models, to handle the complex and voluminous datasets generated, to facilitate the evaluation and validation of the models and the use of higher resolution models. We propose to gather interdisciplinary skills to design, using a component-based approach, a
Full Text Available In the paper, divided into two parts, a problem of advancements in maritime education and research facing the 21st century challenges, based on the case study of the Gdynia Maritime University (GMU experience is discussed. Part I is devoted to the main directions of advances in the maritime education and research towards the challenges in a global meaning. In this context, the education and research potential of the Gdynia Maritime University, as one of the world-leading maritime universities, is shortly presented. Part II is dedicated to the Gdynia Maritime University experiencing the 21st century challenges. The GMU’s contribution and good practices concerning the participation in modification of the processes of the IMO STCW 78/2010 convention, adoption of programmes into the international and national qualification frameworks’ standards and procedures, as well as the development of research addressed to a new technological and organizational solution are described and analyzed.
The recruitment of international academic staff is viewed as one of the strategies to internationalise the universities. International academic staff, however, usually encounter many challenges when in a foreign context. This study aims to investigate the challenges of Chinese academic staff teaching in the UK in terms of language, relationships…
Ravichandran, Swathi; Kretovics, Mark; Kirby, Kara; Ghosh, Ankita
Since 2000, there has been a 72% increase in the number of international students attending US institutions of higher education. The increase, specifically of international graduate students, has brought to light the writing challenges experienced by this population of students. This study explored specific writing challenges experienced by…
Writing at the doctoral level presents many challenges for second language writers. This paper reports on a longitudinal study investigating English as a second language (ESL) doctoral students' writing problems and the strategies they developed to meet these challenges. Eight students were interviewed four times over a two-year period during…
Tanksley, James F.
The United States public education system is facing a possible shortage of several hundred thousand teachers over the next decade. To overcome the projected shortfall in teacher supply, schools of education of state university and college systems may need to look to the fastest growing segment of the college student population, the non-traditional…
In trying to understand some of the gendered discourses that shape the management of schools as organisations in South Africa, I analyse woman principals' experiences as they try to navigate a balance between their home and work responsibilities. After their appointment as principals, some South African women face difficulties in striking the…
Full Text Available This original research confronted challenges to environmental management and sustainability posed by veld fires in the Bulilima and Mangwe Districts of Matabeleland in the South Province in southern Zimbabwe. Veld fires have affected the fauna and flora, polluted air and water, and destroyed livelihoods. The study aimed at establishing challenges to environmental sustainability posed by veld fires, identifying the type of environment upon which veld fires have impacted, analysing legal issues and other interventions surrounding the control of veld fires and suggesting new control measures for veld fires. A qualitative research design and quota sampling were used. The study involved 30 participants. Data was collected through a questionnaire, an interview guide and participant observation. Challenges to environmental management and sustainability posed by veld fires include property damage, reduced soil fertility, destruction of vegetation, air and water pollution and destruction of wildlife. Most veld fires are a result of human actions that emanate from the disposal of cigarettes, the burning of vegetation when preparing fields, the use of fire by hunters, smoking out bees and the making of fires by motorists along highways. The government should consider reviewing the current environmental statues. Fireguards should be wide enough to lessen veld-fire impact. Lastly, veld-fire campaigns and rehearsals should be run on a regular basis. It is hoped that this work would make a significant contribution through improving the current thinking about environmental management and sustainability, thereby benefiting policy makers, practitioners and stakeholders.
A new superintendent in a new school district (NSND) can be a challenging position. The literature review asserts that many challenges faced by NSNDs are due to the absence of a shared vision. Challenges can be listed as work stoppage, personnel, financial, fighting ghosts, homecoming procession and many other aspects of running a district.…
O'Toole, Stephanie; Lambert, Veronica; Gallagher, Pamela; Shahwan, Amre; Austin, Joan K
The aim of this qualitative study was to explore the challenges that parents of children with epilepsy experienced when engaging in dialog with their child about epilepsy and epilepsy-related issues. Using a qualitative exploratory approach, interviews were conducted with 34 parents of children with epilepsy (aged 6-16 years), consisting of 27 mothers and 7 fathers. Data were transcribed verbatim and thematically analyzed. Findings revealed five main themes: normalizing epilepsy, the invisibility of epilepsy, information concealment, fear of misinforming the child, and difficulty in discussing particular epilepsy-related issues. Many of the communicative challenges experienced by parents impacted on their ability to engage openly in parent-child dialog about epilepsy in the home. Parents face specific challenges when choosing to communicate with their child about epilepsy, relating to creating a sense of normality, reducing fear of causing their child worry, and having a lack of epilepsy-related knowledge. Healthcare professionals who work closely with families living with epilepsy should remain mindful of the importance of discussing family communication surrounding epilepsy and the challenges parents of children with epilepsy face when talking about epilepsy within the home. Copyright © 2016 Elsevier Inc. All rights reserved.
Maria Adriana Rangel
Full Text Available The authors present a case report of antituberculosis drug-induced liver injury that offered diagnostic challenges (namely, the possibility of drug-induced autoimmune hepatitis and treatment difficulties.
Walubita, Mulima; Sikateyo, Bornwell; Zulu, Joseph M
Zambia is experiencing high prevalence of childhood cancer. However, very few children access and complete treatment for cancer. This study aimed to document the challenges for health care providers, parents and patients who face a child hood cancer diagnosis in Zambia, and their coping strategies. This was an exploratory health facility-based qualitative study that was conducted at a Paediatric oncology ward at referral hospital in Zambia. In-depth individual interviews conducted with fifteen (15) caregivers and seven (7) key informants were analysed using thematic analysis. Several challenges related to managing the childhood cancer diagnosis were recorded. Individual and family challenges were inadequate knowledge on childhood cancer, lack of finances to meet treatment and transport costs as well as long period of hospitalisation that affected women's ability to perform multiple responsibilities. Whereas challenges at community level were inadequate support to address emotional and physical distress and social stigmatisation experienced by caregivers. Health systems issues included inadequate specialised health workers, poor communication among health workers, limited space and beds as well as insufficient supplies such as blood. Cultural related factors were the belief that cancer is a product of witchcraft as well as religious beliefs regarding the role of faith healing in childhood cancer treatment. Coping strategies used by parents/ caregivers included praying to God, material support from organisations and church as well as delaying having another child. Addressing the challenges for health care providers, parents and patients who face a childhood cancer diagnosis may require adopting a systems or an ecological approach that allows developing strategies that simultaneously address challenges related to the individual, family, community, health system and cultural aspects.
Hansen, Zaza Nadja Lee; Jacobsen, Peter
This paper investigates the challenges in the food industry, illustrated by a case study from the baked goods sector in Denmark. The paper proposes key elements this sector needs to address in order to limit waste, improve productivity and increase profitability.......This paper investigates the challenges in the food industry, illustrated by a case study from the baked goods sector in Denmark. The paper proposes key elements this sector needs to address in order to limit waste, improve productivity and increase profitability....
Conclusion: The researchers concluded that the participants in this study experience a range of challenges in parenting their children with learning disabilities. The main challenges emanate from financial instability, as well as lack of knowledge regarding services and programmes for children with learning disabilities. This lack of knowledge on the part of participants could indicate poor policy education by policy implementers at grass-roots level.
Godfrey, Linda K
Full Text Available and Tourism (DEAT, 2007) highlighted the obstacles that are faced by local government in achieving service delivery for waste. The three identified obstacles included Financial Capacity; Institutional Capacity; Technical Capacity. 2 Opportunity cost... the systems diagrams show (Figure 2), is that without intervention by national government departments, e.g. National Treasury, Department of Provincial and Local Government, or Department of Environmental Affairs and Tourism, municipalities will be unable...
and compare the operational effectiveness and life cycle costs of potential solutions. This testimony is based on a report GAO issued in March...Technology, House of Representatives For Release on Delivery Expected at 10 a.m. ET Thursday, July 7, 2016 GAO-16-769T United States...Environment, Committee on Science, Space, and Technology, House of Representatives July 2016 DEFENSE WEATHER SATELLITES DOD Faces Acquisition
Museums are part of a wider cultural and entertainment environment, which is ruled by highly demanding visitors who seek immersive experiences (edutainment) and time-saving arrangement. This has encouraged and, in some opinions, forced museums to turn their focus from collections to visitors. In addition, museums have faced competition and new technologies in the form of virtual museums and virtual reality. This has emphasized the need to accept marketing as a survival tool and to make it int...
Farrell, Gerald A; Shafiei, Touran; Salmon, Peter
This paper draws on theory and evidence to develop a conceptual staff training model for the management of 'challenging behaviour'. Staff working with clients who are experienced as challenging commonly report negative feelings such as anxiety, anger, guilt, fear, self-blame and powerlessness, as well as dissatisfaction with their jobs. Current training programmes in challenging behaviour offer a 'smorgasbord' of content, without a clearly defined conceptual framework. Medline and PsychInfo were searched for papers in English from 1998 to 2008, linking 'nurs*' to 'challenging behavio*' and its related terms. Additional hand-searching identified informative papers from disciplines outside nursing older than the search period. We developed an applied model for training educators in respect of challenging behaviours. The model directs educators to consider: the influence of the nurse, including their values, emotional processes and behavioural skills; features of the client; and features of the situation in which the behaviour occurs, including its culture and working practices and physical environment. The most striking implication of the model is that it explicitly recognizes the importance of domains of learning other than skill. This enables educators to find educationally appropriate responses to resource limitations that inevitably constrain training. Challenging behaviour should be considered as a product of several intertwined factors: the actors involved - nurses, clients and others - and the situation in which the behaviour occurs, including its culture and working practices and physical environment.
Musinguzi, Geofrey; Bastiaens, Hilde; Wanyenze, Rhoda K; Mukose, Aggrey; Van Geertruyden, Jean-Pierre; Nuwaha, Fred
The burden of chronic diseases is increasing in both low- and middle-income countries. However, healthcare systems in low-income countries are inadequately equipped to deal with the growing disease burden, which requires chronic care for patients. The aim of this study was to assess the capacity of health facilities to manage hypertension in two districts in Uganda. In a cross-sectional study conducted between June and October 2012, we surveyed 126 health facilities (6 hospitals, 4 Health Center IV (HCIV), 23 Health Center III (HCIII), 41 Health Center II (HCII) and 52 private clinics/dispensaries) in Mukono and Buikwe districts in Uganda. We assessed records, conducted structured interviews with heads of facilities, and administered questionnaires to 271 health workers. The study assessed service provision for hypertension, availability of supplies such as medicines, guidelines and equipment, in-service training for hypertension, knowledge of hypertension management, challenges and recommendations. Of the 126 health facilities, 92.9% reported managing (diagnosing/treating) patients with hypertension, and most (80.2%) were run by non-medical doctors or non-physician health workers (NPHW). Less than half (46%) of the facilities had guidelines for managing hypertension. A 10th of the facilities lacked functioning blood pressure devices and 28% did not have stethoscopes. No facilities ever calibrated their BP devices except one. About a half of the facilities had anti-hypertensive medicines in stock; mainly thiazide diuretics (46%), beta blockers (56%) and calcium channel blockers (48.4%). Alpha blockers, mixed alpha & beta blockers and angiotensin II receptor antagonists were only stocked by private clinics/dispensaries. Most HCIIs lacked anti-hypertensive medicines, including the first line thiazide diuretics. Significant knowledge gaps in classification of patients as hypertensive were noted among respondents. All health workers (except 5, 1.9%) indicated that they
Munga Michael A
Full Text Available Abstract Background Tanzania is experiencing acute shortages of Health Workers (HWs, a situation which has forced health managers, especially in the underserved districts, to hastily cope with health workers’ shortages by adopting task shifting. This has however been due to limited options for dealing with the crisis of health personnel. There are on-going discussions in the country on whether to scale up task shifting as one of the strategies for addressing health personnel crisis. However, these discussions are not backed up by rigorous scientific evidence. The aim of this paper is two-fold. Firstly, to describe the current situation of implementing task shifting in the context of acute shortages of health workers and, secondly, to provide a descriptive account of the potential opportunities or benefits and the likely challenges which might ensue as a result of implementing task shifting. Methods We employed in-depth interviews with informants at the district level and supplemented the information with additional interviews with informants at the national level. Interviews focussed on the informants’ practical experiences of implementing task shifting in their respective health facilities (district level and their opinions regarding opportunities and challenges which might be associated with implementation of task shifting practices. At the national level, the main focus was on policy issues related to management of health personnel in the context of implementation of task shifting, in addition to seeking their opinions and perceptions regarding opportunities and challenges of implementing task shifting if formally adopted. Results Task shifting has been in practice for many years in Tanzania and has been perceived as an inevitable coping mechanism due to limited options for addressing health personnel shortages in the country. Majority of informants had the concern that quality of services is likely to be affected if appropriate policy
Zamanzadeh, Vahid; Valizadeh, Leila; Negarandeh, Reza; Monadi, Morteza; Azadi, Arman
Men entering the nursing profession have been investigated from several different perspectives. Due to male gender characteristics and existing public image, nursing is often not considered as a career choice by men. Whether nursing would benefit from increased number of men is a key question in the literature. The purpose of this integrative review of the literature was to identify factors influencing men to enter the nursing profession. In addition, it sought to understand the challenges they are confronted within this profession. A systematic search of the existing literature was performed using an Internet search with broad keywords to access related articles in both Persian and English databases. Finally, 34 studies (written between 2000 and early 2013) were selected and surveyed. Most of the studies were conducted in developed counties. The review identified reasons why males choose nursing, and other challenges facing men entering and working in nursing. Themes that emerged from the literature include educational and societal barriers experienced by men in nursing, recruitment, career choice, and role strain. Regarding men's influences on professional development, and also the importance of gender-based caring, policies for recruitment and retention of men in nursing must be followed hastily. However, there is a need for further research regarding the challenges faced by men entering nursing, in both Iran and other developing countries.
On July 21, 2000, the Asian Forum of Parliamentarians on Population and Development (AFPPD) Malaysia, in cooperation with the UN Population Fund and the UN Development Program (Malaysia), organized the National HIV/AIDS Seminar for Parliamentarians in Kuala Lumpur, Malaysia. During the seminar, Mr. Colin Hollis, secretary general of AFPPD, spoke about the challenge posed by HIV/AIDS on the government. He noted that the epidemic is a part of life and these figures should not only challenge the assumptions of legislators but for them to act as well. He further informed that AFPPD would organize the Asia-Africa Meeting of Parliamentarians and Asia European Dialogue.
Full Text Available This article provides evidence to show that the contributions of African researchers to the informetrics literature are minimal. The three main challenges identified as limiting the contributions of African scholars to the informetrics literature are lack of appropriate skills, inadequate data collection sources, and unaffordable analytical tools. To overcome these challenges, it is suggested that regular pre-conference workshops on informetrics should be organized, an African Citation Index should be developed, and the use of free analytical tools should be encouraged.
level, and then we can get into the discussion with Dataguise. The security of data is important at generated. So, all of these non-functional attributes of data security are very important, and all of them Text Version | Energy Systems Integration Facility | NREL Solution for Data Security Challenges
The findings of the study indicate that the economic situation in the country coupled with the lack of adequate rainfall has posed challenges to the ability of HIV/AIDS patients to maintain a healthy diet. In addition, there were concerns about the departure of non-government organisations which used to provide them with food ...
Simo, Nuria; Telford, Jon
The arrival over the last 15 years of a substantial number of pupils of immigrant origin has presented Catalan schools with significant challenges. The schools in Vic (70 km north of Barcelona) have been at the forefront of attempts to adjust to this new multicultural reality. This article describes the results of three studies carried out by the…
Fernandez Laris, Georgette A; Gascon, Charles S.
Springfield, Mo., a city with a common name, has an economy with familiar successes and challenges. The health care sector is booming, and the cost of living is somewhat low, as are wages. But labor productivity seems to be subpar, and the poverty rate is above average.
After Hong Kong returned to China in 1997, those in the Chinese migrant community in the UK who anticipated returning to China saw the significant benefits of learning Mandarin. The challenges are not only related to the social and cultural differences between the Cantonese and Mandarin migrant groups, but also the intrinsic linguistic differences…
Johnson, David R.; Stodden, Robert A.; Emanuel, Ellen J.; Luecking, Richard; Mack, Mary
The transition challenges discussed are to ensure that (1) students have access to the full range of curriculum options and learning experiences; (2) high school graduation decisions are based on meaningful indicators of learning; (3) students have access to postsecondary education, employment, and independent living options; (4) student and…
Traditional learning spaces have evolved into dynamic blended tertiary environments (BTEs), providing a modern means through which tertiary education institutes (TEIs) can augment delivery to meet stakeholder needs. Despite the significant demand for web-enabled learning, there are obstacles concerning the use of EOTs, which challenge the…
Lauridsen, Karen M.
Changing demographics, internationalisation of higher education, and migration has resulted in much more diverse student cohorts than it has previously been the case in higher education. While this provides new opportunities, many educators also find that there are new challenges to be met...
This qualitative study focused on the successes and challenges experienced by four undergraduate college women while holding top leadership roles in student organizations. Interpretive and descriptive qualitative research methods were employed with aspects of case study and phenomenological approaches of inquiry. Data were collected through…
Kathleen L. Wolf
Many small cities and towns are located near resource lands, and their central business districts serve both residents and visitors. Such quasi-rural retail centers face competitive challenges from regional shopping malls, online purchasing, and big box discount retailers. District merchants must strategically enhance their market...
Rhudzani V. Mafune
Conclusion: The conclusions drawn from this research are that caregivers hardly receive any support from family members or the community. Fear of disclosing the HIV-positive status of children resulted in the delay of financial support from the government, thus leading to serious financial burden on the caregivers.
Rodrigues, Paulo Henrique de Almeida
This article investigates the circumstances in which Brazil’s sanitation reform was conceived and the Sistema Único de Saúde (SUS) was constructed. A brief analysis is conducted of Brazil’s political transition to democracy, focusing on three political challenges facing the consolidation of SUS: its weak support base amongst workers, competition with the private sector, and the fragmentation of its administration caused by its municipalization. Finally, the changes in the scenario caused by the weakening of neoliberalism since the 2008 crisis, the reemergence of a multipolar political scenario internationally, and the financing conditions of the Brazilian State are described.
Full Text Available Liezel Ennion, Anthea Rhoda Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa Background: Major lower limb amputations result in a significant sense of loss, psychological stress, and decrease in function and overall quality of life for the amputee. The holistic, patient-centered prosthetic rehabilitation of an amputee requires input from a team of dedicated health professionals from different disciplines commonly referred to as a multidisciplinary team (MDT. MDT rehabilitation is considered crucial in the reintegration of the amputee into the community, as well as for providing psychological support after limb loss. Multidisciplinary and interdisciplinary rehabilitation has been proven to be more successful than therapy provided by individual therapists in a number of different populations, regardless of the population studied. However, in most developing countries, there is a significant lack of multidisciplinary rehabilitation.Aim: To explore the roles and challenges of the members of the MDT involved in trans-tibial amputation rehabilitation in a rural community in South Africa (SA.Design: An explorative sequential qualitative descriptive study.Setting: A rural district in the KwaZulu Natal province in SA.Participants: Nine prosthetic users, three surgeons, three traditional healers, 17 therapists, four prosthetists, and four community health workers.Instruments for data collection: Semistructured interviews and focus group discussions.Results: The roles of the members of the MDT were clarified, and various members of the MDT highlighted specific challenges relating to their experiences and roles in the rehabilitation team. Lack of interdisciplinary rehabilitation and communication among team members, as well as lack of resources, and patient education negatively impact the rehabilitation of trans-tibial amputees.Conclusion: Aiming to address the limited resources
Full Text Available The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28-35], a median of 3 living children [IQR: 2-5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member
Ashaba, Scholastic; Kaida, Angela; Coleman, Jessica N; Burns, Bridget F; Dunkley, Emma; O'Neil, Kasey; Kastner, Jasmine; Sanyu, Naomi; Akatukwasa, Cecilia; Bangsberg, David R; Matthews, Lynn T; Psaros, Christina
The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28-35], a median of 3 living children [IQR: 2-5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member as well as policy
From the standpoint of urban planning, the ability to describe the cold air system in a district in both qualitative and quantitative terms is of major significance. Various model calculations are used for this purpose, although in respect of cold air production rates and consequently possible volumetric flows, considerable research still remains to be performed. As a result, in individual cases, methods such as tracer gas tests and measurements also have to be used. The aim here must be to maintain the existing natural ventilation and cooling system and where possible to improve it in order to diminish the effects of increases in temperature in the city resulting from climate change and consequently relieve heat stress brought about by excessive heating of buildings and recreational areas. As part of an urban adjustment strategy, the preservation of areas of relevance for cold air generation in the development plans can consequently serve as an effective means of reducing vulnerability to excess heat in city districts by ensuring an adequate influx of cold air, where this focuses on overall system protection. This stands in contradiction to a small-scale method of determining relevance relating only to individual cases and involving fixed threshold values. The consequence of this approach would be an array of individual plans which - each taken on its own merits - would have only an insignificant impact on a cold air system but which in total and taken over the long term would exert a substantially detrimental impact on the system. This requirement for system protection as outlined here fundamentally needs to be anchored in a city-wide concept, in other words in an urban development concept, as despite its major relevance for planning, the term ''climate adjustment'' does not feature to date in the Federal Building Code (BauGB). This firm anchorage could be established using the model of sustainable urban building development. This model is
Josefina Quintero Corzo
Full Text Available Complying with school regulations and teachers' instructions is a basic principle of an excellent class; both novice and experienced teachers face challenging situations when getting into real classrooms, especially those related to classroom management. There are various reasons that explain discipline problems in public schools, as well as varied strategies beginning teachers create and try when coping with those challenges. This article reports an action research study on how this methodology helped a group of teacher-trainees overcome indiscipline in English as a foreign language classrooms at public schools, and align with professional development initiatives which focus on reflection and decision-making processes that the new Colombian policies demand from new teachers seeking a higher quality of education.
Tolon, Mert; Yazgan, Ufuk; Ural, Derin N; Goss, Kay C
On October 23, 2011, a M7.2 earthquake caused damage in a widespread area in the Van province located in eastern Turkey. This strong earthquake was followed by a M5.7 earthquake on November 9, 2011. This sequence of damaging earthquakes led to 644 fatalities. The management during and after these earthquake disaster imposed many critical challenges. In this article, an overview of these challenges is presented based on the observations by the authors in the aftermath of this disaster. This article presents the characteristics of 2011 Van earthquakes. Afterward, the key information related to the four main phases (ie, preparedness, mitigation, response, and recovery) of the disaster in Van is presented. The potential strategies that can be taken to improve the disaster management practice are identified, and a set of recommendations are proposed to improve the existing situation.
Mattsson, Mats-Olof; Simkó, Myrtill
Risk assessment (RA) of manufactured nanomaterials (MNM) is essential for regulatory purposes and risk management activities. Similar to RA of "classical" chemicals, MNM RA requires knowledge about exposure as well as of hazard potential and dose response relationships. What makes MNM RA especially challenging is the multitude of materials (which is expected to increase substantially in the future), the complexity of MNM value chains and life cycles, the accompanying possible changes in material properties over time and in contact with various environmental and organismal milieus, and the difficulties to obtain proper exposure data and to consider the proper dose metric. This article discusses these challenges and also critically overviews the current state of the art regarding MNM RA approaches. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available This paper discusses how Industrial Design Education should be adapted to pressing future challenges of higher education with respect to promoting high quality mentorship and scholarship, as well as being more economically self-sufficient through stronger collaborative engagements with industry. The four (4 following trends will be presented on how prospective design programs are to be developed: (1 Mass-education and rationalisation, (2 Links between education and research, (3 Globalisation and internationalisation, and (4 Collaboration with industry and research commercialisation.Given the challenges of market forces within academia, a consensus within the design education community should be established in order to expose students more to “active learning” and to vice-versa commute from generic to specialist and from abstract to concrete modes of working. Comprehensive and collaborative studio projects should be implemented as platforms, where social, interdisciplinary and inquiry-based learning can be developed in line with selected design themes, processes and methods.
Räthzel, N; Uzzell, David
This paper presents results of a project aimed at investigating the ways in which trade unions in the “Global North” and the “Global South” respond to the dual challenge of a globalising work division and globalising environmental degradation, and whether and under what conditions trade unions perceive and address these issues as connected. While globalising corporations are forming new international relations of power, trade unions are lagging behind in unifying their efforts to counter glob...
Cha, Hyungyeon; Kim, Junhyeok; Lee, Yoonji; Cho, Jaephil; Park, Minjoon
With the advent of flexible electronics, lithium-ion batteries have become a key component of high performance energy storage systems. Thus, considerable effort is made to keep up with the development of flexible lithium-ion batteries. To date, many researchers have studied newly designed batteries with flexibility, however, there are several significant challenges that need to be overcome, such as degradation of electrodes under external load, poor battery performance, and complicated cell preparation procedures. In addition, an in-depth understanding of the current challenges for flexible batteries is rarely addressed in a systematical and practical way. Herein, recent progress and current issues of flexible lithium-ion batteries in terms of battery materials and cell designs are reviewed. A critical overview of important issues and challenges for the practical application of flexible lithium-ion batteries is also provided. Finally, the strategies are discussed to overcome current limitations of the practical use of flexible lithium-based batteries, providing a direction for future research. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
Full Text Available This article explores the academic and social challenges experienced by students from the gay, lesbian, bisexual and transgender (glbt community on campus at a South African university. A qualitative study to investigate some of these academic and social challenges experienced by glbt students at a university campus was conducted. The population of the study was all students from glbt community on campus and a purposive sample of twelve (12 respondents was constituted and a semi-structured interview guide was designed and administered to all twelve (12 participants. Data were audio recorded and transcribed. Content analysis which is a method used to systematically analyse the meaning of communications was used to analyse data. Of central interest were the core themes that speakers referred to, the information or messages that they wanted to pass on to their audience. The findings suggest that glbt students grapple with issues such as labelling, sexual abuse, discrimination/marginalisation and unfairness in the allocation of resources such as accommodation. In response to these cancerous societal ills, the helping professions exhort practitioners to empower vulnerable populations, promote social justice, support client self-determination and keep abreast of current knowledge relevant to professional practice. This article concludes with a set of recommendations on some of the strategies to address the identified socio-academic challenges.
Nursing faculty are facing challenges in facilitating student learning of complex concepts such as compassionate practice. Compassion is a stated expectation of Registered Nurse (RN) and student nurse practice, and yet how it is enabled and learned within the challenging environments of university and health service provider organisations are not yet understood. There is currently an international concern that student nurses are not being adequately prepared for compassion to flourish and for compassionate practice to be sustained upon professional qualification. In order to investigate the experiences of nursing faculty in their preparation of student nurses for compassionate practice, an exploratory aesthetic phenomenological research study was undertaken using in depth interviews with five nurse teachers in the North of England. Findings from this study were analysed and presented using embodied interpretation, and indicate that nurse teachers recognise the importance of the professional ideal of compassionate practice alongside specific challenges this expectation presents. They have concerns about how the economically constrained and target driven practice reality faced by RNs promotes compassionate practice, and that students are left feeling vulnerable to dissonance between learned professional ideals and the RNs' practice reality they witness. Nurse teachers also experience dissonance within the university setting, between the pressures of managing large student groups and the time and opportunity required for small group discussion with students that enables compassion to develop in a meaningful and emotionally sustainable way. Teachers also express discomfort due to a perceived promotion of an 'unachievable utopia' within practice, identifying how the constraints within practice could be better managed to support professional ideals. The nurse teachers within this exploratory study identify the need for strong nurse leadership in practice to challenge
Full Text Available BackgroundChild healthcare practices in China over the last 60 yearshave extensively improved children’s health and growth, yetnew challenges lie ahead. This review aims to summarisethe successful experiences and the newly identifiedproblems in child healthcare in China.MethodInformation, available to the public, was obtained fromChinese databases and Chinese Government websites,chiefly the Chinese National Knowledge Infrastructuredatabase, the Chinese Biomedical Literature database, theMinistry of Health website and the National WorkingCommittee on Children and Women website.ResultsDuring its poverty-stricken 1950s–1970s, China protectedchildren’s health mainly through prevention and control ofcommon infectious diseases and severe malnutrition withina comprehensive healthcare system. After the subsequent30 years of rapid socio-economic development, China hasachieved great success in reducing childhood mortality ratesand promoting child growth, meeting the MillenniumDevelopment Goal 4 targets and the WHO child growthstandards. Meanwhile, new challenges for children’shealthcare emerged, including: large disparities in thehealth, growth and nutritional status of children, and in theaccessibility and quality of child healthcare, between urbanand rural areas and across different regions of China; thenutritional and healthcare concerns of the fast-expandingpopulation of migrant children and rural left-behindchildren; the burgeoning epidemic of childhood obesity inurban and economically developed areas; micronutrientdeficiencies such as calcium, iron, zinc and vitamin A; andincreasing prevalence of mental and behavioural disorders.ConclusionUnder poor economic conditions, healthcare plays a keyrole in protecting children against diseases. With thedevelopment of social economy, new challenges present tohealthcare services, specifically, to comprehensivelypromote and optimise childrens’ health and nutrition.
Bamidele A. OJO
Full Text Available This paper examines the question of distance education and its pivotal role in promoting social change and development in Africa. It also discussed within the context of the global digital divide and the ongoing need for collaborative effort at global education, the limitation imposed by the socio-economic and political environment on the continent. The paper in its findings conclude that the crisis within African societies constitutes a serious challenge to the implementation of and the effectiveness of distance education in Africa and therefore contributes to the widening of the digital divide rather than reducing it.
Mahmoud, Samhar; Boyd, Andy; Curcin, Vasa; Bache, Richard; Ali, Asad; Miles, Simon; Taweel, Adel; Delaney, Brendan; Macleod, John
Data about patients are available from diverse sources, including those routinely collected as individuals interact with service providers, and those provided directly by individuals through surveys. Linking these data can lead to a more complete picture about the individual, to inform either care decision making or research investigations. However, post-linkage, differences in data recording systems and formats present barriers to achieving these aims. This paper describes an approach to combine linked GP records with study observations, and reports initial challenges related to semantic and syntactic interoperability issues.
Syse, A.; Syse, A.; Geller, B.
Cancer survivorship research includes the study of physical, psychosocial, and economic consequences of cancer diagnosis and treatment among pediatric and adult cancer survivors. Historically, the majority of cancer survivorship studies were from the United States, but survivorship issues are increasingly being addressed in other developed countries. Cross-cultural studies remain, however, scarce. The degree to which knowledge attained may or may not be transferred across cultures, countries, or regions is not known. Some important challenges for comparative research are therefore discussed in a cross-cultural perspective. Several substantive and methodological challenges that complicate the execution of cross-cultural cancer survivorship research are presented with examples and discussed to facilitate comparative research efforts in the establishment of new survivorship cohorts and in the planning and implementation of survivorship studies. Comparative research is one key to understanding the nature of cancer survivorship, distinguishing modifiable from non modifiable factors at individual, hospital, societal, and system levels and may thus guide appropriate interventions. Lastly, suggested future courses of action within the field of comparative cancer survivorship research are provided.
Fekete Mária FARKASNÉ
Full Text Available Apart from the financial risk the insurance industry are facing with in association with climate change, there are also opportun ities to the sector to develop new markets and provide coverage against weather related risks. This study presents a possible method to examine the potential for introducing a new insurance product, namely an agricultural flood insurance scheme in the United Kingdom. The investigation included the calculation of agricultural flood damage costs, the possible changes in flood risk, the description of farmers’ risk attitude and interests in insurance. In a small scale survey, farmers were asked their experiences related to flooding, farm management practices and thei r willingness to pay for flood insurance using a contingent valuation method. Using statistical analysis it was found the insurance demand is positively correlated with the damage cost predicted and association is likely between farm types and WTP for insurance. Linear regression model suggests that the demand for flood insurance is low amongst farmers in the present risk level. The findi ngs of this research highlight that there is little evidence for the viability of a farmer financed agricultural flood insurance scheme at the moment in the United Kingdom.
Goldsby, M.; Padowski, J.; Katz, S.; Brady, M.; Hampton, S. E.
Ensuring the security of food, energy and water in the face of a changing environment is a top societal priority. In order to make sound policy decisions aimed at meeting those needs, policy-makers need decision-relevant information. As such, considerable effort and resources have recently been devoted to investigating the Food-Energy-Water (FEW) Nexus in order to better provide that information. However, despite the increased research activity into FEW systems and FEW problems, little attention has been devoted to the fundamental conceptual issues underlying contemporary FEW systems. Consequently, this inattention has led to conceptual confusion about what is and what is not a FEW system. This project aims to fill that lacuna in order to better facilitate the FEW research agenda. Toward that end, we identify three features that distinguish FEW problems from other resource management problems: (1) the production and management of the resources in each sector of a FEW system is specialized to its own sector; (2) interdependencies exist between sectors such that overproduction in one sector, for example, may have impacts on other sectors; and (3) there are real limits to FEW resource availability as well as limits on the ability to transact across sector boundaries. We contend that once armed with this distinction, one can model the stocks and flows of FEW capital in a conceptually rigorous way that may lead to operational innovations of FEW management.
Szilard, Ronaldo [Idaho National Lab. (INL), Idaho Falls, ID (United States); Sharpe, Phil [Idaho National Lab. (INL), Idaho Falls, ID (United States); Kee, Edward [Nuclear Economics Consulting Group, Washington, DC (United States); Davis, Edward [Nuclear Economics Consulting Group, Washington, DC (United States); Grecheck, Eugene [Grecheck Consulting LLC, Midlothian, VA (United States)
This report identifies underlying economic and electricity market factors that have led to early retirements of U.S. operating nuclear power plants, assesses the Gap between operating revenues and operating costs for selected nuclear power plants, and discusses a range of actions that might be taken to stop early retirement of operating nuclear power plants. The Kewaunee and Vermont Yankee nuclear power plants were retired early for economic and financial reasons. Early retirement has been announced or proposed for Clinton and Quad Cities in Illinois, Fitzpatrick and Ginna in New York, Fort Calhoun in Nebraska. Other nuclear power plants, including Palisades, Davis-Besse, Prairie Island, and Three Mile Island Unit 1, have been identified as facing financial stress that might lead to early retirement. The early retirement of operating nuclear power plants will mean the loss of a large amount of zero-emission electricity, inconsistent with the goal of reducing carbon emissions in the electricity sector. This report provides a high-level view of the major factors driving early retirement: • The U.S. market and private ownership approach to the electricity sector; • Low electricity market prices resulting from low natural gas prices, low demand growth, increased penetration of renewable generation, and negative electricity market prices; and • No compensation to nuclear power plants for public benefits including zero-emission electricity.
Grossman-Kahn, Rebecca; Schoen, Julia; Mallett, John William; Brentani, Alexandra; Kaselitz, Elizabeth; Heisler, Michele
Community health worker (CHW) programs are implemented in many low- and middle-income countries such as Brazil to increase access to and quality of care for underserved populations; CHW programs have been found to improve certain indicators of health, but few studies have investigated the daily work of CHWs, their perspectives on what both helps and hinders them from fulfilling their roles, and ways that their effectiveness and job satisfaction could be increased. To examine these questions, we observed clinic visits, CHW home visits, and conducted semistructured interviews with CHWs in 7 primary care centers in Brazil-2 in Salvador, Bahia, and 5 in São Paulo, SP-in which CHWs are incorporated into the work of all primary care health teams. In addition to enhancing communication between the medical system and the community, CHWs consider their key roles to be helping persuade community members to seek medical care and increasing health professionals' awareness of the social conditions affecting their patients' health. Key obstacles that CHWs face include failure to be fully integrated into the primary care team, inability to follow-up on identified health needs due to limited resources, as well as community members' lack of understanding of their work and undervaluing of preventative medicine. Increased training, better incorporation of CHWs into clinic flow and decision making, and establishing a clear community awareness of the roles and value of CHWs will help increase the motivation and effectiveness of CHWs in Brazil. Copyright © 2017 John Wiley & Sons, Ltd.
Szilard, Ronaldo; Sharpe, Phil; Kee, Edward; Davis, Edward; Grecheck, Eugene
This report identifies underlying economic and electricity market factors that have led to early retirements of U.S. operating nuclear power plants, assesses the Gap between operating revenues and operating costs for selected nuclear power plants, and discusses a range of actions that might be taken to stop early retirement of operating nuclear power plants. The Kewaunee and Vermont Yankee nuclear power plants were retired early for economic and financial reasons. Early retirement has been announced or proposed for Clinton and Quad Cities in Illinois, Fitzpatrick and Ginna in New York, Fort Calhoun in Nebraska. Other nuclear power plants, including Palisades, Davis-Besse, Prairie Island, and Three Mile Island Unit 1, have been identified as facing financial stress that might lead to early retirement. The early retirement of operating nuclear power plants will mean the loss of a large amount of zero-emission electricity, inconsistent with the goal of reducing carbon emissions in the electricity sector. This report provides a high-level view of the major factors driving early retirement: • The U.S. market and private ownership approach to the electricity sector; • Low electricity market prices resulting from low natural gas prices, low demand growth, increased penetration of renewable generation, and negative electricity market prices; and • No compensation to nuclear power plants for public benefits including zero-emission electricity.
Vande Putte, Danny; Verhelst, Marc
Risk management has never been easy. Finding efficient mitigating measures is not always straightforward. Finding measures for cyber crime, however, is a really huge challenge because cyber threats are changing all the time. As the sophistication of these threats is growing, their impact increases. Moreover, society and its economy have become increasingly dependent on information and communication technologies. Standard risk analysis methodologies will help to score the cyber risk and to place it in the risk tolerance matrix. This will allow business continuity managers to figure out if there is still a gap with the maximum tolerable outage for time-critical business processes and if extra business continuity measures are necessary to fill the gap.
Das, Kaushik; Altin, Müfit; Hansen, Anca Daniela
power flow in 60kV distribution networks through controlling the ability of wind power plants (WPPs) to generate or absorb reactive power. This paper aims to understand the characteristics of a distribution network with high penetration of distributed generation. A detailed analysis of the active...... and reactive power flows in a real distribution network under different wind and load conditions based on actual measurements is performed in order to understand the correlation between the consumption, wind power production, and the network losses. Conclusive remarks are presented, briefly expressing......This paper addresses the challenges associated with the operation of a distribution system with high penetration of wind power. The paper presents some preliminary investigations of an ongoing Danish research work, which has as main objective to reduce the network losses by optimizing the reactive...
Moridis, G.J.; Collett, T.S.; Pooladi-Darvish, M.; Hancock, S.; Santamarina, C.; Boswell, R.; Kneafsey, T.; Rutqvist, J.; Kowalsky, M.; Reagan, M.T.; Sloan, E.D.; Sum, A.K.; Koh, C.
The current paper complements the Moridis et al. (2009) review of the status of the effort toward commercial gas production from hydrates. We aim to describe the concept of the gas hydrate petroleum system, to discuss advances, requirement and suggested practices in gas hydrate (GH) prospecting and GH deposit characterization, and to review the associated technical, economic and environmental challenges and uncertainties, including: the accurate assessment of producible fractions of the GH resource, the development of methodologies for identifying suitable production targets, the sampling of hydrate-bearing sediments and sample analysis, the analysis and interpretation of geophysical surveys of GH reservoirs, well testing methods and interpretation of the results, geomechanical and reservoir/well stability concerns, well design, operation and installation, field operations and extending production beyond sand-dominated GH reservoirs, monitoring production and geomechanical stability, laboratory investigations, fundamental knowledge of hydrate behavior, the economics of commercial gas production from hydrates, and the associated environmental concerns.
Rodrigo José Teixeira
Full Text Available This article offers an analysis of the intrinsic relationship between the social question and Social Work. The analysis of the social question starts from the meticulous and rigorous reading of the labor theory of value and the Critique of Political Economy written by Karl Marx. It is from this analysis that we try to justify the genesis of the profession linked to the role of the state and the bourgeoisie in the consolidation of monopoly capitalism. It starts from the analysis of Social Work as a profession inserted in the social and technical division of labor that by its own action, in the contradictory movement of the capitalist reality, defends the interests of capital and labor. In addition, the article presents, in a succinct way, the trajectory of Social Work in Brazil and its ethical and political project in relation to the working class challenges to guarantee this direction in times of dismantling social policies and financial capitalism.
James J.F. Forest
Full Text Available Many kinds of entities—including terrorists and insurgents—seek to influence perceptions and behavior among various target audiences, and have become increasingly reliant on the Internet in their efforts, incorporating social media, blogging, public video sharing and other online tools. This article is focused on the ideological messages that terrorist groups use to convey with these tools. Drawing from a study of Al-Qaeda, this discussion illustrates how ideologies of violence have certain vulnerabilities that can be exploited in order to degrade a terrorist group’s ability to achieve its objectives. While crafting and disseminating counter-narratives can be a critical part of a counterterrorism strategy, it is also important to identify ways in which terrorists undermine their own central narratives and exacerbate pre-existing “influence warfare” challenges
Fiore, J. J.; Murphie, W. E.; Meador, S. W.
The Office of Site Closure (OSC) was formed in November 1999 when the Department of Energy's (DOE's) Office of Environmental Management (EM) reorganized to focus specifically on site cleanup and closure. OSC's objective is to achieve safe and cost-effective cleanups and closures that are protective of our workers, the public, and the environment, now and in the future. Since its inception, OSC has focused on implementing a culture of safe closure, with emphasis in three primary areas: complete our responsibility for the Closure Sites Rocky Flats, Mound, Fernald, Ashtabula, and Weldon Spring; complete our responsibility for cleanup at sites where the DOE mission has been completed (examples include Battelle King Avenue and Battelle West Jefferson in Columbus, and General Atomics) or where other Departmental organizations have an ongoing mission (examples include the Brookhaven, Livermore, or Los Alamos National Laboratories, and the Nevada Test Site); and create a framework a nd develop specific business closure tools that will help sites close, such as guidance for and decisions on post-contract benefit liabilities, records retention, and Federal employee incentives for site closure. This paper discusses OSC's 2001 progress in achieving site cleanups, moving towards site closure, and developing specific business closure tools to support site closure. It describes the tools used to achieve progress towards cleanup and closure, such as the application of new technologies, changes in contracting approaches, and the development of agreements between sites and with host states. The paper also identifies upcoming challenges and explores options for how Headquarters and the sites can work together to address these challenges. Finally, it articulates OSC's new focus on oversight of Field Offices to ensure they have the systems in place to oversee contractor activities resulting in site cleanups and closures
Cotelo, E.; Padilla, M.; Dibarboure, L.
Despite the fact that in recent years an increasing number of radiologists and radiological technologists have been applying radiation dose optimization techniques in paediatric Computed Tomography (CT) examinations, dual and multi -slice CT (MSCT) scanners present a new challenge in Radiation Protection (RP). While on one hand these scanners are provided with Automatic Exposure Control (AEC) devices, dose reduction modes and dose estimation software, on the other hand Quality Control (QC) tests and CT Kerma Index (C) measurements and patient dose estimation present specific difficulties and require changes or adaptations of traditional QC protocols. This implies a major challenge in most developing countries where Quality Assurance Programmes (QAP) have not been implemented yet and there is a shortage in the number of medical physicists This paper analyses clinical and technical protocols as well as patient doses in 204 CT body procedures performed in 154 children. The investigation was carried out in a paediatric reference hospital of Uruguay, where are performed an average of 450 paediatric CT examinations per month in a sole CT dual scanner. Besides, C VOL reported from the scanner display was registered in order to be related with the same dosimetric quantity derived from technical parameters and C values published on tables. Results showed that not all the radiologists applied the same protocol in similar clinical situations delivering unnecessary patient dose with no significant differences in image quality. Moreover, it was found that dose reduction modes represent a drawback in order to estimate patient dose when mA changes according to tissue attenuation, in most cases in each rotation. The study concluded on the importance of QAP that must include education on RP of radiologists and technologists, as well as in the need of medical physicists to perform QC tests and patient dose estimations and measurements. (author)
Entsminger, J. R., II
From a sociocultural point of view, this qualitative case study explored how upper-level, female undergraduate engineering students perceived the possibility of or experience with stereotype threat as shaping their experiences. The study also investigated how these students explained their reasons for choosing their engineering major, the challenges they encountered in the major, and their reasons for persevering in spite of those challenges. Using Steele and Aronson's (1995) stereotype threat theory as a framework, and considering the documented underrepresentation of females in engineering, the study sought to examine how stereotype threat shaped the experiences of these students and if stereotype threat could be considered a valid reason for the underrepresentation. The study was conducted at a large, four-year public university. First, students in the College of Engineering and Engineering Technology completed the Participant Screening Survey. Based on responses from the survey, six female engineering students from the college were identified and invited to participate in the study. The participants came from the following majors: Electrical Engineering, Industrial and Systems Engineering, and Mechanical Engineering. After receiving the study consent letter and agreeing to participate, the students were involved in a 90-minute focus group meeting, a 45-minute one-on-one interview, and a 30-minute follow-up interview. After conducting the data collection methods, the data were then transcribed, analyzed, and coded for theme development. The themes that emerged coincided with each research question. The themes highlighted the complex interactions and experiences shared by the female engineering majors. The female students were enveloped in an environment where there existed an increased risk for activating stereotype threat. In addition, the female students described feeling pushed to prove to themselves and to others that the negative stereotype that 'females
In order for the U.S. Geological Survey (USGS) to respond to evolving national and global priorities, it must periodically reflect on, and optimize, its strategic directions. This report is the first comprehensive science strategy since the early 1990s to examine critically major USGS science goals and priorities. The development of this science strategy comes at a time of global trends and rapidly evolving societal needs that pose important natural-science challenges. The emergence of a global economy affects the demand for all resources. The last decade has witnessed the emergence of a new model for managing Federal lands-ecosystem-based management. The U.S. Climate Change Science Program predicts that the next few decades will see rapid changes in the Nation's and the Earth's environment. Finally, the natural environment continues to pose risks to society in the form of volcanoes, earthquakes, wildland fires, floods, droughts, invasive species, variable and changing climate, and natural and anthropogenic toxins, as well as animal-borne diseases that affect humans. The use of, and competition for, natural resources on the global scale, and natural threats to those resources, has the potential to impact the Nation's ability to sustain its economy, national security, quality of life, and natural environment. Responding to these national priorities and global trends requires a science strategy that not only builds on existing USGS strengths and partnerships but also demands the innovation made possible by integrating the full breadth and depth of USGS capabilities. The USGS chooses to go forward in the science directions proposed here because the societal issues addressed by these science directions represent major challenges for the Nation's future and for the stewards of Federal lands, both onshore and offshore. The six science directions proposed in this science strategy are listed as follows. The ecosystems strategy is listed first because it has a dual nature
Groisman, Pavel; Gutman, Garik; Gulev, Sergey; Maksyutov, Shamil; Qi, Jiaguo
foci emerged in discussions within the NEESPI community during the past 20 months. Presentation will provide justification of these foci and approach examples addressing them. The societal challenges, particularly the socio-economic challenges are the top priority in most of them. Throughout the NEESP Initiative duration, support for it studies has been provided by different national and international Agencies of the United States (in particular, the NASA Land Cover and Land Use Change Program), the Russian Federation (in particular, the Ministry of Education and Science, e.g., mega-grant 14.B25.31.0026), European Union, Japan, and China. After the NEFI White Paper release, we anticipate a similar kind of support for this new Initiative.
Samuel N. Luoma
Full Text Available doi: http://dx.doi.org/10.15447/sfews.2015v13iss3art7Freshwater is a scarce and precious resource in California; its overall value is being made clear by the current severe drought. The Sacramento–San Joaquin Delta is a critical node in a complex water supply system that extends throughout much of the western U.S. wherein demand is exceeding supply. The Delta also underpins a major component of the U.S. economy, helps feed a substantial part of the country, is a unique and valuable ecological resource, and is a place with a rich cultural heritage. Sustaining the Delta is a problem that manifests itself in many dimensions including the physical structure of the Delta, the conflicting demands for water, changing water quality, rapidly evolving ecological character, and high institutional complexity. The problems of the California Delta are increasingly complex, sometimes chaotic, and always contentious. There is general agreement that current management will sustain neither the Delta ecosystem nor high-quality water exports, as required under the Delta Reform Act, so there is a renewed urgency to address all dimensions of the problem aggressively. Sustainable management of the Delta ecosystem and California’s highly variable water supply, in the face of global climate change, will require bold political decisions that include adjustments to the infrastructure but give equal emphasis to chronic overuse and misuse of water, promote enhanced efficiency of water use, and facilitate new initiatives for ecosystem recovery. This new approach will need to be underpinned by collaborative science that supports ongoing evaluation and re-adjustment of actions. Problems like the Delta are formally “wicked" problems that cannot be “solved” in the traditional sense, but they can be managed with appropriate knowledge and flexible institutions. Where possible, it is advisable to approach major actions incrementally, with an eye toward avoiding
Nuwagaba-Biribonwoha, H; Mayon-White, R T; Okong, P; Carpenter, L M
To report the experience of health workers who had played key roles in the early stages of implementing the prevention of mother-to-child HIV transmission services (PMTCT) in Uganda. Interviews were conducted with 15 key informants including counsellors, obstetricians and PMTCT coordinators at the five PMTCT test sites in Uganda to investigate the benefits, challenges and sustainability of the PMTCT programme. Audio-taped interviews were held with each informant between January and June 2003. These were transcribed verbatim and manually analysed using the framework approach. The perceived benefits reported by informants were improvement of general obstetric care, provision of antiretroviral prophylaxis for HIV-positive mothers, staff training and community awareness. The main challenges lay in the reluctance of women to be tested for HIV, incomplete follow-up of participants, non-disclosure of HIV status and difficulties with infant feeding for HIV-positive mothers. Key informants thought that the programme's sustainability depended on maintaining staff morale and numbers, on improving services and providing more resources, particularly antiretroviral therapy for the HIV-positive women and their families. Uganda's experience in piloting the PMTCT programme reflected the many challenges faced by health workers. Potentially resource-sparing strategies such as the 'opt-out' approach to HIV testing required further evaluation.
Updike, Randall G.; Page, William R.
Along the nearly 3,200 kilometers (almost 2,000 miles) of the United States–Mexican border, we are witnessing the expression of the challenges of the 21st century. The Borderlands have become a microcosm for the entire United States and Mexico; the issues faced in that region are felt throughout both nations—water availability and quality, ecosystem health, natural resource needs, safety from natural hazards, and human socioeconomic well-being. If these issues were not challenging enough, we now recognize that the difficulties of addressing them are exacerbated by the onset of climate change, and as we come to better understand the complexities of the components of these challenge themes, we discover that each part is inextricably intertwined with other overarching issues. Further, because we are a creative and progressive society, we all seek to understand and appreciate the natural environments associated with the Borderlands while at the same time benefitting from the region’s many social and economic values. It is little wonder that we as a society find it increasingly difficult to ask the right questions, much less find suitable answers to the questions we do ask. For the many scientists who have worked in the Borderlands and contributed to the preceding chapters, this circular is a way to describe to the two nations of the region the capabilities the U.S. Geological Survey can provide to assist in that quest for knowledge and understanding in preparation for the future.
Lu, Xi; McElroy, Michael B.; Peng, Wei; Liu, Shiyang; Nielsen, Chris P.; Wang, Haikun
In the 21st Conference of the Parties held in Paris in December 2015, China pledged to peak its carbon emissions and increase non-fossil energy to 20% by 2030 or earlier. Expanding renewable capacity, especially wind power, is a central strategy to achieve these climate goals. Despite greater capacity for wind installation in China compared to the US (145.1 versus 75.0 GW), less wind electricity is generated in China (186.3 versus 190.9 TWh). Here, we quantify the relative importance of the key factors accounting for the unsatisfactory performance of Chinese wind farms. Different from the results in earlier qualitative studies, we find that the difference in wind resources explains only a small fraction of the present China-US difference in wind power output (-17.9% in 2012); the curtailment of wind power, differences in turbine quality, and delayed connection to the grid are identified as the three primary factors (respectively -49.3%, -50.2%, and -50.3% in 2012). Improvements in both technology choices and the policy environment are critical in addressing these challenges.
Kramer, Shira; Soskolne, Colin L
This review integrates historical developments and key events in bringing ethics into epidemiology in general and into environmental epidemiology in particular. The goal is to provide context for and discern among the various approaches and motivations that drive the need for ethical conduct in support of the public interest. The need for ethics guidelines in epidemiology is different from developments in other biomedical-related fields by virtue of its focus on populations rather than on individuals. The need for ethics guidelines in environmental epidemiology as a subspecialty of epidemiology stems from the larger scale of its mission than that of epidemiology per se. Ethics guidelines in the field of environmental epidemiology have been established. They articulate not only the profession's core values and mission, but more specifically, they address the environmental epidemiologist's obligations to the participants in research, to colleagues, and to employers. They are the product of consensus, scholarship, and diligent stewardship over several decades. The next challenge is ensuring their value and impact. The forces that support professional and institutional success, and the power of special interests, are the major threats to achieving the goals of ethical conduct and research for the public good. In environmental epidemiology, these threats have global implications.
Moridis, G.J.; Collett, T.S.; Pooladi-Darvish, M.; Hancock, S.; Santamarina, C.; Boswel, R.; Kneafsey, T.; Rutqvist, J.; Kowalsky, M.B.; Reagan, M.T.; Sloan, E.D.; Sum, A.K.; Koh, C.A.
The current paper complements the Moridis et al. (2009) review of the status of the effort toward commercial gas production from hydrates. We aim to describe the concept of the gas-hydrate (GH) petroleum system; to discuss advances, requirements, and suggested practices in GH prospecting and GH deposit characterization; and to review the associated technical, economic, and environmental challenges and uncertainties, which include the following: accurate assessment of producible fractions of the GH resource; development of methods for identifying suitable production targets; sampling of hydrate-bearing sediments (HBS) and sample analysis; analysis and interpretation of geophysical surveys of GH reservoirs; well-testing methods; interpretation of well-testing results; geomechanical and reservoir/well stability concerns; well design, operation, and installation; field operations and extending production beyond sand-dominated GH reservoirs; monitoring production and geomechanical stability; laboratory investigations; fundamental knowledge of hydrate behavior; the economics of commercial gas production from hydrates; and associated environmental concerns. ?? 2011 Society of Petroleum Engineers.
Full Text Available Despite a record-breaking 14.5 per cent increase in world merchandise exports, the effects of the financial crisis and global recession are still hampering faster economic recovery. Relatively high oil prices combined with persistent unemployment and measures designed to reduce budget deficits have undermined short-term growth prospects. While South–South trade continues to explode, trade imbalances – i.e. the gap between exports and imports – widened in 2010 compared to 2009 (though smaller than pre-crisis levels. Meanwhile, trade negotiations under the Doha Round have reached an impasse, generating uncertainties about the future of the World Trade Organization (WTO as a negotiating forum. Under these circumstances, should the system rethink its decision-making process founded upon the predominance of member states, the principle of consensus and the notion of single undertaking, as some critics have suggested? And, if so, how could such a reform agenda be initiated at the WTO? Moreover, beyond the negotiating function of the WTO, the paralysis of the system also raises urgent questions about the ability of the system to respond to pressing challenges of our times, such as trade and climate change, or food security and price volatility.
Martin, Graeme; Beech, Nic; MacIntosh, Robert; Bushfield, Stacey
The discourse of leaderism in health care has been a subject of much academic and practical debate. Recently, distributed leadership (DL) has been adopted as a key strand of policy in the UK National Health Service (NHS). However, there is some confusion over the meaning of DL and uncertainty over its application to clinical and non-clinical staff. This article examines the potential for DL in the NHS by drawing on qualitative data from three co-located health-care organisations that embraced DL as part of their organisational strategy. Recent theorising positions DL as a hybrid model combining focused and dispersed leadership; however, our data raise important challenges for policymakers and senior managers who are implementing such a leadership policy. We show that there are three distinct forms of disconnect and that these pose a significant problem for DL. However, we argue that instead of these disconnects posing a significant problem for the discourse of leaderism, they enable a fantasy of leadership that draws on and supports the discourse. © 2014 The Authors. Sociology of Health & Illness © 2014 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.
Fernandino, Gerson; Elliff, Carla I; Silva, Iracema R
Climate change effects have the potential of affecting both ocean and atmospheric processes. These changes pose serious threats to the millions of people that live by the coast. Thus, the objective of the present review is to discuss how climate change is altering (and will continue to alter) atmospheric and oceanic processes, what are the main implications of these alterations along the coastline, and which are the ecosystem-based management (EBM) strategies that have been proposed and applied to address these issues. While ocean warming, ocean acidification and increasing sea level have been more extensively studied, investigations on the effects of climate change to wind and wave climates are less frequent. Coastal ecosystems and their respective natural resources will respond differently according to location, environmental drivers and coastal processes. EBM strategies have mostly concentrated on improving ecosystem services, which can be used to assist in mitigating climate change effects. The main challenge for developing nations regards gaps in information and scarcity of resources. Thus, for effective management and adaptive EBM strategies to be developed worldwide, information at a local level is greatly needed. Copyright © 2018 Elsevier Ltd. All rights reserved.
Callegary, James; Langeman, Jeff; Leenhouts, Jim; Martin, Peter
Along the United States–Mexican border, the health of communities, economies, and ecosystems is inextricably intertwined with the availability and quality of water, but effective water management in the Borderlands is complicated. Water users compete for resources, and their needs are increasing. Managers are faced with issues such as finding a balance between agriculture and rapidly growing cities or maintaining public supplies while ensuring sufficient resources for aquatic ecosystems. In addition to human factors, the dry climate of the Borderlands, as compared to more temperate regions, also increases the challenge of balancing water supplies between humans and ecosystems. Warmer, drier, and more variable conditions across the southwestern United States—the projected results of climate change (Seager and others, 2007)—would further stress water supplies.
Over the past two decades, the IAEA has conducted a series of major conferences that have addressed topical issues and strategies critical to nuclear safety for consideration by the world's nuclear regulators. More recently, the IAEA organized the International Conference on Effective Nuclear Regulatory Systems - Facing Safety and Security Challenges, held in Moscow in 2006. The Moscow conference was the first of its kind, because it brought together senior regulators of nuclear safety, radiation safety and security from around the world to discuss how to improve regulatory effectiveness with the objective of improving the protection of the public and the users of nuclear and radioactive material. The International Conference on Challenges Faced by Technical and Scientific Support Organizations in Enhancing Nuclear Safety was held in Aix-en-Provence, France, from 23 to 27 April 2007. This conference, again, was the first of its kind, because it was the first to address technical and scientific support organizations (TSOs), the role they play in supporting either the national regulatory bodies or the industry in making optimum safety decisions and the challenges they face in providing this support. This conference provided a forum for the TSOs to discuss these and other issues with the organizations to which they provide this support - that is, the regulators and the operators/industry - as well as with other stakeholders such as research organizations and public authorities. This conference can also be considered to have a link to the Moscow conference. The Moscow conference concluded that effective regulation of nuclear safety is vital for the safe use of nuclear energy and associated technologies, both now and in the future, and is an essential prerequisite for establishing an effective Global Nuclear Safety Regime. The Moscow conference also highlighted the importance of continued and improved international cooperation in the area of nuclear safety. These
Full Text Available Background Thalassemia is considered an important public health problem worldwide, especially in developing and poor countries. Although several advanced techniques have been developed for prevention of thalassemia in the recent years, many adolescents and youths are still living with this disease. Independence from parents, decisions about high-risk behaviors, uncovering the identity, and adapting to mental and physical effects of the disease occur together in adolescents. Objectives This study was conducted to explore challenges of self-management empowerment in adolescents and youths with major thalassemia. Materials and Methods This was a descriptive-exploratory study. The study population consisted of adolescents and youths with major thalassemia who had medical records in the Bushehr Thalassemia Center, affiliated with Bushehr University of Medical Sciences. The study samples were purposively selected. Demographic information questionnaire and empowerment questionnaire were used to collect data from the semistructured interview. We analyzed qualitative data by content analysis method and quantitative data by descriptive (mean, standard deviation and analytical (Student's t-test, ANOVA and Pearson’s correlation coefficient statistical methods, using the statistical software SPSS 18. Results In qualitative part of the study, data from semistructured in-depth interviews with 15 participants were coded and summarized in five themes including: 1 awareness of personal changes; 2 need for adaptation; 3 maintaining independence and self-management; 4 uncovering the identity and role playing; and 5 sense of control and satisfaction. Results of the quantitative part showed that the overall score of participants on empowerment was 92.46 of 149 scores, which showed a moderate situation in the empowerment of these individuals. In addition, the empowerment score showed no statistically significant correlation with demographic characteristics
Kikuchi, R. K.; Elliff, C. I.
to increase resilience and guarantee the adaptation of this ecosystem to climate change. Thus, considering that the majority of the marine ecosystem services we benefit from are provided from coastal habitats, of which coral reefs play an important role, the challenge at hand is in fact the interaction between local factors and climate change
Alidmat, Ali Odeh Hammoud; Ayassrah, Mohamed Ayed
Teaching English for Special Purposes (ESP) in a context where English is taught as a Foreign Language (EFL) is no easy task. There is in fact extensive research reporting on challenges facing both teacher and student in the Foreign Language classroom where language skills must be learnt outside their usual context. Even more challenging is…
Schmitt, Margaret L; Clatworthy, David; Ratnayake, Ruwan; Klaesener-Metzner, Nicole; Roesch, Elizabeth; Wheeler, Erin; Sommer, Marni
There is a significant gap in empirical evidence on the menstrual hygiene management (MHM) challenges faced by adolescent girls and women in emergency contexts, and on appropriate humanitarian response approaches to meet their needs in diverse emergency contexts. To begin filling the gap in the evidence, we conducted a study in two diverse contexts (Myanmar and Lebanon), exploring the MHM barriers facing girls and women, and the various relevant sectoral responses being conducted (e.g. water, sanitation and hygiene (WASH), Protection, Health, Education and Camp Management). Two qualitative assessments were conducted: one in camps for internally displaced populations in Myanmar, and one with refugees living in informal settlements and host communities in Lebanon. Key informant interviews were conducted with emergency response staff in both sites, and focus group discussion and participatory mapping activities conducted with adolescent girls and women. Key findings included that there was insufficient access to safe and private facilities for MHM coupled with displacement induced shifts in menstrual practices by girls and women. Among staff, there was a narrow interpretation of what an MHM response includes, with a focus on supplies; significant interest in understanding what an improved MHM response would include and acknowledgement of limited existing MHM guidance across various sectors; and insufficient consultation with beneficiaries, related to discomfort asking about menstruation, and limited coordination between sectors. There is a significant need for improved guidance across all relevant sectors for improving MHM response in emergency context, along with increased evidence on effective approaches for integrating MHM into existing responses.
Conflicts of interest (COIs) in research have received increasing attention, but many questions arise about how Institutional Review Boards (IRBs) view and approach these. I conducted in-depth interviews of 2 hours each with 46 US IRB chairs, administrators, and members, exploring COI and other issues related to research integrity. I contacted leaders of 60 IRBs (every fourth one among the top 240 institutions by NIH funding), and interviewed IRB leaders from 34 of these institutions (response rate = 55%). Data were analyzed using standard qualitative methods, informed by Grounded Theory. IRBs confront financial and non-financial COIs of PIs, institutions, and IRBs themselves. IRB members may seek to help, or compete with, principal investigators (PIs). Non-financial COI also often appear to be "indirect financial" conflicts based on gain (or loss) not to oneself, but to one's colleagues or larger institution. IRBs faced challenges identifying and managing these COI, and often felt that they could be more effective. IRBs' management of their own potential COI vary, and conflicted members may observe, participate, and/or vote in discussions. Individual IRB members frequently judge for themselves whether to recuse themselves. Challenges arise in addressing these issues, since institutions and PIs need funding, financial information is considered confidential, and COI can be unconscious. This study, the first to explore qualitatively how IRBs confront COIs and probe how IRBs confront non-financial COIs, suggests that IRBs face several types of financial and non-financial COIs, involving themselves, PIs, and institutions, and respond varyingly. These data have critical implications for practice and policy. Disclosure of indirect and non-financial COIs to subjects may not be feasible, partly since IRBs, not PIs, are conflicted. Needs exist to consider guidelines and clarifications concerning when and how, in protocol reviews, IRB members should recuse themselves
Full Text Available Abstract Background The upsurge in the uptake of antiretroviral therapy (ART has led to a significant increase in the survival of vertically acquired HIV infected children, many of whom are currently living into adolescence and early adulthood. However little if anything is known of the lived experiences and the challenges faced by HIV positive adolescents in the African context. We set out to investigate psychosocial challenges faced by HIV infected adolescents on the Kenyan coast. Methods A total of 44 participants (12 HIV-infected adolescents, 7 HIV uninfected adolescents, and 25 key informants took part in this qualitative study, using individually administered in-depth interviews. A framework approach was used to analyze the data using NVIVO software. Results We observed that the challenges faced by adolescents in rural Kenya could be placed into six major themes: poverty, poor mental and physical health, the lack of a school system that is responsive to their needs, challenges in how to disclose to peers and family members, high levels of stigma in its various forms, and challenges of medical adherence leading to the need for close monitoring. Conclusion In this African community, vertically acquired HIV-infected adolescents face a complex set of social, economic and medical challenges. Our study points to the urgent need to develop multisectorial intervention support programmes to fully address these challenges.
Shalev, Ariel; Phongtankuel, Veerawat; Lampa, Katherine; Reid, M C; Eiss, Brian M; Bhatia, Sonica; Adelman, Ronald D
The transition into home hospice care is often a critical time in a patient's medical care. Studies have shown patients and caregivers desire continuity with their physicians at the end of life (EoL). However, it is unclear what roles primary care physicians (PCPs) play and what challenges they face caring for patients transitioning into home hospice care. To understand PCPs' experiences, challenges, and preferences when their patients transition to home hospice care. Nineteen semi-structured phone interviews with PCPs were conducted. Study data were analyzed using standard qualitative methods. Participants included PCPs from 3 academic group practices in New York City. Measured: Physician recordings were transcribed and analyzed using content analysis. Most PCPs noted that there was a discrepancy between their actual role and ideal role when their patients transitioned to home hospice care. Primary care physicians expressed a desire to maintain continuity, provide psychosocial support, and collaborate actively with the hospice team. Better establishment of roles, more frequent communication with the hospice team, and use of technology to communicate with patients were mentioned as possible ways to help PCPs achieve their ideal role caring for their patients receiving home hospice care. Primary care physicians expressed varying degrees of involvement during a patient's transition to home hospice care, but many desired to be more involved in their patient's care. As with patients, physicians desire to maintain continuity with their patients at the EoL and solutions to improve communication between PCPs, hospice providers, and patients need to be explored.
Fridman, Ayala; Bakermans-Kranenburg, Marian J; Sagi-Schwartz, Abraham; Van IJzendoorn, Marinus H
The Holocaust has become an iconic example of immense human-made catastrophes, and survivors are now coping with normal aging processes. Childhood trauma may leave the survivors more vulnerable when they are facing stress related to old age, whereas their offspring might have a challenging role of protecting their own parents from further pain. Here we examine the psychological adaptation of Holocaust survivors and their offspring in light of these new challenges, examining satisfaction with life, mental health, cognitive abilities, dissociative symptoms, and physical health. Careful matching of female Holocaust survivors and comparison subjects living in Israel was employed to form a case-control study design with two generations, including four groups: 32 elderly female Holocaust survivors and 47 daughters, and 33 elderly women in the comparison group, and 32 daughters (total N = 174). Participants completed several measures of mental and physical health, and their cognitive functioning was examined. The current study is a follow-up of a previous study conducted 11 years ago with the same participants. Holocaust survivors showed more dissociative symptomatology (odds = 2.39) and less satisfaction with their life (odds = 2.79) as compared to a matched group. Nonetheless, adult offspring of Holocaust survivors showed no differences in their physical, psychological, and cognitive functioning as compared to matched controls. Holocaust survivors still display posttraumatic stress symptoms almost 70 years after the trauma, whereas no intergenerational transmission of trauma was found among the second generation.
Frumence, Gasto; Nyamhanga, Tumaini; Mwangu, Mughwira; Hurtig, Anna-Karin
Decentralised health systems in Tanzania depend largely on funding from the central government to run health services. Experience has shown that central funding in a decentralised system is not an appropriate approach to ensure the effective and efficient performance of local authorities due to several limitations. One of the limitations is that funds from the central government are not disbursed on a timely basis, which in turn, leads to the serious problem of shortage of financial resources for Council Health Management Teams (CHMT). This paper examines how dependency on central government funding in Tanzania affects health activities in Kongwa district council and the strategies used by the CHMT cope with the situation. The study adopted a qualitative approach and data were collected using semi-structured interviews and focus group discussions. One district in the central region of Tanzania was strategically selected. Ten key informants involved in the management of health service delivery at the district level were interviewed and one focus group discussion was held, which consisted of members of the council health management team. The data generated were analysed for themes and patterns. The results showed that late disbursement of funds interrupts the implementation of health activities in the district health system. This situation delays the implementation of some activities, while a few activities may not be implemented at all. However, based on their prior knowledge of the anticipated delays in financial disbursements, the council health management team has adopted three main strategies to cope with this situation. These include obtaining supplies and other services on credit, borrowing money from other projects in the council, and using money generated from cost sharing. Local government authorities (LGAs) face delays in the disbursement of funds from the central government. This has necessitated introduction of informal coping strategies to deal with the
The Mexican Nuclear Research Institute (ININ) played an important role in setting up of nuclear power plants (two) and development of fuel technology. However, with no current plans for expansion of this programme, the Institute is looking mainly into multi-cycle fuel management and life extension issues. The Institute focuses on programmes related to radioisotope and radiation applications and on the use of nuclear technologies for non-nuclear applications. The ININ is the major provider of radioisotopes for medical uses. It also promotes and uses nuclear analytical techniques for addressing a variety of problems. In non-nuclear areas some R and D examples include: the use of thermal plasma for hazardous waste incineration, biodegradation of polymers and development of separation techniques for treating industrial effluents. For preservation of knowledge, the Institute has instituted PhD. programmes in materials science, medical physics and nuclear science in collaboration with a university. (author)
Kaur, Rajanbir; Kaur, Kanwaljit; Kaur, Rajinder
Menstruation and menstrual practices still face many social, cultural, and religious restrictions which are a big barrier in the path of menstrual hygiene management. In many parts of the country especially in rural areas girls are not prepared and aware about menstruation so they face many difficulties and challenges at home, schools, and work places. While reviewing literature, we found that little, inaccurate, or incomplete knowledge about menstruation is a great hindrance in the path of personal and menstrual hygiene management. Girls and women have very less or no knowledge about reproductive tract infections caused due to ignorance of personal hygiene during menstruation time. In rural areas, women do not have access to sanitary products or they know very little about the types and method of using them or are unable to afford such products due to high cost. So, they mostly rely on reusable cloth pads which they wash and use again. Needs and requirements of the adolescent girls and women are ignored despite the fact that there are major developments in the area of water and sanitation. Women manage menstruation differently when they are at home or outside; at homes, they dispose of menstrual products in domestic wastes and in public toilets and they flush them in the toilets without knowing the consequences of choking. So, there should be a need to educate and make them aware about the environmental pollution and health hazards associated with them. Implementation of modern techniques like incineration can help to reduce the waste. Also, awareness should be created to emphasize the use of reusable sanitary products or the natural sanitary products made from materials like banana fibre, bamboo fibre, sea sponges, water hyacinth, and so on.
Full Text Available Menstruation and menstrual practices still face many social, cultural, and religious restrictions which are a big barrier in the path of menstrual hygiene management. In many parts of the country especially in rural areas girls are not prepared and aware about menstruation so they face many difficulties and challenges at home, schools, and work places. While reviewing literature, we found that little, inaccurate, or incomplete knowledge about menstruation is a great hindrance in the path of personal and menstrual hygiene management. Girls and women have very less or no knowledge about reproductive tract infections caused due to ignorance of personal hygiene during menstruation time. In rural areas, women do not have access to sanitary products or they know very little about the types and method of using them or are unable to afford such products due to high cost. So, they mostly rely on reusable cloth pads which they wash and use again. Needs and requirements of the adolescent girls and women are ignored despite the fact that there are major developments in the area of water and sanitation. Women manage menstruation differently when they are at home or outside; at homes, they dispose of menstrual products in domestic wastes and in public toilets and they flush them in the toilets without knowing the consequences of choking. So, there should be a need to educate and make them aware about the environmental pollution and health hazards associated with them. Implementation of modern techniques like incineration can help to reduce the waste. Also, awareness should be created to emphasize the use of reusable sanitary products or the natural sanitary products made from materials like banana fibre, bamboo fibre, sea sponges, water hyacinth, and so on.
de Lesquen, Henri; Beranger, Fabien; Berbis, Julie; Boddaert, Guillaume; Poichotte, Antoine; Pons, Francois; Avaro, Jean-Philippe
This study reports the challenges faced by French military surgeons in the management of thoracic injury during the latest Afghanistan war. From January 2009 to April 2013, all of the civilian, French and Coalition casualties admitted to French NATO Combat Support Hospital situated on Kabul were prospectively recorded in the French Military Health Service Registry (OPEX(®)). Only penetrating and blunt thoracic trauma patients were retrospectively included. Eighty-nine casualties were included who were mainly civilian (61%) and men (94%) with a mean age of 27.9 years old. Surgeons dealt with polytraumas (78%), severe injuries (mean Injury Severity Score=39.2) and penetrating wounds (96%) due to explosion in 37%, gunshot in 53% and stabbing in 9%. Most of casualties were first observed or drained (n=56). In this non-operative group more than 40% of casualties needed further actions. In the operative group, Damage Control Thoracotomy (n=22) was performed to stop ongoing bleeding and air leakage and Emergency Department Thoracotomy (n=11) for agonal patient. Casualties suffered from hemothorax (60%), pneumothorax (39%), diaphragmatic (37%), lung (35%), heart or great vessels (20%) injuries. The main actions were diaphragmatic sutures (n=25), lung resections (wedge n=6, lobectomy n=4) and haemostasis (intercostal artery ligation n=3, heart injury repairs n=5, great vessels injury repairs n=5). Overall mortality was 11%. The rate of subsequent surgery was 34%. The analysis of the OPEX(®) registry reflects the thoracic surgical challenges of general (visceral) surgeons serving in combat environment during the latest Afghanistan War. Copyright © 2016 Elsevier Ltd. All rights reserved.
Simpson, Kweku Bedu; Howard, Peggy Maansah Ankai; Peligah, Y. S.; Cann, Lily Obu
The purpose of the study was to assess the challenges HoDs in Senior High Schools face during instructional supervision. In so doing, the study employed case study and used mixed method approach. In all a total of 92 questionnaires were administered with a response rate of 75.40%. The population consisted of School Heads /Assistant Heads, HoDs and…
District consolidation is a highly emotional process. One key to success is sticking to the facts. In Iowa, school districts facing financial difficulties or enrollment concerns do not have to move directly to consolidation. In many cases, districts begin by developing sharing agreements. These sharing agreements may start with simple sharing of…
Godwin, Debbie; Mahajan, Bhushan; Silcott, Monica; Kjar, Dean
Background/Aims This presentation will focus on challenges faced by new HMO Research Network (HMORN) sites and their experiences with the Virtual Data Warehouse (VDW) tables for version 3 specifications. The step-by-step procedure developed by Scott and White will be showcased to provide a head start for new incoming sites. Sharing lessons learned during our one year in the HMORN VDW, our objective is to provide best practices regarding resources, time allocation, priorities, schedules, financing, backups, and possible available alternatives. Methods The comprehensive procedure followed by Scott & White to build VDW V3 tables: Setting up your SAS Environment Establishing an architecture and components Analyzing and forecasting server specifications; Identifying and understanding the multiple data sorces embedded in your organization Claims data EMR Lab Pharmacy Other; Detailed variable mapping of sources to VDW specifications; Assessment of source data availability; Getting your site’s first feed from the source and following through with quality checks; Methods for building transformation logic for the table; Choosing the methodology to approach table-building. Results We will showcase Scott & White metrics for building a VDW starting with version 3 and best practices used. We improved the validity and completeness of the data through person-to-person interactions with claims personnel who often were disinterested in the needs of research. Having strong advocates who think of research as a part of the institutional mission was helpful. The VDW data team included a sole programmer for the first 6 months along with the Site Data Manager; adding a second programmer improved the rate of progress. Conclusions A structured, step-by-step, approach is recommended for new incoming sites joining the HMORN. This approach will optimize efficiency and effectiveness. The more information and guidance the existing members can provide, the better the achieved results will be
Beger, Hans G
Pancreaticoduodenectomy and left-sided pancreatectomy are the surgical treatment standards for tumors of the pancreas. Surgeons, who are requested to treat patients with benign tumors, using standard oncological resections, face the challenge of sacrificing pancreatic and extra-pancreatic tissue. Tumor enucleation, pancreatic middle segment resection and local, duodenum-preserving pancreatic head resections are surgical procedures increasingly used as alternative treatment modalities compared to classical pancreatic resections. Use of local resection procedures for cystic neoplasms and neuro-endocrine tumors of the pancreas (panNETs) is associated with an improvement of procedure-related morbidity, when compared to classical Whipple OP (PD) and left-sided pancreatectomy (LP). The procedure-related advantages are a 90-day mortality below 1% and a low level of POPF B+C rates. Most importantly, the long-term benefits of the use of local surgical procedures are the preservation of the endocrine and exocrine pancreatic functions. PD performed for benign tumors on preoperative normo-glycemic patients is followed by the postoperative development of new onset of diabetes mellitus (NODM) in 4 to 24% of patients, measured by fasting blood glucose and/or oral/intravenous glucose tolerance test, according to the criteria of the international consensus guidelines. Persistence of new diabetes mellitus during the long-term follow-up after PD for benign tumors is observed in 14.5% of cases and after surgery for malignant tumors in 15.5%. Pancreatic exocrine insufficiency after PD is found in the long-term follow-up for benign tumors in 25% and for malignant tumors in 49%. Following LP, 14-31% of patients experience postoperatively NODM; many of the patients subsequently change to insulin-dependent diabetes mellitus (IDDM). The decision-making for cystic neoplasms and panNETs of the pancreas should be guided by the low surgical risk and the preservation of pancreatic metabolic
This document provides the presentations proposed during the day Cathala-Letort on the challenges of the processes engineering facing the hydrogen-energy. In the context of the greenhouse effect increase and the fossil energies resources decrease, it brings information on researches on hydrogen technologies, carbon dioxide sequestration, hydrogen supply, production, storage and distribution and the thermo-chemical cycles. (A.L.B.)
Nonverbal Learning Disabilities : What kind of communication challenges do parents face when communicating with their children with Nonverbal Learning Disabilities, and what kind of strategies the parents use to overcome the challenges?
Ramos, Alexandra Jacinta
This is a qualitative study that explores and tries to understand what kind of communicational challenges do parents face when communicating with their children with Nonverbal Learning Disabilities, and to comprehend what kind of strategies these parents use to overcome these challenges. The designation of the Nonverbal Learning Disabilities (NLD) was formerly proposed by Johnson and Myklebust. NLD were firstly described by Myklebust as an inability to read and understand nonverbal aspect...
Full Text Available Background: Maternal complications contribute to maternal deaths in developing countries. Bangladesh still has a high prevalence of maternal mortality, which is often preventable. There are some geographically challenging and hard to reach rural districts in Bangladesh and it is difficult to get information about maternal complications in these areas. In this study, we examined the community lay knowledge of possible pregnancy complications. We also examined the common practices associated with complications and we discuss the challenges for the community. Methods: The study was conducted in Moulvibazar of north east Bangladesh, a geographically challenged, difficult to reach district. Qualitative methods were used to collect the information. Pregnant women, mothers who had recently delivered, their guardians and traditional birth attendants participated in focus group discussions. Additionally, in-depth interviews were conducted with the family members. Thematic analyses were performed. Results: The study revealed that there is a lack of knowledge of maternal complications. In the majority of cases, the mothers did not receive proper treatment for maternal complications. There are significant challenges that these rural societies need to address: problems of ignorance, traditional myths and family restrictions on seeking better treatment. Moreover, traditional birth attendants and village doctors also have an important role in assuring appropriate, effective and timely treatment. Conclusions: The rural community lacks adequate knowledge on maternal complications. Reduction of the societal barriers including barriers within the family can improve overall practices. Moreover, dissemination of adequate information to the traditional birth attendant and village doctors may improve the overall situation, which would eventually help to reduce maternal deaths.
Boadu, Nana Yaa; Amuasi, John; Ansong, Daniel; Einsiedel, Edna; Menon, Devidas; Yanow, Stephanie K
Rapid diagnostic Tests (RDTs) for malaria enable diagnostic testing at primary care facilities in resource-limited settings, where weak infrastructure limits the use of microscopy. In 2010, Ghana adopted a test-before-treat guideline for malaria, with RDT use promoted to facilitate diagnosis. Yet healthcare practitioners still treat febrile patients without testing, or despite negative malaria test results. Few studies have explored RDT implementation beyond the notions of provider or patient acceptability. The aim of this study was to identify the factors directly influencing malaria RDT implementation at primary care facilities in a Ghanaian district. Qualitative interviews, focus groups and direct observations were conducted with 50 providers at six purposively selected primary care facilities in the Atwima-Nwabiagya district. Data were analysed thematically. RDT implementation was hampered by: (1) healthcare delivery constraints (weak supply chain, limited quality assurance and control, inadequate guideline emphasis, staffing limitations); (2) provider perceptions (entrenched case-management paradigms, limited preparedness for change); (3) social dynamics of care delivery (expected norms of provider-patient interaction, test affordability); and (4) limited provider engagement in policy processes leading to fragmented implementation of health sector reform. Limited health system capacity, socio-economic, political, and historical factors hampered malaria RDT implementation at primary care facilities in the study district. For effective RDT implementation providers must be: (1) adequately enabled through efficient allocation and management of essential healthcare commodities; (2) appropriately empowered with the requisite knowledge and skill through ongoing, effective professional development; and (3) actively engaged in policy dialogue to demystify socio-political misconceptions that hinder health sector reform policies from improving care delivery. Clear
Groisman, Pavel; Shugart, Herman; Kicklighter, David; Henebry, Geoffrey; Tchebakova, Nadezhda; Maksyutov, Shamil; Monier, Erwan; Gutman, Garik; Gulev, Sergey; Qi, Jiaguo; Prishchepov, Alexander; Kukavskaya, Elena; Porfiriev, Boris; Shiklomanov, Alexander; Loboda, Tatiana; Shiklomanov, Nikolay; Nghiem, Son; Bergen, Kathleen; Albrechtová, Jana; Chen, Jiquan; Shahgedanova, Maria; Shvidenko, Anatoly; Speranskaya, Nina; Soja, Amber; de Beurs, Kirsten; Bulygina, Olga; McCarty, Jessica; Zhuang, Qianlai; Zolina, Olga
During the past several decades, the Earth system has changed significantly, especially across Northern Eurasia. Changes in the socio-economic conditions of the larger countries in the region have also resulted in a variety of regional environmental changes that can have global consequences. The Northern Eurasia Future Initiative (NEFI) has been designed as an essential continuation of the Northern Eurasia Earth Science Partnership Initiative (NEESPI), which was launched in 2004. NEESPI sought to elucidate all aspects of ongoing environmental change, to inform societies and, thus, to better prepare societies for future developments. A key principle of NEFI is that these developments must now be secured through science-based strategies co-designed with regional decision-makers to lead their societies to prosperity in the face of environmental and institutional challenges. NEESPI scientific research, data, and models have created a solid knowledge base to support the NEFI program. This paper presents the NEFI research vision consensus based on that knowledge. It provides the reader with samples of recent accomplishments in regional studies and formulates new NEFI science questions. To address these questions, nine research foci are identified and their selections are briefly justified. These foci include warming of the Arctic; changing frequency, pattern, and intensity of extreme and inclement environmental conditions; retreat of the cryosphere; changes in terrestrial water cycles; changes in the biosphere; pressures on land use; changes in infrastructure; societal actions in response to environmental change; and quantification of Northern Eurasia's role in the global Earth system. Powerful feedbacks between the Earth and human systems in Northern Eurasia (e.g., mega-fires, droughts, depletion of the cryosphere essential for water supply, retreat of sea ice) result from past and current human activities (e.g., large-scale water withdrawals, land use, and governance
HEC numerical modeling and data collection capabilities, and sediment challenges in river and reservoir systems. In addition to the presentations, much...the sediment impact analysis methods (SIAM) in HEC - RAS . In Proceedings, Eighth Joint Federal Interagency Sedimentation Conference. Reno, NV...partnerships, (b) identify both challenges and opportunities in incorporating RSM and EWN into inland river , reservoir, and watershed systems, and (c
An Investigation Into The Impact Of Teaching In Local Languages On Pupils And Teachers Advantages Challenges Opportunities Etc In Selected Primary Schools In Kitwe District Of The Copperbelt Province Of Zambia
Full Text Available The study assessed the impact of teaching in local languages on pupils and teachers of grades one 1 to four 4 advantages challenges opportunities etc in selected primary schools of Kitwe District of Zambia. Recently in response to poor educational outcomes and political pressure a number of Sub-Saharan African countries including Zambia have taken measures to include local languages in their formal education sectors a practice often referred to as mother tongue instruction MTI. Theoretically the eamp64256ect of MTI is ambiguous and a number of studies argue that MTI is superior to second language instruction in facilitating eamp64256ective classroom communication thereby increasing access and quality of education.In view of the aforementioned the objective of the study was to find out the impact of using local language as a medium of instructions to pupils of grades one 1 to four 4 in terms of advantages challenges and opportunities. A survey design which used both quantitative and qualitative aspects of research was used in the study. Questionnaires and interview schedules were used to collect data. The sample included forty five 45 respondents from 20 Primary Schools of Kitwe Districts. Three categories of respondents were identified i Twenty 20 Headmasters School Managers ii Twenty 20 Teachers and iii Five 5 Grade 4 and below pupils.The methods used included three sets of structured questionnaires and personal interviews. The data was analysed using statistical software called STATA. Data was checked for validity reliability identification outliners and normality. The findings of the study revealed that issuing instructions in local language is more beneficial as the pupils grasp things faster pupils participations in classroom improves greatly however some pupils may face language barrier more especially to pupils who come from transfer from other regions and one issue that come out strongly was the lack of teaching and learning materials
Sellappans, Renukha; Lai, Pauline Siew Mei; Ng, Chirk Jenn
The aim of this study was to identify the challenges faced by primary care physicians (PCPs) when prescribing medications for patients with chronic diseases in a teaching hospital in Malaysia. 3 focus group discussions were conducted between July and August 2012 in a teaching primary care clinic in Malaysia. A topic guide was used to facilitate the discussions which were audio-recorded, transcribed verbatim and analysed using a thematic approach. PCPs affiliated to the primary care clinic were purposively sampled to include a range of clinical experience. Sample size was determined by thematic saturation of the data. 14 family medicine trainees and 5 service medical officers participated in this study. PCPs faced difficulties in prescribing for patients with chronic diseases due to a lack of communication among different healthcare providers. Medication changes made by hospital specialists, for example, were often not communicated to the PCPs leading to drug duplications and interactions. The use of paper-based medical records and electronic prescribing created a dual record system for patients' medications and became a problem when the 2 records did not tally. Patients sometimes visited different doctors and pharmacies for their medications and this resulted in the lack of continuity of care. PCPs also faced difficulties in addressing patients' concerns, and dealing with patients' medication requests and adherence issues. Some PCPs lacked time and knowledge to advise patients about their medications and faced difficulties in managing side effects caused by the patients' complex medication regimen. PCPs faced prescribing challenges related to patients, their own practice and the local health system when prescribing for patients with chronic diseases. These challenges must be addressed in order to improve chronic disease management in primary care and, more importantly, patient safety. Published by the BMJ Publishing Group Limited. For permission to use (where not
Town of Cary, North Carolina — View the location of the Town of Cary’s four Town Council districts.Please note that one district, District A, is split into two geo-spatial areas. One area is in...
Louw, Arnt Vestergaard
The findings of the expert group detail the role of youth work and its specific contribution to addressing the challenges young people face, in particular the transition from education to employment. In this context, youth work is defined as 'actions directed towards young people regarding activi...... activities where they take part voluntarily, designed for supporting their personal and social development through non-formal and informal learning'....
Chan Soeung, Sann; Grundy, John; Duncan, Richard; Thor, Rasoka; Bilous, Julian B
Background An international review of the Cambodian Expanded Programme on Immunization (EPI) in 2010 and other data show that despite immunization coverage increases and vaccine preventable diseases incidence reductions, inequities in access to immunization services exist. Utilizing immunization and health systems literature, analysis of global health databases and the EPI review findings, this paper examines the characteristics of immunization access and outcome inequities, and describes proposed longer-term strategic and operational responses to these problems. Findings The national programme has evolved from earlier central and provincial level planning to strengthening routine immunization coverage through the District level ‘Reaching Every District Strategy’. However, despite remarkable improvements, the review found over 20% of children surveyed were not fully immunized, primarily from communities where inequities of both access and impact persist. These inequities relate mainly to socio-economic exposures including wealth and education level, population mobility and ethnicity. To address these problems, a shift in strategic and operational response is proposed that will include (a) a re-focus of planning on facility level to detect disadvantaged communities, (b) establishment of monitoring systems to provide detailed information on community access and utilization, (c) development of communication strategies and health networks that enable providers to adjust service delivery according to the needs of vulnerable populations, and (d) securing financial, management and political commitment for ‘reaching every community’. Conclusions For Cambodia to achieve its immunization equity objectives and disease reduction goals, a shift of emphasis to health centre and community is needed. This approach will maximize the benefits of new vaccine introduction in the coming ‘Decade of Vaccines’, plus potentially extend the reach of other life-saving maternal
Chikumba, Patrick Albert
District pharmacies in Malawi use a computerised IS to monitor the flow of products from a warehouse to health service delivery points and determine understocked or overstocked products at each health facility. Currently, all drug LMIS reports are in tabular forms. The GIS can help health and drug logistics officers to get additional spatial information, such as locations of health facilities and environmental factors, to the existing reports in the form of maps. This paper highlights some opportunities and challenges of applying the GIS in the drug LMIS, which basically involve technologies, organisation, and standards and data integration. It has been found that this idea is very good but it requires much effort, commitment and resources for successful implementation.
In the face of renewed competition from Hollywood since the early 1980s and the challenges posed to Europe's national cinemas by the fall of the Wall in 1989, independent filmmaking in Europe has begun to re-invent itself. European Cinema: Face to Face with Hollywood re-assesses the different
Braim, Kadhim Magdid; McCabe, Scott; Rickly, Jillian; Gadi, Mohamed
Tourism has multiple economic benefits for host countries that receive tourists. Policy makers are becoming more and more aware of the importance that appropriate tourism management has to maximise the benefits that tourism flows can bring. However, many developing countries suffer from a lack of an integrated tourism policy. Particular issues are faced in those countries that are dealing with local conflicts (sometimes over many years). These countries often lack investment in tourism resour...
knowledge the potential of thorium as a fuel source for the future. Notable .... especially one oft criticized for its lack of transparency and accountability? Some of the ... secondary school education was all in Hindi and in college it was English.
Weber, M. C.; Ward, A. S.; Muste, M.
The salinization of groundwater resources is a widespread problem in arid agricultural environments. In Mewat District (Haryana, India), groundwater salinity has rendered much of the accessible supply unfit for human consumption or agriculture. Historically, this closed basin retained fresh pockets of water at the foothills of the Aravalli Hills, where monsoonal precipitation runoff from the mountains was recharged through infiltration or facilitated by man-made structures. To date, an increasing number of pumps supply the region with fresh water for consumption and agriculture leading to shrinking the freshwater zone at an accelerated pace. The potential for increased human consumption corroborated with the effects of climate change bring uncertainty about the future of water security for the Mewat communities, most of them critically bound to the existence of local water. This study addresses the sustainability of the freshwater supply under a range of land interventions and climate scenarios, using a 2-D groundwater flow and transport model. Our results quantify potential futures for this arid, groundwater-dependent location, using numerical groundwater modeling to quantify interactions between human water use, infrastructure, and climate. Outcomes of this modeling study will inform an NGO active in the area on sustainable management of groundwater resources.
Dehnavieh, Reza; Haghdoost, AliAkbar; Khosravi, Ardeshir; Hoseinabadi, Fahime; Rahimi, Hamed; Poursheikhali, Atousa; Khajehpour, Nahid; Khajeh, Zahra; Mirshekari, Nadia; Hasani, Marziyeh; Radmerikhi, Samera; Haghighi, Hajar; Mehrolhassani, Mohammad Hossain; Kazemi, Elaheh; Aghamohamadi, Saeide
Health information systems offer many potential benefits for healthcare, including financial benefits and for improving the quality of patient care. The purpose of District Health Information Systems (DHIS) is to document data that are routinely collected in all public health facilities in a country using the system. The aim of this study was to examine the strengths and operational challenges of DHIS2, with a goal to enable decision makers in different counties to more accurately evaluate the outcomes of introducing DHIS2 into their particular country. A review of the literature combined with the method of meta-synthesis was used to source information and interpret results relating to the strengths and operational challenges of DHIS2. Databases (Embase, PubMed, Scopus and Google Scholar) were searched for documents related to strengths and operational challenges of DHIS2, with no time limit up to 8 April 2017. The review and evaluation of selected studies was conducted in three stages: title, abstract and full text. Each of the selected studies was reviewed carefully and key concepts extracted. These key concepts were divided into two categories of strengths and operational challenges of DHIS2. Then, each category was grouped based on conceptual similarity to achieve the main themes and sub-themes. Content analysis was used to analyse extracted data. Of 766 identified citations, 20 studies from 11 countries were included and analysed in this study. Identified strengths in the DHIS were represented in seven themes (with 21 categories): technical features of software, proper management of data, application flexibility, networking and increasing the satisfaction of stakeholders, development of data management, increasing access to information and economic benefits. Operational challenges were identified and captured in 11 themes (with 18 categories): funds; appropriate communication infrastructure; the need for the existence of appropriate data; political, cultural
Heimbecker, Connie; Bradley-Wilkinson, Evangeline; Begay, Mary Helen; Bradley, Brian; McCarty, Nellie; Nelson, Jacob; Gamble, Armanda; Medina, Catherine; Nelson, Bernita; Pettigrew, Bobbie; Sealander, Karen; Smith, Jody; Snyder, Maria; White, Sherri; Whitehair, Marsha; Redsteer, Denise; Prater, Greg
A study examined the challenges faced by Kayenta Unified School District (KUSD) and outlying communities on the Navajo Reservation in their efforts to adequately provide educational opportunities for their transfer students with special needs. Interviews were conducted with six students from 4th grade through high school; seven parents; special…
Harrison, Mary Kate
With the forthcoming retirement of school foodservice directors, the increasing pressures faced by employees at home and work, and the financial constraints of school districts, recruiting and retaining skilled and diverse employees will be challenging. Marketing work/life benefits to potential employees and supporting these policies to current…
Full Text Available The process of setting up a digital preservation repository in compliance with the OAIS model is not only a technical challenge: libraries also need to develop and maintain appropriate skills and organizations. Digital activities, including digital preservation, are nowadays moving into the mainstream activity of the Library and are integrated in its workflows.The Bibliothèque nationale de France (BnF has been working on the definition of digital preservation activities since 2003. This paper aims at presenting the organizational and human resources challenges that have been faced by the library in this context, and those that are still awaiting us.The library has been facing these challenges through a variety of actions at different levels: organizational changes, training sessions, dedicated working group and task forces, analysis of skills and processes, etc. The results of these actions provide insights on how a national library is going digital, and what is needed to reach this longstanding goal.
Forests play an important socio-economic and environmental role on earth. Exploitation of forest resources within the carrying capacity of the natural ecosystem has always ensured their sustainability but in recent decades man has overexploited these resources to meet various needs. Pakistan with only 4.8% of its total land area under forests was also experiencing unsustainable forest management. In the Siran Watershed of District Mansehra in the North West Frontier Province (NWFP) of Pakistan, forests were exploited to meet not only the domestic and commercial wood-fuel needs but also timber needs of the local and external markets. Moreover, the local communities as a source of income generation have also used forest resources to increase their cash income earnings. Analysis of time series forest cover change in the past three decades was done in three adjacent sub-watersheds having different property right regimes. The GIS based spatial analysis showed that despite government efforts to conserve these forests, 75% of the forests were completely converted either into regeneration area (34%) or barren areas (41 %) during the past three decades. The Protected Forests have lost 41 % of its cover and the Guzara Forests 34%. Results show that the forest degradation stress has greatly increased in the eighties and afterwards. Using stakeholder analysis the key wood demanding stake holders in terms of their wood demand state were the local communities, the external commercial timber consumers, tobacco growers and Afghan refugees. The wood supplies stake holders were the Forest Department that controls the Common Pool Forests (CPF), the Forest Development Corporation (FDC), the Forest Cooperative Societies (FCS) and the farm foresters. Analysis of the cause effect relationship of the system shows that the pressure factors of increased wood demand by various stake holders coupled with the enabling factors of the market failure, government failure and institutional failure
Muslimin, B.; Suadi
Responsible management of fishery resources has been a tradition of Ogan Komering Ilir (OKI) of South Sumatera for generations. It was recorded that since 1630 the Dutch Government had made auction policy for managing water territory in OKI Regency as an effort to preserve nature and to avoid the conflict of inland water ownership. Currently, the community-based management model has been adopted by local governments into formal regulations, known as Regional Regulation on Auction of Flood Water Swamp and Rivers (Lelang Lebak Lebung dan Sungai or L3S). This paper describes the success factors and the threats for the failure of the L3S management model in OKI Regency, based on a case study in Pangkalan Lampam District. The study showed that the management mechanism through the L3S system had been well instituted and become a well-established management practice. The management model is in line with the principle of co-management and the approach has become critical success factor in L3S management. However, ecological, economic and social aspects influence the sustainability of such fishery management model. Besides, L3S management model faces limited data and information related to fish stocks, which result in difficulties in determining the total allowable catch.
Tuthill, Emily L; Chan, Jessica; Butler, Lisa M
Exclusive breastfeeding (EBF) has been identified as the optimal nutrition and critical behavior in attaining human immunodeficiency virus (HIV)-free infant survival in resource-limited settings. Health-care providers (HCPs) in clinic- and community-settings throughout sub-Saharan Africa (sSA) provide infant-feeding counseling. However, rates of EBF at 6 months of age are suboptimal. HCPs are uniquely positioned to educate HIV-positive mothers and provide support by addressing known barriers to EBF. However, limited evidence exists on the experiences faced by HCPs in providing counseling on infant feeding to HIV-positive women. Our objective is to describe experiences faced by HCPs when delivering infant-feeding counseling in the context of HIV in program settings in sSA. We searched a range of electronic databases, including PubMed, CINAHL, and PsycINFO from January 1990 to February 2013, in addition to hand-searching, cross-reference searching, and personal communications. The search was limited to publications in English. Empirical studies of HCP experiences providing infant-feeding counseling in the prevention of mother-to-child transmission (PMTCT) of HIV programs in sSA were selected. We identified 10 peer-reviewed articles reporting HCP challenges in infant-feeding counseling that met inclusion criteria. Articles included qualitative, cross-sectional and mixed-method studies, and cumulatively reported 31 challenges faced by HCPs. Among the challenges identified, the most commonly reported were personal beliefs held by the HCPs toward infant feeding in the context of HIV, contradictory messages, staff workload, directive counseling styles, and a lack of practical strategies to offer mothers, often leading to improvised counseling approaches. Counseling strategies need to be developed that are relevant, meaningful, and responsive to the needs of both HCPs and mothers.
Isabelle, Aaron D.
For students to achieve the goals of the Next Generation Science Standards (NGSS) by Grade 12, thinking and acting like scientists and engineers must begin in the elementary grades. However, elementary teachers may find this challenging -because language arts and mathematics still dominate many classrooms--often at the expense of science. This…
Schlindwein, Ana Flora
Adopting the multiliteracy concept and embracing the challenge of developing meaningful and captivating classes for Portuguese as Foreign Language in Brazil, this paper proposes an approach which includes the use of different technologies to learn and teach Portuguese, the reading of graphic novel adaptations of Brazilian literature classics and…
Günçavdi, Gizem; Göktürk, Söheyda; Bozoglu, Oguzhan
This study aimed to explore the challenges academic women, especially those who were mothers of pre-school age children, went through. The main guiding question of this study was "How do academic mothers with pre-school age children survive in the academia from pregnancy through all the various stages of parenting and motherhood?". This…
Almond, Christopher S D; Chen, Eric A; Berman, Michael R; Less, Joanne R; Baldwin, J Timothy; Linde-Feucht, Sarah R; Hoke, Tracey R; Pearson, Gail D; Jenkins, Kathy; Duncan, Brian W; Zuckerman, Bram D
Pediatric mechanical circulatory support is a critical unmet need in the United States. Infant- and child-sized ventricular assist devices are currently being developed largely through federal contracts and grants through the National Heart, Lung, and Blood Institute (NHLBI). Human testing and marketing of high-risk devices for children raises epidemiologic and regulatory issues that will need to be addressed. Leaders from the US Food and Drug Administration (FDA), NHLBI, academic pediatric community, and industry convened in January 2006 for the first FDA Workshop on the Regulatory Process for Pediatric Mechanical Circulatory Support Devices. The purpose was to provide the pediatric community with an overview of the federal regulatory process for high-risk medical devices and to review the challenges specific to the development and regulation of pediatric mechanical circulatory support devices. Pediatric mechanical circulatory support present significant epidemiologic, logistic, and financial challenges to industry, federal regulators, and the pediatric community. Early interactions with the FDA, shared appreciation of challenges, and careful planning will be critical to avoid unnecessary delays in making potentially life-saving devices available for children. Collaborative efforts to address these challenges are warranted.
Suripto, A.; Sajuti, D.; Aiman, S.; Yuwono, I.; Fathurrachman; Suwarno, H.; Suwardi; Amini, S.; Widjaksana
The proceeding contains papers presented in the Fourth Scientific Presentation on Nuclear Fuel Element Cycle with theme of Technology of Nuclear Fuel Cycle facing the Challenge of Energy Need on the 21 s t Century, held on 1-2 December in Jakarta, Indonesia. These papers were divided by three groups that are technology of exploration, processing, purification and analysis of nuclear materials; technology of nuclear fuel elements and structures; and technology of waste management, safety and management of nuclear fuel cycle. There are 36 papers indexed individually. (ID)
This paper outlines current challenges facing healthcare providers and education providers in trying to ensure Allied Health Professionals (AHPs) are fit for practice, in a climate driven by financial constraints and service improvement directives from the Department of Health (DH). Research was undertaken in 2009 to investigate the current provision of Continuing Professional Development (CPD) in the southwest region of England. The purpose was to define exactly what problems existed with this provision, and to propose changes which could be implemented in order to ensure that the provision meets the needs of stakeholders in future years.
Norman, Laura M.; Hirsch, Derrick D.; Ward, A. Wesley
INTRODUCTION TO THE WORKSHOP PROCEEDINGS Competition for water resources, habitats, and urban areas in the Borderlands has become an international concern. In the United States, Department of Interior Bureaus, Native American Tribes, and other State and Federal partners rely on the U.S. Geological Survey (USGS) to provide unbiased science and leadership in the Borderlands region. Consequently, the USGS hosted a workshop, ?Facing Tomorrow?s Challenges along the U.S.-Mexico Border,? on March 20?22, 2007, in Tucson, Ariz., focused specifically on monitoring, modeling, and forecasting change within the Arizona-Sonora Transboundary Watersheds
Commenting on a recent editorial in this journal which presented four challenges global health networks will have to tackle to be effective, this essay discusses why this type of analysis is important for global health scholars and practitioners, and why it is worth understanding and critically engaging with the complexities behind these challenges. Focusing on the topics of problem definition and positioning, I outline additional insights from social science theory to demonstrate how networks and network researchers can evaluate these processes, and how these processes contribute to better organizing, advocacy, and public health outcomes. This essay also raises multiple questions regarding these processes for future research. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Rivanda Meira Teixeira
Full Text Available Women have gained more and more space in various professional areas and this development also occurs in the field of entrepreneurship. In Brazil GEM 2013 identified for the first time, that the number of new woman entrepreneurs was higher than male entrepreneurs. However, it is recognized that women entrepreneurs face many difficulties when trying to reconcile their companies with the family. The main objective of this research is to analyse the challenges faced by women entrepreneurs of travel agencies to reconcile the conflict between work and family. This study adopted the multiple cases research strategy and were selected seven women creators and managers of travel agencies in the cities of Aracaju and the Barra dos Coqueiros, in the state of Sergipe (east coast of Brazil. In an attempt to reconcile well the multiple roles these women often face the frustration and guilt. At this moment, it shows the importance of emotional contribution of husband and children. It is noticed that the search for balance between the conflicting demands generate emotional distress and / or physical.
Jung, Mary E; Brawley, Lawrence R
Self-regulatory efficacy (SRE) should influence persistence towards goals. Mothers attempting to exercise while managing work and young children (N = 49, M(age) = 35.69, M(children) = 1.88) were stratified into high or low concurrent SRE groups, then randomized to read a hypothetical scenario detailing numerous or minimal exercise barrier conditions. Consistent with self-efficacy theory, when exercise barriers were numerous, mothers with higher concurrent SRE demonstrated greater persistence towards exercise goals, and perceived concurrent management of exercise with their other valued goals as more positively challenging, than mothers with lower concurrent SRE.
Pierce-Weeks, Jennifer; Campbell, Polly
Since 1996, the American Nurses Association has recognized forensic nursing as a formal specialty. Despite this recognition, Sexual Assault Nurse Examiners and Emergency Department nurses struggle with incorporating evidence collection into the care they give the unconscious or comatose patient they suspect has been sexually assaulted. Through case example, this article provides an abbreviated review of the circumstances under which these patients present for care, current challenges, and barriers in upholding the standard of forensic nursing care, as well as proposed interventions for the practicing forensic nurse.
Page, William R.; Parcher, Jean W.; Stefanov, Jim
Natural hazards such as earthquakes, landslides and debris flows, wildfires, hurricanes, and intense storm-induced flash floods threaten communities to varying degrees all along the United States–Mexican border. The U.S. Geological Survey (USGS) collaborates with Federal, State, and local agencies to minimize the effects of natural hazards by providing timely, unbiased science information to emergency response officials, resource managers, and the public to help reduce property damage, injury, and loss of life. The USGS often mobilizes response efforts during and after a natural hazard event to provide technical and scientific counsel on recovery and response, and it has a long history of deploying emergency response teams to major disasters in both domestic and international locations. This chapter describes the challenges of natural hazards in the United States–Mexican border region and the capabilities of the USGS in the fields of hazard research, monitoring, and assessment, as well as preventative mitigation and post-disaster response.
Stuart, Elaine Haycock; Jarvis, Alison; Daniel, Katie
To explore district nurses' workload management, job satisfaction and the challenges they face. This paper reports qualitative findings from a qualitative and quantitative study to identify a district nursing perspective on use of time, challenges and work satisfaction. District nursing is under increasing pressure because of the increasing shift to care in the community, early hospital discharge and changes in demography with an ageing population and more people with chronic illnesses. Qualitative. The study took place in one Scottish Health Board and data were collected in February and March 2005. The qualitative approach involved a total of 31 district nurses and senior managers in focus group discussions or individual interviews. Three main themes were identified: (1) the priorities of district nurses and their views on work unrelated to 'hands on' clinical care, (2) aspects of district nursing considered stressful and (3) district nurses' job satisfaction. District nurses and managers agree that caring work with patients is the priority for the service and provides job satisfaction. Many nurses feel overwhelmed by their workload and have little control over the admission of patients to their caseload; they are mainly demand led and therefore reactive care providers. A culture of long hours has developed as district nurses struggle to meet the needs of patients. Feeling devalued lowers satisfaction and Agenda for Change is perceived as de-valuing the skills of community nurses. More clerical support is required so district nurses can deliver care to patients. District nurses can better represent their workload and how it is managed through expressing the nature of assessing risk and caring for patients as opposed to defining patients care needs by medical diagnoses. Extending the hours of the full district nursing service would benefit patients and staff.
Ahmed, Ayman A.; Diab, Maghawri S.
Wadi Feiran basin is one of the most promising areas in southern Sinai (Egypt) for establishing new communities and for growth in agriculture, tourism, and industry. The present challenges against development include water runoff hazards (flash flooding), the increasing water demand, and water scarcity and contamination. These challenges could be mitigated by efficient use of runoff and rainwater through appropriate management, thereby promoting sustainable development. Strategies include the mitigation of runoff hazards and promoting the natural and artificial recharge of aquifers. This study uses a watershed modeling system, geographic information system, and classification scheme to predict the effects of various mitigation options on the basin's water resources. Rainwater-harvesting techniques could save more than 77% of the basin's runoff (by volume), which could be used for storage and aquifer recharge. A guide map is provided that shows possible locations for the proposed mitigation options in the study basin. Appropriate measures should be undertaken urgently: mitigation of groundwater contamination (including effective sewage effluent management); regular monitoring of the municipal, industrial and agricultural processes that release contaminants; rationalization and regulation of the application of agro-chemicals to farmland; and regular monitoring of contaminants in groundwater. Stringent regulations should be implemented to prevent wastewater disposal to the aquifers in the study area.
Verges, Paul; Galliot, Michel; Mondon, Sylvain; Reysset, Bertrand; Zilli, Dario; Bourcier, Vincent; Duvernoy, Jerome; Omarjee, Younous; Duvat, Virginie; Mossot, Gabrielle; Magnan, Alexandre; Allenbach, Michel; Bocquet, Aurelie; Bonnardot, Francois; Dandin, Philippe; Palany, Philippe; Pontaud, Marc; Porcher, Michel; Delalande, Daniel
This report identifies the social-environmental challenges associated with climate change for French overseas territories, proposes an analysis of the impact of activities of the different economic sectors on the environment, and proposes some principles for action. After an introduction which outlines the importance of addressing climate change and adaptation, and describes the situation of French overseas territories in front of climate change, a first part identifies and discusses the main social-environmental challenges associated with climate change (climate evolution, role of climate change in a context of economic development, the territory as a resource system, climate change considered as an impact chain, the relative weight of climatic uncertainties). Then, the report analyses the potential impacts of climate change on biodiversity, on tourism, on fishing and aquaculture, on agriculture and breeding, on forestry, on health, and on the energy sector. For each of them, the economic weight is indicated and commented, expected impacts are discussed, and adaptation possibilities and implementation modalities are commented. The issue of coastal planning and risks related to climate change is also addressed
Fitzpatrick, Joan; Gray, Floyd; Dubiel, Russell; Langman, Jeff; Moring, J. Bruce; Norman, Laura M.; Page, William R.; Parcher, Jean W.
The prediction of global climate change in response to both natural forces and human activity is one of the defining issues of our times. The unprecedented observational capacity of modern earth-orbiting satellites coupled with the development of robust computational representations (models) of the Earth’s weather and climate systems afford us the opportunity to observe and investigate how these systems work now, how they have worked in the past, and how they will work in the future when forced in specific ways. In the most recent report on global climate change by the Intergovernmental Panel on Climate Change (IPCC; Solomon and others, 2007), analyses using multiple climate models support recent observations that the Earth’s climate is changing in response to a combination of natural and human-induced causes. These changes will be significant in the United States–Mexican border region, where the process of climate change affects all of the Borderlands challenge themes discussed in the preceding chapters. The dual possibilities of both significantly-changed climate and increasing variability in climate make it challenging to take full measure of the potential effects because the Borderlands already experience a high degree of interannual variability and climatological extremes.
Ruschi, Allan; Cardos, Celina; Soares, Felipe; Mariot, Guilherme; Loureiro, Regis R [Petroleo Brasileiro S/A, Petrobras Engineering, Rio de Janeiro/ RJ (Brazil)
The GASENE project is the largest gas pipeline constructed in Brazil in the past 10 years, it interconnects the southeast to the northeast of Brazil. The Cacimbas Catu Gas Pipeline (GASCAC) is a part of the project; it has a 28 inch diameter and is 958 km long. The aim of this paper is to present the construction and assembly process undertaken to meet the deadline and complete the GASCAC to a high quality standard. The main challenges of this project were its length, the short period for completion and the numerous geological and man-made features along the pipeline route. To overcome these difficulties, technologies that had never been used in Brazil before were employed, such as vacuum pipe lifting, bag weights and automatic welding. The GASCAC project was completed in time and with to a high standard of quality, demonstrating that strategic planning and the use of new technologies can increase productivity, quality and safety.
Kaiser, Brooks; Fernandez, Linda; Sundet, Jan
inherent in these species’ introductions. The challenges of effectively managing these species are particularly high, mainly due to their twofold role as invasive species and market commodities. Part of the balancing act needed for a solution to the spread of the RKC has been directed at spatial...... less open to the spread of invasive species are now responsible for the expansiveness of the problem. At stake are unique species and co-evolved systems that have taken millennia to develop. Even small-scale disturbances in the pristine Arctic ecosystems are likely to have outsized impacts both...... on an ecological and on an economic level. This work discusses optimal management approaches regarding threats from invasive species on an international scale in order to delineate international policy characteristics that may reduce overall damages and costs. The purposeful introduction of the Red King Crab (RKC...
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
Parcher, Jean W.; Page, William R.
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.
Compagnone, Christian; Schatman, Michael E; Rauck, Richard L; Van Zundert, Jan; Kraus, Monika; Primorac, Dragan; Williams, Frances; Allegri, Massimo; Saccani Jordi, Gloria; Fanelli, Guido
In recent decades, there has been a revision of the role of institutional review boards with the intention of protecting human subjects from harm and exploitation in research. Informed consent aims to protect the subject by explaining all of the benefits and risks associated with a specific research project. To date, there has not been a review published analyzing issues of informed consent in research in the field of genetic/Omics in subjects with chronic pain, and the current review aims to fill that gap in the ethical aspects of such investigation. Despite the extensive discussion on ethical challenges unique to the field of genetic/Omics, this is the first attempt at addressing ethical challenges regarding Informed Consent Forms for pain research as the primary focus. We see this contribution as an important one, for while ethical issues are too often ignored in pain research in general, the numerous arising ethical issues that are unique to pain genetic/Omics suggest that researchers in the field need to pay even greater attention to the rights of subjects/patients. This article presents the work of the Ethic Committee of the Pain-Omics Group (www.painomics.eu), a consortium of 11 centers that is running the Pain-Omics project funded by the European Community in the 7th Framework Program theme (HEALTH.2013.2.2.1-5-Understanding and controlling pain). The Ethic Committee is composed of 1 member of each group of the consortium as well as key opinion leaders in the field of ethics and pain more generally. © 2016 The Authors. Pain Practice published by Wiley Periodicals, Inc. on behalf of World Institute of Pain.
Full Text Available The aim of the this study was survey of cultural-social and human recourses challenges facing development of information technology in higher education in Iran. The population of this study was all graduate students studying in the Department of the State University in academic year 2010-2011. In first stage, Tehran, Allameh-Tabatabaee, San’ati-Sharif, Isfahan, Shiraz and Kurdistan Universities were selected as samples. Among these universities, 460 patients were randomly selected in proportion. Data were collected via a questionnaire. Reliability using Cronbach's alpha coefficient respectively 0/94, and its validity was confirmed by several professors. The data were calculated using SPSS statistical software and then analyzed. In Descriptive statistics level, indicators of frequency, percentage and standard deviation, and in inferential statistics level, T test, ANOVA and post hoc test was used. The results showed that in cultural-social dimension including the important challenges were the high ratio of computers to students, poor students searching spirit, and lack of English language teachers and students. In human resource dimension are also unfamiliar of the students with the how access to information in databases, shortage or lack of professional expertise in information technology, faculty and administrators do not understand the capabilities of information technology, were most important challenges Information technology in Iran's higher education.
O'Toole, S; Lambert, V; Gallagher, P; Shahwan, A; Austin, J K
Childhood epilepsy not only significantly impacts a child's social relationships and psychosocial wellbeing, but it can also cause disruptions in family relations. Children living with epilepsy often rely on parental figures for guidance in relation to their condition. A paucity of research has examined the challenges for children when communicating about epilepsy with parental figures. This qualitative study explored the challenges faced by children when talking about epilepsy with their parent(s). Semi-structured interviews were conducted with 29 children (aged 6-16 years) living with epilepsy. Participants were recruited from a neurology department of a major pediatric hospital and from a national epilepsy association. Interviews were transcribed verbatim and thematically analyzed. Findings revealed four themes: communication impeding normalcy, parental overprotection, parental reactions to epilepsy-related communication, and restriction of activities as a consequence of epilepsy-related communication. The study highlights the need for a greater understanding of parent-child dialogue surrounding epilepsy and where challenges lie for children in conversing about their condition. Parents and health care professionals play a pivotal role in facilitating an environment where children feel comfortable talking about epilepsy. This information will be instrumental in the development of a communication-based intervention for families living with epilepsy. © The Author(s) 2016.
The challenges posed by the energy turnaround in Germany to the power industry and the national economy after the Fukushima events were the topic of the ''Energy in a Dialog'' meeting organized by the Deutsches Atomforum in Berlin on December 14, 2011. Dr. Ralf Gueldner, President of the Deutsches Atomforum, opened the conference by drawing attention to the real purposes of the energy turnaround, namely to prevent severe climate changes and, thus, also carbon emissions. Both nationally in Germany and worldwide, nuclear power made major contributions to achieving these goals. Referring to developments in many neighboring countries, he underlined that opting out of the use of nuclear power in Germany was not tantamount to the end of nuclear power. Reality in energy policy had to be accepted, however, namely that nuclear power played, and would go on playing, an important role in Europe. Other contributions by Dr. Juergen Grossmann (Chief Executive Officer of RWE AG), Stefan Kohler (Chairman of the Board of Management of the German Energy Agency - dena), and Prof.Dr. Felix Muesgens (Brandenburg Technical University of Cottbus, Chair of Power Economics) dealt with political and other boundary conditions required for the energy turnaround, and with the consequences and burdens on the power industry and the national economy. A final panel discussion chaired by Henning Krumrey (Wirtschaftswoche) was attended by F. Muesgens and Prof. Dr. Hans-Werner Sinn (President of the Munich-based Info Institute) and Prof. Dr. Michael Huether (German Business Institute). (orig.)
Borges, Maria Jucineide Lopes; Sampaio, Aletheia Soares; Gurgel, Idê Gomes Dantas
The complexity of providing healthcare to people with HIV/Aids requires investment in comprehensive action and care, constituting a challenge for the multidisciplinary work teams to build an interdisciplinary practice. This study sought to analyze comprehensive healthcare in the Specialized Assistance Services for HIV/Aids (SAE-HIV/Aids) in Recife, in the State of Pernambuco, starting with the process and organization of team work. This is a case study developed in three SAE-HIV/Aids units, based on a qualitative approach using different research techniques. The results show that SAE-HIV/Aids have complied with most of the Brazilian Health Ministry recommendations in terms of basic infrastructure, though none of them had a team of appropriate size. These services have shown signs of fragmentation and difficulty in establishing a systematic intersectorial and interdisciplinary practice, with failings in ensuring the reference and counter-reference flow. It was seen that there was little appreciation of the role of the manager as team leader. The need to perceive the user as a whole was identified, as well as for the team to work in a coordinated manner in order to ensure communicative and relational activities.
Lauenstein, J M.
An overview is presented of the space radiation environment and its effects on electrical, electronic, and electromechanical parts. Relevant test standards and guidelines are listed. Test standards and guidelines are necessary to ensure best practices, minimize and bound systematic and random errors, and to ensure comparable results from different testers and vendors. Test standards are by their nature static but exist in a dynamic environment of advancing technology and radiation effects research. New technologies, failure mechanisms, and advancement in our understanding of known failure mechanisms drive the revision or development of test standards. Changes to standards must be weighed against their impact on cost and existing part qualifications. There must be consensus on new best practices. The complexity of some new technologies exceeds the scope of existing test standards and may require development of a guideline specific to the technology. Examples are given to illuminate the value and limitations of key radiation test standards as well as the challenges in keeping these standards up to date.
Full Text Available In Human Resource Management (HRM, Recruitment is the first and foremost issue to be considered with full of sincerity, because its role is to create a positive impression about the employer in the job market by ensuring effective stimuli for the job seekers. At the beginning, the study sets a picture that focuses on the importance of effective recruitment in the hospitality sector of Bangladesh and then the study details obligatory determinants of attracting efficient human resource for the development of this sector. The main objective of the paper is to study the status and the scopes of recruitment function in hospitality industry with focus towards star rated residential hotels. This study is based on primary data collection through a formal questionnaire. The questionnaire was of mixed mode with most questions in likert-type scale and few were dichotomous in nature. The key finding of the study is that recruitment is a highly challenging task in hospitality and it is quite evident that attractive compensation package is the key factor to attract potential employees. The need and scope to modernize the recruitment practices along with the line of company and employer branding ideas are also recommended in details. There is a long way to go on the way of conceptualizing and actualizing recruitment functions and practices. A paper like this can help to discuss and debate on the necessity of developing better recruitment cultural and conceptual change in these sectors.
Full Text Available Thirty years ago, starting from a new awareness of the limits of biomedical power and healthcare services to solve all population’ health problems, the Ottawa Conference coined a New Public Health by defining Health Promotion (HP as “the process of enabling people to increase control over and to improve their health and well-being”. Since then and over the next 30 years, several programs have been developed all over the world to translate HP concepts into practical actions and many health successes have been achieved as well. Nowadays, even if the global health context has strongly changed, the original principles of HP still provide a solid ground for action, being the community engagement and empowerment of women and men still at the heart of any health strategy, in a shared responsibility of all society’s sectors approach. However, since now HP promotion efforts have been directed toward priority health problems in a issue- settings-based approach, but in a sustainable and ethical prospective this will be not enough now: a deeper attention on effectiveness is request and an evidence- and value-based HP approach is needed to support the Public Health community and the policy-making, including the new challenges related to Public Health Genomics.
Prieto Gonzalez, Jose Manuel
Full Text Available The current “Barrio Antiguo” (Old Quarter of Monterrey (Mexico, formerly known as "Cathedral Quarter", is a postmodern product arising from the intervention between 1988 and 1994 in a sector called First Square, shortly after the construction of the “Macroplaza” (1979-1985 destroyed a significant part of that same sector. Thus, “Barrio Antiguo” became an example of consciousness cleansing experience. The area is a part of what would become the center of Monterrey, whose physical and conceptual boundaries are still undefined. After a harsh period of degradation in the quarter, especially profound in the context of organized crime and its resulting violence in recent years, the Municipal Institute for Planning and Coexistence of Monterrey (IMPLANC has undertaken the task of regenerating the area. The aim of this lecture is to reveal the difficulties faced by the previously mentioned regeneration, starting with the "inferiority complex" that stirs up among the Monterrey population –traditionally-identified with the official discourse of "greatness"– due to the humility of both the architecture and the vernacular northeastern atmosphere of the quarter, especially when comparisons are made with national historic centers which are World Heritage Sites. El actual Barrio Antiguo de Monterrey, antaño conocido como “Barrio de Catedral”, es un producto posmoderno que surge de la intervención realizada entre 1988 y 1994 en un sector del llamado Primer Cuadro de la ciudad, poco después de que las obras de la Macroplaza (1979-85 destruyeran una parte importante de ese mismo sector. Barrio Antiguo vino a ser así una especie de lavado de conciencia. La zona es una parte de lo que sería el centro histórico de Monterrey, cuyos límites físicos y conceptuales aún están sin definir. Después de una dura etapa de degradación del Barrio, especialmente intensa en el contexto de la ola de violencia de los últimos años, el Instituto
Massett, Holly A; Mishkin, Grace; Rubinstein, Larry; Ivy, S Percy; Denicoff, Andrea; Godwin, Elizabeth; DiPiazza, Kate; Bolognese, Jennifer; Zwiebel, James A; Abrams, Jeffrey S
Accruing patients in a timely manner represents a significant challenge to early phase cancer clinical trials. The NCI Cancer Therapy Evaluation Program analyzed 19 months of corrective action plans (CAP) received for slow-accruing phase I and II trials to identify slow accrual reasons, evaluate whether proposed corrective actions matched these reasons, and assess the CAP impact on trial accrual, duration, and likelihood of meeting primary scientific objectives. Of the 135 CAPs analyzed, 69 were for phase I trials and 66 for phase II trials. Primary reasons cited for slow accrual were safety/toxicity (phase I: 48%), design/protocol concerns (phase I: 42%, phase II: 33%), and eligibility criteria (phase I: 41%, phase II: 35%). The most commonly proposed corrective actions were adding institutions (phase I: 43%, phase II: 85%) and amending the trial to change eligibility or design (phase I: 55%, phase II: 44%). Only 40% of CAPs provided proposed corrective actions that matched the reasons given for slow accrual. Seventy percent of trials were closed to accrual at time of analysis (phase I = 48; phase II = 46). Of these, 67% of phase I and 70% of phase II trials met their primary objectives, but they were active three times longer than projected. Among closed trials, 24% had an accrual rate increase associated with a greater likelihood of meeting their primary scientific objectives. Ultimately, trials receiving CAPs saw improved accrual rates. Future trials may benefit from implementing CAPs early in trial life cycles, but it may be more beneficial to invest in earlier accrual planning. Clin Cancer Res; 22(22); 5408-16. ©2016 AACRSee related commentary by Mileham and Kim, p. 5397. ©2016 American Association for Cancer Research.
Reid, Bernie; Kane, Kay; Curran, Carol
District nursing services in Northern Ireland face increasing demands and challenges which may be responded to by effective and efficient workforce planning and development. The aim of this paper is to critically analyse district nursing workforce planning and development methods, in an attempt to find a suitable method for Northern Ireland. A systematic analysis of the literature reveals four methods: professional judgement; population-based health needs; caseload analysis and dependency-acuity. Each method has strengths and weaknesses. Professional judgement offers a 'belt and braces' approach but lacks sensitivity to fluctuating patient numbers. Population-based health needs methods develop staffing algorithms that reflect deprivation and geographical spread, but are poorly understood by district nurses. Caseload analysis promotes equitable workloads but poorly performing district nursing localities may continue if benchmarking processes only consider local data. Dependency-acuity methods provide a means of equalizing and prioritizing workload but are prone to district nurses overstating factors in patient dependency or understating carers' capability. In summary a mixed method approach is advocated to evaluate and adjust the size and mix of district nursing teams using empirically determined patient dependency and activity-based variables based on the population's health needs.
Research on disability issues in countries of the South is primarily dominated by a focus on generating large scale quantitative data sets. This paper discusses the many challenges, opportunities and dilemmas faced in designing and undertaking a qualitative research study in one district in India. The Disability, Education and Poverty Project…
Meschi, Tiziana; Ticinesi, Andrea; Prati, Beatrice; Montali, Arianna; Ventura, Antonio; Nouvenne, Antonio; Borghi, Loris
Continuous increase of elderly patients with multimorbidity and Emergency Department (ED) overcrowding are great challenges for modern medicine. Traditional hospital organizations are often too rigid to solve them without consistently rising healthcare costs. In this paper we present a new organizational model achieved at Internal Medicine and Critical Subacute Care Unit of Parma University Hospital, Italy, a 106-bed internal medicine area organized by intensity of care and specifically dedicated to such patients. The unit is partitioned into smaller wards, each with a specific intensity level of care, including a rapid-turnover ward (mean length of stay model, compared with other peer units of the hospital and of other teaching hospitals of the region, showed a better performance, efficacy and effectiveness indexes calculated on Regional Hospital Discharge Records database system, allowing a capacity to face a massive (+22 %) rise in medical admissions from the ED. Further studies are needed to validate this model from a patient outcome point of view.
Phillips, Charles D
Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.
Full Text Available This article analyses the various challenges facing use of energy for sustainable tourism development in Zimbabwe on the backdrop of Zimbabwe’s reliance mainly on non-renewable energy sources such as fossil fuels and wood whilst very little use is being made of the abundant renewable sources of energy for instance the sun and wind technologies. It is based on the research carried out with the objective of establishing policies that can promote the sustainable use of renewable energy sources in the country. The findings reveal that stakeholders in the tourism and hospitality industry are largely in favour of formulating and expanding policies that encourage use of solar and wind technologies, at the same time mitigating environmental degradation. The article summarises the findings and duly recommends policies than can be used in Zimbabwe to promote the sustainable use of renewable energy employing solar and wind among others for tourism development.
Maimu Alissa Rehbein
Full Text Available Relative to healthy controls, anxiety-disorder patients show anomalies in classical conditioning that may either result from, or provide a risk factor for, clinically relevant anxiety. Here, we investigated whether healthy participants with enhanced anxiety vulnerability show abnormalities in a challenging affective-conditioning paradigm, in which many stimulus-reinforcer associations had to be acquired with only few learning trials. Forty-seven high and low trait-anxious females underwent MultiCS conditioning, in which 52 different neutral faces (CS+ were paired with an aversive noise (US, while further 52 faces (CS- remained unpaired. Emotional learning was assessed by evaluative (rating, behavioral (dot-probe, contingency report, and neurophysiological (magnetoencephalography measures before, during, and after learning. High and low trait-anxious groups did not differ in evaluative ratings or response priming before or after conditioning. High trait-anxious women, however, were better than low trait-anxious women at reporting CS+/US contingencies after conditioning, and showed an enhanced prefrontal cortex activation towards CS+ in the M1 (i.e., 80 to 117 ms and M170 time intervals (i.e., 140 to 160 ms during acquisition. These effects in MultiCS conditioning observed in individuals with elevated trait anxiety are consistent with theories of enhanced conditionability in anxiety vulnerability. Furthermore, they point towards increased threat monitoring and detection in highly trait-anxious females, possibly mediated by alterations in visual working memory.
Rehbein, Maimu Alissa; Wessing, Ida; Zwitserlood, Pienie; Steinberg, Christian; Eden, Annuschka Salima; Dobel, Christian; Junghöfer, Markus
Relative to healthy controls, anxiety-disorder patients show anomalies in classical conditioning that may either result from, or provide a risk factor for, clinically relevant anxiety. Here, we investigated whether healthy participants with enhanced anxiety vulnerability show abnormalities in a challenging affective-conditioning paradigm, in which many stimulus-reinforcer associations had to be acquired with only few learning trials. Forty-seven high and low trait-anxious females underwent MultiCS conditioning, in which 52 different neutral faces (CS+) were paired with an aversive noise (US), while further 52 faces (CS−) remained unpaired. Emotional learning was assessed by evaluative (rating), behavioral (dot-probe, contingency report), and neurophysiological (magnetoencephalography) measures before, during, and after learning. High and low trait-anxious groups did not differ in evaluative ratings or response priming before or after conditioning. High trait-anxious women, however, were better than low trait-anxious women at reporting CS+/US contingencies after conditioning, and showed an enhanced prefrontal cortex (PFC) activation towards CS+ in the M1 (i.e., 80–117 ms) and M170 time intervals (i.e., 140–160 ms) during acquisition. These effects in MultiCS conditioning observed in individuals with elevated trait anxiety are consistent with theories of enhanced conditionability in anxiety vulnerability. Furthermore, they point towards increased threat monitoring and detection in highly trait-anxious females, possibly mediated by alterations in visual working memory. PMID:26113814
Conflicts of interest (COIs) in research have received increasing attention, but many questions arise about how Institutional Review Boards (IRBs) view and approach these. Methods I conducted in-depth interviews of 2 hours each with 46 US IRB chairs, administrators, and members, exploring COI and other issues related to research integrity. I contacted leaders of 60 IRBs (every fourth one among the top 240 institutions by NIH funding), and interviewed IRB leaders from 34 of these institutions (response rate = 55%). Data were analyzed using standard qualitative methods, informed by Grounded Theory. Results IRBs confront financial and non-financial COIs of PIs, institutions, and IRBs themselves. IRB members may seek to help, or compete with, principal investigators (PIs). Non-financial COI also often appear to be “indirect financial” conflicts based on gain (or loss) not to oneself, but to one's colleagues or larger institution. IRBs faced challenges identifying and managing these COI, and often felt that they could be more effective. IRBs' management of their own potential COI vary, and conflicted members may observe, participate, and/or vote in discussions. Individual IRB members frequently judge for themselves whether to recuse themselves. Challenges arise in addressing these issues, since institutions and PIs need funding, financial information is considered confidential, and COI can be unconscious. Conclusions This study, the first to explore qualitatively how IRBs confront COIs and probe how IRBs confront non-financial COIs, suggests that IRBs face several types of financial and non-financial COIs, involving themselves, PIs, and institutions, and respond varyingly. These data have critical implications for practice and policy. Disclosure of indirect and non-financial COIs to subjects may not be feasible, partly since IRBs, not PIs, are conflicted. Needs exist to consider guidelines and clarifications concerning when and how, in protocol reviews, IRB
Sen, Kasturi; Al-Faisal, Waleed
The past year witnessed considerable turbulence in the Arab world-in this case, Syria, a lower middle-income country with a record of a strong public health infrastructure. This paper explores the current challenges facing its health system from reforms, civil strife and international sanctions all of which we argue have serious implications for population health. The health sector in Syria was little known, and until recently, it was well integrated to provide preventive and specialized care when needed. Regionally, it was one of the few countries ready and capable of addressing the challenges of demographic and epidemiologic transition with a long-standing emphasis on primary care and prevention, unlike most countries of the region. This context has changed dramatically through the recent implementation of reforms and the current civil war. Changes to financing, management and the delivery of health service placed access to services in jeopardy, but now, these are compounded by the destruction from an intractable and violent conflict and international sanctions. This paper explores some of the combined effects of reforms, conflict and sanctions on population health. Copyright © 2013 John Wiley & Sons, Ltd.
Zhang, J.; Zhang, J.; Huo, X.; Zheng, W.; Zheng, X.; Zhang, M.
Historic districts are a special type of cultural heritage, as living cultural heritage, the utilization and development of historical districts is an inevitable issue. How to accurately position the protection and utilization of districts and achieve its healthy and sustainable development is the key work in the protection of districts. In this paper, the Internet data including Tencent's location big data are employed to study some Chinese historic and cultural streets, establish protection and development index system for historic and cultural streets, carry out in-depth study of ten core indicators, and sum up the positioning and development direction for the protection and use of districts. Historic district, as a special type of cultural heritage, is the birthplace and supporting zone of urban context, and also the place for the daily life of the general public. It boasts profound historic and humanistic background and the characteristics of a living form. As the living cultural heritage, its use and development are necessary, and attention shall also be paid to static protection and dynamic comprehensive management. But judging from the current practice, protection and use of historic districts face a host of challenges. Some districts are devoid of popularity and vitality and become cold galleries. Some districts suffer excessive development for tourism and commercialism, and lose its "original" cultural characteristics. In addition, throngs of tourists exert a negative impact on the life of the local people and the protection of immovable cultural relics. Disorderly business format and increasingly similar landscape go against the presentation of local characteristics. We should regard historic district as a dynamic urban heritage, and achieve dynamic development and protection in accordance with its inherent development laws and the principle of "step by step" through the "organic update" mode, with emphasis on the continuous comprehensive management of
Kaveh, Mohammad Hossein; Rokhbin, Moslem; Mani, Arash; Maghsoudi, Ahmad
Introduction: Psychological distress is among physical and mental health threats, and health volunteers can play a critical role in empowerment of women. However, evidence has revealed a decline in health volunteers’ activities. Therefore, the present study aimed to investigate the challenges faced by health volunteers in empowerment of women. Methods: The participants’ knowledge level was assessed using a written test. Their perceived skills were also measured using Coping Inventory for Stressful Situations by Endler and Parker and Chesney’s Coping Self-efficacy Scale, respectively. The study data were entered into the SPSS statistical software, version 11.5 and were analyzed using chi-square, sample t-test, and Pearson’s correlation coefficient. Results: The results showed a considerable increase in the intervention group health volunteers’ knowledge about stress, as well as their self-efficacy. Besides, a significant correlation was observed between self-efficacy and task-oriented strategy scores. However, no significant increase was found in this group’s coping strategies. The results also indicated a significant increase in the intervention group women’s knowledge about stress, but no significant change was observed in other constructs. Some challenging factors, such as managerial, personal, and interpersonal factors, were also detected that might have affected the results. Discussion: This study caused no considerable change in coping with stress, except for increasing the women’s knowledge in this regard. Considering the challenges identified in this study, programs should be developed for researchers and health center managers to improve this condition in future. Creative Commons Attribution License
Agyepong, I A
Many countries in sub-Saharan Africa face the problem of organizing health service delivery in a manner that provides adequate quality and coverage of health care to their populations against a background of economic recession and limited resources. In response to these challenges, different governments, including that of Ghana, have been considering or are in the process of implementing varying degrees of reform in the health sector. This paper examines aspects of health services delivery, and trends in utilization and coverage, using routine data over time in the Dangme West district of the Greater Accra region of Ghana, from the perspective of a district health manager. Specific interventions through which health services delivery and utilization at district level could be improved are suggested. Suggestions include raising awareness among care providers and health managers that increased resource availability is only a success in so far as it leads to improvements in coverage, utilization and quality; and developing indicators of performance which assess and reward use of resources at the local level to improve coverage, utilization and quality. Also needed are more flexibility in Central Government regulations for resource allocation and use; integration of service delivery at district level with more decentralized planning to make services better responsive to local needs; changes in basic and inservice training strategies; and exploration of how the public and private sectors can effectively collaborate to achieve maximum coverage and quality of care within available resources.
This paper uses Queer theory, specifically literature on Bowers v. Hardwick, to analyze debates over legislation proposed in Quebec regarding covered faces. Queer theory sheds light on legal responses to the veil. Parliamentary debates in Quebec reconstitute the polity, notably as secular and united. The paper highlights the contradictory and unstable character of four binaries: legislative text versus social practice, act versus status, majority versus minority, and knowable versus unknowabl...
The recently published Washington International Energy Group's 1993 Electric Utility Outlook states that nearly one-third (31 percent) of U.S. utility executives expect reliability to decrease in the near future. Electric power system stability is crucial to reliability. Stability analysis determines whether a system will stay intact under normal operating conditions, during minor disturbances such as load fluctuations, and during major disturbances when one or more parts of the system fails. All system elements contribute to reliability or the lack of it. However, this report centers on the transmission segment of the electric system. The North American Electric Reliability Council (NERC) says the transmission systems as planned will be adequate over the next 10 years. However, delays in building new lines and increasing demands for transmission services are serious concerns. Reliability concerns exist in the Mid-Continent Area Power Pool and the Mid-America Interconnected Network regions where transmission facilities have not been allowed to be constructed as planned. Portions of the transmission systems in other regions are loaded at or near their limits. NERC further states that utilities must be allowed to complete planned generation and transmission as scheduled. A reliable supply of electricity also depends on adhering to established operating criteria. Factors that could complicate operations include: More interchange schedules resulting from increased transmission services. Increased line loadings in portions of the transmission systems. Proliferation of non-utility generators
aDepartment of Social Work, Bindura University of Science. Education, P. O. Box 1020, ... ultimately stand alone because they are left in a specific time, in a specific .... have divided attention as they sought solace with other women outside ...
Every school budget tells a story--about a district's spending plan, its priorities, goals, and financial health. The challenge is to wade through the jargon and numbers to unlock that story. Although budgets can vary significantly from district to district, and state to state, this primer seeks to introduce reporters to the fundamental components…
Kamuhabwa, Appolinary Ar; Manyanga, Vicky
If children born to HIV-infected mothers are not identified early, approximately 30% of them will die within the first year of life due to opportunistic infections. In order to prevent morbidity and mortality due to opportunistic infections in children, the World Health Organization recommends the use of prophylaxis using co-trimoxazole. However, the challenges affecting effective implementation of this policy in Tanzania have not been documented. In this study, we assessed the challenges facing the provision of co-trimoxazole prophylaxis among children born to HIV-infected mothers in the public hospitals of Dar es Salaam, Tanzania. Four hundred and ninety-eight infants' PMTCT (Prevention of Mother-to-Child Transmission of HIV) register books for the past 2 years were reviewed to obtain information regarding the provision of co-trimoxazole prophylaxis. One hundred and twenty-six health care workers were interviewed to identify success stories and challenges in the provision of co-trimoxazole prophylaxis in children. In addition, 321 parents and guardians of children born to HIV-infected mothers were interviewed in the health facilities. Approximately 80% of children were initiated with co-trimoxazole prophylaxis within 2 months after birth. Two hundred and ninety-one (58.4%) children started using co-trimoxazole within 4 weeks after birth. Majority (n=458, 91.8%) of the children were prescribed 120 mg of co-trimoxazole per day, whereas 39 (7.8%) received 240 mg per day. Only a small proportion (n=1, 0.2%) of children received 480 mg/day. Dose determination was based on the child's age rather than body weight. Parents and guardians reported that 42 (13.1%) children had missed one or more doses of co-trimoxazole during the course of prophylaxis. The majority of health care workers (89.7%) reported that co-trimoxazole is very effective for the prevention of opportunistic infections among children, but frequent shortage of co-trimoxazole in the health facilities was
Erard, Timothee; Chancel, Lucas; Saujot, Mathieu
The authors address three main questions: how are structured the network of actors and the tools for the struggle against fuel poverty, what are the specific data challenges faced by the actors and the possible responses, and which lessons can be learned for the governance of energy transition in its whole. After a presentation of the context of fuel poverty (analysis of tools for the struggle against fuel poverty, the use of social-energetic data), this study, based on about forty interviews of various actors and on a workshop, proposes an analysis framework which distinguishes six steps in the definition and implementation of policies of struggle against fuel poverty. After a description of the current status and an identification of required improvements for each step, the authors propose a set of recommendations, draw lessons for urban policies aimed at an ecologic transformation and a modernisation of the social protection system in terms of level of intervention, scope of actions, and ownership and access to data bases. These recommendations more particularly address the definition of fuel poverty, its diagnosis at the national and at the territorial level, a better identification of concerned households, and an assessment of existing arrangements
Phillips, Charles D.
Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges. PMID:26740744
Full Text Available Starting from the premises that the competitive capacity of the SMEs is determined by their nature: some of them having rapidly growing capacity, others being totally dependent on local or regional markets, the present paper aims to investigate the capacity of SMEs from Bihor county, which carry out export and import activity, to face the challenges of integration in the European Single Market, with the purpose to guide them towards that initiatives and measures that correspond to their nature, by exploiting the possibilities offered by structural funds. The paper presents the general situation of the SMEs from Bihor county focused on those which are part of intra-communitary trade, and, on the base of a questionnaire applied to a number of 50 of them, their perceptions regarding the threats and opportunities of the European Single Market, in order to increase the absorption of structural funds and to design a Euroregional strategy for the SME sector with direct benefits for the economic agents and communities from Romania and Hungary. The paper is based on the preliminary research results of the project called “The encouragement of SMEs which carry out import-export activity from Bihor county regarding the integration in the European Single Market through the development of cross-border business services”, financed by the PHARE CBC 2005 Programme. The data used have been offered for the mentioned project by Local SMEs Council, Oradea.
Full Text Available European cities and regions are facing the crucial challenge of greening their economy towards more sustainable patterns. Politicians and policy-makers should promote new policies for sustainable growth including renewables, greenhouse gas emissions, energy efficiency and biodiversity. All of these aspects can be considered as a boost for local and regional economy. In this regard, European countries and regions can benefit from the Europe 2020 Strategy which is defined as Europe’s blueprint for a smart, sustainable and inclusive future, providing a ten year roadmap for growth and jobs. EU2020S was designed as a European exit strategy from the global economic and financial crisis in view of new European economic governance. This study discusses the above issues regarding Italy and intends to provide some answers on the perspectives of the new EU2020S. It draws from a research project supported by ESPON, the S.I.E.S.T.A. Project, focused on the territorial dimension of the EU2020S. Therefore, this paper aims at analyzing Italian regional patterns on climate change, green economy and energy within the context of EU2020S and at providing policy recommendations for better achieving the goals of the Strategy.
Full Text Available Aim: Both brain tumors and their treatments have a major negative impact on the quality of life (QoL. EORTC BN20 and Functional Assessment of Cancer Therapy-Brain (FACT-BR are the most commonly used tools to assess QoL. The FACT-BR is a 23-item questionnaire, especially about the psychosocial aspects of QoL. This paper describes the challenges we faced during the process of translation and validation of the FACT-BR into Malayalam. Methods: We first screened the patients to ensure their mental status was satisfactory and that they could communicate well in both languages. According to the Functional Assessment of Chronic Illness Therapy methodology, there were two forward translations from English to Malayalam by two independent translators, a reconciliation of the two forward translations, a back-translation into English, a review/finalization by a fifth translator, proofreading, and then testing on a small cohort of patients. Results: The whole process of translation was fraught with small and large hurdles – from small technical issues to the gaps in sociocultural norms. The sub item BR 7, due to the lack of an exact equivalent word, had issues that persisted up to the validation phase. The postquestionnaire debriefing interviews confirmed that the translations were well understood and conceptually equivalent to the original English one. Conclusions: Translation of the FACT-BR into Malayalam nearly completely reproduced the concepts of the original English questionnaire, as proved in the subsequent validation process.
Charles D. Phillips
Full Text Available Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.
Vermont Center for Geographic Information — The Fisheries districts data layer is part of a larger dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset...
Vermont Center for Geographic Information — This dataset is a representation overlay of warden (areas of responsibility). The Vermont Warden Districts layer is part of a dataset that contains administrative...
Vermont Center for Geographic Information — The Forestry Districts layer is part of a dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. This is a layer file which...
Vermont Center for Geographic Information — The Wastewater districts layer is part of a larger dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset includes...
Vermont Center for Geographic Information — The Wildlife Districts layer is part of a larger dataset contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset includes feature...
Vermont Center for Geographic Information — The Parks Districts layer is part of a dataset contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset includes feature classes for...
The case study explores how the expansion of the health services during the interwar period impacted upon the status of district nursing and examines how being a voluntary service shaped district nursing associations. A range of primary sources were used; the Association Annual Reports, the Medical Officer for Health Annual Reports for the Borough of Chelsea, the Ministry of Health records, the archives of the Queen's Nursing Institute (QNI) and the Borough of Chelsea Council Minutes. The Medical Officer for Health Reports and the Council minutes identify efforts to improve environmental factors that impacted upon health. These primary sources briefly note the contribution of the Association suggesting that it was integral to the health care provision but considered a constant. The impact of changes to the 1932 Sunday Entertainments Act provide an interesting juxtaposition between the acknowledged value of district nursing and the constant struggle to fundraise in order to provide home nursing. Throughout the 1930s the Association experienced staff shortages and challenges regarding recruitment. The complexities of payment for municipal health services following the 1929 Local Government Act contributed to the staffing challenges. The move to a block grant in 1938 provided increased stability with regards to income. The case study identifies a contradiction regarding the esteem and value placed upon district nursing associations providing home nursing and the constant challenge of resources. District nursing services face similar challenges and this is the 130 th anniversary of the Queen's Nursing Institute.
Waters, John K.
It was the perfect Halloween project. Each class would construct a three-dimensional "monster" out of common classroom materials (construction paper, cardboard boxes, tape, markers, glue, string, etc.), then write down instructions for building the monster and send them off to another class in the district, or in some other district, or even some…
Developing Academic Literacy and Voice: Challenges Faced by a Mature ESL Student and Her Instructors (Desarrollo del discurso académico y la voz: retos de una estudiante de inglés como segunda lengua y sus profesores)
Drawing on critical, socio-cultural and sociolinguistic theories of writing, text and voice, this ethnographic study examines the challenges that a mature ESL student and her instructors in a university course on Spanish Language Media face as they co-construct a common understanding of academic literacy and voice in an undergraduate General…
Lamperez, Edmond Allen, Jr.; Dereshiwsky, Mary
Student under preparedness is one of the major challenges facing community colleges in the United States. A contributing factor of student under preparedness at the postsecondary level is an inequitable and inadequate distribution of resources at the K-12 level. Students residing in socio-economically disadvantaged school districts that often…
Full Text Available This paper uses Queer theory, specifically literature on Bowers v. Hardwick, to analyze debates over legislation proposed in Quebec regarding covered faces. Queer theory sheds light on legal responses to the veil. Parliamentary debates in Quebec reconstitute the polity, notably as secular and united. The paper highlights the contradictory and unstable character of four binaries: legislative text versus social practice, act versus status, majority versus minority, and knowable versus unknowable. As with contradictory propositions about homosexuality, contradiction does not undermine discourse but makes it stronger and more agile. Este artículo utiliza la teoría Queer, más concretamente la literatura sobre Bowers vs. Hardwick, para analizar los debates sobre la legislación propuesta en Quebec en relación al velo. La teoría Queer arroja luz sobre las respuestas legales al velo. Los debates parlamentarios en Quebec reconstituyen la forma de gobierno, especialmente como secular y unido. El documento pone de relieve el carácter contradictorio e inestable de cuatro binarios: texto legislativo frente a las prácticas sociales; legislación frente a estado; mayoría versus minoría; y conocible frente a incognoscible. Al igual que con las proposiciones contradictorias acerca de la homosexualidad, la contradicción no socava el discurso, sino que lo hace más fuerte y más ágil.
Full Text Available Appolinary AR Kamuhabwa,1 Vicky Manyanga21Unit of Pharmacology and Therapeutics, 2Department of Medicinal Chemistry, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaBackground: If children born to HIV-infected mothers are not identified early, approximately 30% of them will die within the first year of life due to opportunistic infections. In order to prevent morbidity and mortality due to opportunistic infections in children, the World Health Organization recommends the use of prophylaxis using co-trimoxazole. However, the challenges affecting effective implementation of this policy in Tanzania have not been documented.Aim: In this study, we assessed the challenges facing the provision of co-trimoxazole prophylaxis among children born to HIV-infected mothers in the public hospitals of Dar es Salaam, Tanzania.Methodology: Four hundred and ninety-eight infants' PMTCT (Prevention of Mother-to-Child Transmission of HIV register books for the past 2 years were reviewed to obtain information regarding the provision of co-trimoxazole prophylaxis. One hundred and twenty-six health care workers were interviewed to identify success stories and challenges in the provision of co-trimoxazole prophylaxis in children. In addition, 321 parents and guardians of children born to HIV-infected mothers were interviewed in the health facilities.Results: Approximately 80% of children were initiated with co-trimoxazole prophylaxis within 2 months after birth. Two hundred and ninety-one (58.4% children started using co-trimoxazole within 4 weeks after birth. Majority (n=458, 91.8% of the children were prescribed 120 mg of co-trimoxazole per day, whereas 39 (7.8% received 240 mg per day. Only a small proportion (n=1, 0.2% of children received 480 mg/day. Dose determination was based on the child's age rather than body weight. Parents and guardians reported that 42 (13.1% children had missed one or more doses of co
This paper considers a basic question that many schools districts face in attempting to develop affordable, expandable district-wide computer networks that are resistant to obsolescence: Should these wide area networks (WANs) employ wireless technology, stick to venerable hard-wired solutions, or combine both. This publication explores the…
Saprii, Lipekho; Richards, Esther; Kokho, Puni; Theobald, Sally
Globally, there is increasing interest in community health worker's (CHW) performance; however, there are gaps in the evidence with respect to CHWs' role in community participation and empowerment. Accredited Social Health Activists (ASHAs), whose roles include social activism, are the key cadre in India's CHW programme which is designed to improve maternal and child health. In a diverse country like India, there is a need to understand how the ASHA programme operates in different underserved Indian contexts, such as rural Manipur. We undertook qualitative research to explore stakeholders' perceptions and experiences of the ASHA scheme in strengthening maternal health and uncover the opportunities and challenges ASHAs face in realising their multiple roles in rural Manipur, India. Data was collected through in-depth interviews (n = 18) and focus group discussions (n = 3 FGDs, 18 participants). Participants included ASHAs, key stakeholders and community members. They were purposively sampled based on remoteness of villages and primary health centres to capture diverse and relevant constituencies, as we believed experiences of ASHAs can be shaped by remoteness. Data were analysed using the thematic framework approach. Findings suggested that ASHAs are mostly understood as link workers. ASHA's ability to address the immediate needs of rural and marginalised communities meant that they were valued as service providers. The programme is perceived to be beneficial as it improves awareness and behaviour change towards maternal care. However, there are a number of challenges; the selection of ASHAs is influenced by power structures and poor community sensitisation of the ASHA programme presents a major risk to success and sustainability. The primary health centres which ASHAs link to are ill-equipped. Thus, ASHAs experience adverse consequences in their ability to inspire trust and credibility in the community. Small and irregular monetary incentives demotivate
This paper presented an analysis of the technical and economic characteristics of district energy in Ontario. The market context for district energy was evaluated, and institutional issues that may influence the future development and operation of district energy systems in Ontario were explored. Technical, economic, and environmental analyses of district energy based on different neighbourhood sizes, types, and district energy systems were presented. Three case studies were included to demonstrate real world district energy applications. A set of interviews conducted with representatives of the province's district energy supply chain was also provided in order to provide a framework for district energy opportunities and challenges within the province. 22 tabs., 16 figs.
Li, Yu; Rezgui, Yacine
District heating (DH) is a promising energy pathway to alleviate environmental negative impacts induced by fossil fuels. Improving the performance of DH systems is one of the major challenges facing its wide adoption. This paper discusses the heat losses of the next generation DH based on the constructed Simulink model. Results show that lower distribution temperature and advanced insulation technology greatly reduce network heat losses. Also, the network heat loss can be further minimized by a reduction of heat demand in buildings.
Espinosa, Ruben W.
The educational community and the courts continue to struggle with the challenges of intra-district resource inequality revealed by the California Supreme Court landmark case "Rodriguez v. Los Angeles Unified School District" (1992). Intra-district school resource inequality is one of the remaining bastions of major inequalities in the…
Measuring regional and district variations in the incidence of pregnancy-induced hypertension in Ghana: challenges, opportunities and implications for maternal and newborn health policy and programmes.
Antwi, Edward; Klipstein-Grobusch, Kerstin; Quansah Asare, Gloria; Koram, Kwadwo A; Grobbee, Diederick; Agyepong, Irene A
The objectives were to assess the quality of health management information system (HMIS) data needed for assessment of local area variation in pregnancy-induced hypertension (PIH) incidence and to describe district and regional variations in PIH incidence. A retrospective review of antenatal and delivery records of 2682 pregnant women in 10 district hospitals in the Greater Accra and Upper West regions of Ghana was conducted in 2013. Quality of HMIS data was assessed by completeness of reporting. The incidence of PIH was estimated for each district. Key variables for routine assessment of PIH such as blood pressure (BP) at antenatal visits, weight and height were 95-100% complete. Fundal height, gestational age and BP at delivery were not consistently reported. The incidence of PIH differed significantly between Greater Accra region (6.1%) and Upper West region (3.2%). Prevalence of obesity among pregnant women in Greater Accra region (13.9%) was significantly higher than that of women in Upper West region (2.2%). More attention needs to be given to understanding local area variations in PIH and possible relationships with urbanisation and lifestyle changes that promote obesity, to inform maternal and newborn health policy. This can be done with good quality routine HMIS data. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.
Smith, Shirley G.; Firmin, Michael W.
This is a phenomenological study of 25 school nurses employed in a large, urban school district in the midwestern section of the United States. In addition to school nursing, the participants also had professional work experience in other nursing specialties. Thematic analysis of the data focused on the challenges faced by the school nurses, their…
Charles D. Phillips
Full Text Available The vast majority of assessment instruments developed to assess children facing special healthcare challenges were constructed to assess children within a limited age range or children who face specific conditions or impairments. In contrast, the interRAI Pediatric Home Care (PEDS HC Assessment Form was specifically designed to assess the long-term community-based service and support needs of children and youth aged from four to 20 years who face a wide range of chronic physical or behavioral health challenges. Initial research indicates that PEDS HC items exhibit good predictive validity–-explaining significant proportions of the variance in parents’ perceptions of needs, case managers’ service authorizations, and Medicaid program expenditures for long-term community-based services and supports. In addition, PEDS HC items have been used to construct scales that summarize the strengths and needs of children facing special healthcare challenges. Versions of the PEDS HC are now being used in Medicaid programs in three states in the United States.
Therefore, this study assessed students‟ perception on Intensive Face to Face sessions. The study specifically aimed at identifying students‟ perception on quality of interaction between tutors and students and between students on the other hand. It also explored the nature of challenges students meet in attending face to ...
Thibault, K. M.
of tasks that previously required hours to days of each data user's time, with decreased error rates and increased useability of the data. The Ecological Data wiki (ecologicaldata.org) provides a forum for users of ecological datasets to share relevant metadata and tips and tricks for using the data, in order to flatten learning curves, as well as minimize redundancy of efforts among users of the same datasets. Finally, Software Carpentry (software-carpentry.org) has developed curricula for scientific computing and provides both online training and low cost, short courses that can be tailored to the specific needs of the students. Demand for these courses has been increasing exponentially in recent years, and represent a significant educational resource for biologists. I will conclude by linking these initiatives to the challenges facing ecologists related to the effective and efficient exploitation of NEON's diverse data streams.
Santemiz, P.; Spreeuwers, Lieuwe Jan; Veldhuis, Raymond N.J.
Side-view face recognition is a challenging problem with many applications. Especially in real-life scenarios where the environment is uncontrolled, coping with pose variations up to side-view positions is an important task for face recognition. In this paper we discuss the use of side view face
Managing Plan Implementation in the Asante Akyem South District Assembly: Capacity Issues and Challenges. ... This paper uses a case study approach to appraise the capacity of the Asante Akyem South District Assembly (AASDA) in ...
Toledo, Chelsea E; Jacobson, Julie; Wainwright, Emily C; Ottesen, Eric A; Lammie, Patrick J
While global programs targeting the control or elimination of five of the neglected tropical diseases (NTDs)-lymphatic filariasis, onchocerciasis, soil-transmitted helminthiasis, schistosomiasis and trachoma-are well underway, they still face many operational challenges. Because of the urgency of 2020 program targets, the Bill & Melinda Gates Foundation and the U.S. Agency for International Development devised a novel rapid research response (RRR) framework to engage national programs, researchers, implementers and WHO in a Coalition for Operational Research on NTDs. After 2 years, this effort has succeeded as an important basis for the research response to programmatic challenges facing NTD programs. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.
Lei, Zhen; Pietikäinen, Matti; Li, Stan Z
Local feature descriptor is an important module for face recognition and those like Gabor and local binary patterns (LBP) have proven effective face descriptors. Traditionally, the form of such local descriptors is predefined in a handcrafted way. In this paper, we propose a method to learn a discriminant face descriptor (DFD) in a data-driven way. The idea is to learn the most discriminant local features that minimize the difference of the features between images of the same person and maximize that between images from different people. In particular, we propose to enhance the discriminative ability of face representation in three aspects. First, the discriminant image filters are learned. Second, the optimal neighborhood sampling strategy is soft determined. Third, the dominant patterns are statistically constructed. Discriminative learning is incorporated to extract effective and robust features. We further apply the proposed method to the heterogeneous (cross-modality) face recognition problem and learn DFD in a coupled way (coupled DFD or C-DFD) to reduce the gap between features of heterogeneous face images to improve the performance of this challenging problem. Extensive experiments on FERET, CAS-PEAL-R1, LFW, and HFB face databases validate the effectiveness of the proposed DFD learning on both homogeneous and heterogeneous face recognition problems. The DFD improves POEM and LQP by about 4.5 percent on LFW database and the C-DFD enhances the heterogeneous face recognition performance of LBP by over 25 percent.
The small goat holders to face food security, poverty and environmental challenges: conditions for experiencing successful projects : Lessons from a comparative analysis in different regions of the world (governance, markets, production systems)
Farming and agri-food systems have to face urgent social and environmental issues linked between them within the Millennium Development Goals firmed by the International Community. Poverty reduction and food safety is considered as a major challenge as at least 800 million people are suffering hunger and extreme poverty particularly in rural areas. The development of livestock for small holders is often seen as a solution to reduce poverty To explore and document the operational articulation ...
David F Nichols
Full Text Available A great challenge to the field of visual neuroscience is to understand how faces are encoded and represented within the human brain. Here we show evidence from functional magnetic resonance imaging (fMRI for spatially distributed processing of the whole face and its components in face-sensitive human visual cortex. We used multi-class linear pattern classifiers constructed with a leave-one-scan-out verification procedure to discriminate brain activation patterns elicited by whole faces, the internal features alone, and the external head outline alone. Furthermore, our results suggest that whole faces are represented disproportionately in the fusiform cortex (FFA whereas the building blocks of faces are represented disproportionately in occipitotemporal cortex (OFA. Faces and face components may therefore be organized with functional clustering within both the FFA and OFA, but with specialization for face components in the OFA and the whole face in the FFA.
Background Widespread parasite resistance to first-line treatment for uncomplicated malaria leads to introduction of new drug interventions. Introducing such interventions is complex and sensitive because of stakeholder interests and public resistance. To enhance take up of such interventions, health policy communication strategies need to deliver accurate and accessible information to empower communities with necessary information and address problems of cultural acceptance of new interventions. Objectives To explore community understanding of policy changes in first-line treatment for uncomplicated malaria in Kenya; to evaluate the potential role of policy communication in influencing responses to changes in first-line treatment policy. Methods Data collection involved qualitative strategies in a remote district in the Kenyan Coast: in-depth interviews (n = 29), focus group discussions (n = 14), informal conversations (n = 11) and patient narratives (n = 8). Constant comparative method was used in the analysis. Being malaria-prone and remotely located, the district offered an ideal area to investigate whether or not and how policy communication about a matter as critical as change of treatment policy reaches vulnerable populations. Results Three years after initial implementation (2009), there was limited knowledge or understanding regarding change of first-line treatment from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (AL) for treatment of uncomplicated malaria in the study district. The print and electronic media used to create awareness about the drug change appeared to have had little impact. Although respondents were aware of the existence of AL, the drug was known neither by name nor as the official first-line treatment. Depending on individuals or groups, AL was largely viewed negatively. The weaknesses in communication strategy surrounding the change to AL included poor choice of communication tools, confusing
Full Text Available ... Basics PTSD Treatment What is AboutFace? Resources for Professionals Get Help Home Watch Videos by Topic Videos ... Basics PTSD Treatment What is AboutFace? Resources for Professionals Get Help PTSD We've been there. After ...
Full Text Available ... Treatment What is AboutFace? Resources for Professionals Get Help Home Watch Videos by Topic Videos by Type ... Treatment What is AboutFace? Resources for Professionals Get Help PTSD We've been there. After a traumatic ...
Wang, Jianfeng; Yuan, Ye; Yu, Gang
The performance of face detection has been largely improved with the development of convolutional neural network. However, the occlusion issue due to mask and sunglasses, is still a challenging problem. The improvement on the recall of these occluded cases usually brings the risk of high false positives. In this paper, we present a novel face detector called Face Attention Network (FAN), which can significantly improve the recall of the face detection problem in the occluded case without comp...
Stroke is a major cause of long-term disability. Information regarding the limitations in activity and participation experienced by patients with stroke in a specific setting such as Musanze district in Rwanda would assist to develop the rehabilitation programmes that would take into consideration the functional challenges experienced post stroke. To explore the activity limitations and participation restrictions experienced by people with stroke in Musanze district in Rwanda. A qualitative phenomenological approach using in-depth face-to-face interviews with 10 participants was employed to gather the data that was analyzed using a qualitative thematic approach. The themes that arose as activity limitations included limitations in walking, self care, and domestic life activities. The themes related to participation restrictions as expressed by the participants were inability to return to previous occupation, decreased social interactions and inability to participate in religious activities. The current study findings highlight the need for interventions to improve the functional status of stroke survivors.
Sørensen, Mette-Marie Zacher
artist Marnix de Nijs' Physiognomic Scrutinizer is an interactive installation whereby the viewer's face is scanned and identified with historical figures. The American artist Zach Blas' project Fag Face Mask consists of three-dimensional portraits that blend biometric facial data from 30 gay men's faces...... and critically examine bias in surveillance technologies, as well as scientific investigations, regarding the stereotyping mode of the human gaze. The American artist Heather Dewey-Hagborg creates three-dimensional portraits of persons she has “identified” from their garbage. Her project from 2013 entitled...
Robotham, Julia Emma; Lindegaard, Martin Weis; Delfi, Tzvetelina Shentova
unilateral lesions, we found no patient with a selective deficit in either reading or face processing. Rather, the patients showing a deficit in processing either words or faces were also impaired with the other category. One patient performed within the normal range on all tasks. In addition, all patients......It has long been argued that perceptual processing of faces and words is largely independent, highly specialised and strongly lateralised. Studies of patients with either pure alexia or prosopagnosia have strongly contributed to this view. The aim of our study was to investigate how visual...... perception of faces and words is affected by unilateral posterior stroke. Two patients with lesions in their dominant hemisphere and two with lesions in their non-dominant hemisphere were tested on sensitive tests of face and word perception during the stable phase of recovery. Despite all patients having...
Full Text Available For students who are actively engaged in social justice efforts on their college/university campuses, the transition from a relatively easy platform for engagement to the “real world” can pose significant challenges and create new realities for negotiation. Little is known, however, about the nature of these transitions into post-graduate social justice experiences. Drawing on an open-ended survey of recent graduates (92 respondents, 50% response rate from a social justice minor in a school of social work, we explore the ways in which respondents described their transitions into social justice work, focusing on a set of key challenges that emerged from our analysis and reflecting on the implications of these challenges for social work practice and future research. Understanding some of the challenges in making this transition will help social work and non-profit administrators to better support this population’s future volunteer, service, and employment needs.
Conclusion: South Africa’s HRH strategy for the Health Sector 2012/13–2015/16 had highlighted the key challenges raised by respondents and identified strategies aimed at addressing these challenges. Implementation of these strategies is key to improving both living and working conditions, and providing health personnel with opportunities for further development will require inter-ministerial collaboration if the HRH 2030 objectives are to be realised.
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Full Text Available ... not feeling better, you may have PTSD (posttraumatic stress disorder). Watch the intro This is AboutFace In these videos, Veterans, family members, and clinicians share their experiences with PTSD ...
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Lund, Henrik; Werner, Sven; Wiltshire, Robin
This paper defines the concept of 4th Generation District Heating (4GDH) including the relations to District Cooling and the concepts of smart energy and smart thermal grids. The motive is to identify the future challenges of reaching a future renewable non-fossil heat supply as part...... of the implementation of overall sustainable energy systems. The basic assumption is that district heating and cooling has an important role to play in future sustainable energy systems – including 100 percent renewable energy systems – but the present generation of district heating and cooling technologies will have...
Full Text Available This study crafts a policy framework for sustainable utilisation of farmland for the Waterberg District Municipality in South Africa. The district, being predominantly agricultural and rural, faces contention in terms of land allocation...
Full Text Available The district heating (DH system of Greece, mainly supported from lignite fired stations, is facing lately significant challenges. Stricter emission limits, decreased efficiency due to old age and increased costs are major challenges of the lignite sector and are expected to result in the decommissioning of several lignite-fired units in the coming years. As a result, managers of DH networks are currently investigating alternative scenarios for the substitution of thermal power that it is expected to be lost, through the integration of Renewable Energy Sources (RES into the system. In this paper, the DH systems of Kozani and Ptolemaida are examined regarding possible introduction of RES. The first study examines district heating of Kozani and alternative future options for covering a part of city’s thermal load whereas the second study refers to a biomass CHP plant (ORC technology, 1MWe, 5MWth to be powered from a biomass mixture (wood chips and straw.
The environmental risks and uncertainties of a high-energy future are disturbing and give rise to several reservations concerning the use of fossil fuels. A number of technologies will help to reduce atmospheric pollution. In Denmark special importance is attached to the following: Energy conservation. Efficient energy conversion. Renewable energy sources. District heating, combined production of heat and power. Many agree that district heating (DH), produced by the traditional heat-only plant, and combined heat and power (CHP) have enormous potential when considering thermal efficiency and lowered environmental impacts: The basic technology of each is proven, it would be relatively simple to satisfy a substantial part of the energy demand, and their high efficiencies mean reduced pollution including greenhouse gas emissions. This is especially important in high population density areas - the obviously preferred sites for such energy generation. Compared with individual heating DH can provide a community with an operationally efficient and most often also an economically competitive heat supply. This is particularly true under the circumstances where the DH system is supplied from CHP plants. Their use results in very substantial improvements in overall efficiency. Further environmental improvements arise from the reduced air pollution obtainable in reasonably large CHP plants equipped with flue gas cleaning to remove particles, sulphur dioxide, and nitrogen acids. As a consequence of these considerations, DH plays an important role in fulfilling the space and water heating demand in many countries. This is especially the case in Denmark where this technology is utilised to a very great extent. Indeed, DH is one of the reasons why Denmark has relatively good air quality in the cities. (au)
This report, based on clinical practice on a childrenÃ¢Â€Â™s ward in New Zealand, examines the role of short-term music therapy in supporting children and their parents facing the difficulties of hospitalisation. It endeavours to explore three questions. How might music therapy support hospitalised children? How can it support parents of hospitalised children? Is it important/valuable for music therapists working in a paediatric ward to involve parent(s) in music therapy sessions? Three ho...
Full Text Available Historic districts are a special type of cultural heritage, as living cultural heritage, the utilization and development of historical districts is an inevitable issue. How to accurately position the protection and utilization of districts and achieve its healthy and sustainable development is the key work in the protection of districts. In this paper, the Internet data including Tencent’s location big data are employed to study some Chinese historic and cultural streets, establish protection and development index system for historic and cultural streets, carry out in-depth study of ten core indicators, and sum up the positioning and development direction for the protection and use of districts. Historic district, as a special type of cultural heritage, is the birthplace and supporting zone of urban context, and also the place for the daily life of the general public. It boasts profound historic and humanistic background and the characteristics of a living form. As the living cultural heritage, its use and development are necessary, and attention shall also be paid to static protection and dynamic comprehensive management. But judging from the current practice, protection and use of historic districts face a host of challenges. Some districts are devoid of popularity and vitality and become cold galleries. Some districts suffer excessive development for tourism and commercialism, and lose its “original” cultural characteristics. In addition, throngs of tourists exert a negative impact on the life of the local people and the protection of immovable cultural relics. Disorderly business format and increasingly similar landscape go against the presentation of local characteristics. We should regard historic district as a dynamic urban heritage, and achieve dynamic development and protection in accordance with its inherent development laws and the principle of “step by step” through the “organic update” mode, with emphasis on the
Maretha De Waal
Full Text Available Because of its potential self-sustainability, communities of practice may serve as useful practice-based knowledge sharing platforms for collaborative research and training, and thereby enhance development of human resources in the health sector. However, communities of practice are complex structures and need support from their host organisations and commitment from their members. This article examines the diverse ways in which communities of nurse educators and practitioners who were part of a funded program in Tshwane District, South Africa evolved over a period of seven years. Adopting an ethnographic approach of reflexivity and learning, we compared and analysed the ways in which the communities of practice became sustainable over time. Our recommendations for institutional support of communities of practice in the health sector are based on the lessons we learned during the program that contributed to the configuration and reconfiguration of some of our communities of practice and the disengagement of others. We believe that our findings may have implications for replicability and sustainability of other communities of practice. Keywords: collaborative learning, collective knowledge, self-sustainability
Dodo, Obediah; Makwerere, David; Parwada, Matavire; Parwada, Cosmas
After realizing that the traditional modes of tuition in Zimbabwe's andragogy had either gone obsolete or over-crowded, BUSE ventured into a "virtualised" model of open and distance learning as a way of out-doing other competing universities. However, as the programme was rolled out, there came a myriad of challenges affecting the…
Reza MOHAMMADY GARFAMY
Full Text Available This paper provides a comparison study of industrial districts in two European countries, Spain and Sweden, using the conceptual framework of corporation. The relevance of this approach is based on the specific qualities that the industrial districts have, including the preexisting conditions, local traditions, products and production characteristics, marketing strategies, local policies and present challenges. The findings indicate the ways in which different patterns of inter-firm relationships, organization of production and dynamics of local alliances have shaped divergent regional responses to the industrial construction.
The history of district nursing in Australia explored in this paper reveals a continuity in the essential values held by district nurses for over a century. These nurses practised holistic, family-centred nursing from the very origins of district nursing service. The events surrounding the establishment of Community Health Centres in the 1970s challenged district nurses to reconsider their role, while at the same time reconfirming their essential ethos. These values that underpinned district nursing practice and challenges to these values are examined in this paper.
Knowledge Shumba; Stanislous Zindiye; Gift Donga
Franchising plays a pivotal role in sustainable economic development through employment creation, improving the standards of living and increasing the growth of entrepreneurship worldwide. However, the volatile business environment in Zimbabwe has a negative impact on the growth of franchising in the fast food industry. The aim of the study was to uncover the challenges of franchising in a volatile business environment in Zimbabwe. The study focused on an under studied area of franchising in ...
Full Text Available ... at first. But if it's been months or years since the trauma and you're not feeling better, you may have PTSD (posttraumatic stress disorder). Watch the intro This is AboutFace In these videos, Veterans, family members, ...
Full Text Available ... What is AboutFace? Resources for Professionals Get Help PTSD We've been there. After a traumatic event — ... you're not feeling better, you may have PTSD (posttraumatic stress disorder). Watch the intro This is ...
Santemiz, P.; Spreeuwers, Lieuwe Jan; Veldhuis, Raymond N.J.; van den Biggelaar, Olivier
As a widely used biometrics, face recognition has many advantages such as being non-intrusive, natural and passive. On the other hand, in real-life scenarios with uncontrolled environment, pose variation up to side-view positions makes face recognition a challenging work. In this paper we discuss
Background It is widely accepted that emotion processing difficulties are involved in Autism Spectrum Conditions (ASC). An increasing number of studies have focused on the development of training programs and have shown promising results. However, most of these programs are appropriate for individuals with high-functioning ASC (HFA) but exclude individuals with low-functioning ASC (LFA). We have developed a computer-based game called JeStiMulE based on logical skills to teach emotions to individuals with ASC, independently of their age, intellectual, verbal and academic level. The aim of the present study was to verify the usability of JeStiMulE (which is its adaptability, effectiveness and efficiency) on a heterogeneous ASC group. We hypothesized that after JeStiMulE training, a performance improvement would be found in emotion recognition tasks. Methods A heterogeneous group of thirty-three children and adolescents with ASC received two one-hour JeStiMulE sessions per week over four weeks. In order to verify the usability of JeStiMulE, game data were collected for each participant. Furthermore, all participants were presented before and after training with five emotion recognition tasks, two including pictures of game avatars (faces and gestures) and three including pictures of real-life characters (faces, gestures and social scenes). Results Descriptive data showed suitable adaptability, effectiveness and efficiency of JeStiMulE. Results revealed a significant main effect of Session on avatars (ANOVA: F (1,32) = 98.48, P Emotion interaction was also found for avatars (ANOVA: F (6,192) = 2.84, P = .01). This triple interaction was close to significance for pictures of real-life characters (ANOVA: F (12,384) = 1.73, P = .057). Post-hoc analyses revealed that 30 out of 35 conditions found a significant increase after training. Conclusions JeStiMulE appears to be a promising tool to teach emotion recognition not only to individuals with HFA but
Full Text Available Background: Providing cooked food to about hundred million children under mid-day meal scheme has been accomplished. Focus has now shifted to delivery of nutrition since the National Food Security Act specifies statutory quantities of protein and calories. Aims & Objectives: Delivery of nutrition requires comprehensive overhaul to include interventions in area of storage, preparation and practices, stoves, human resource development and community participation. Methodology: Based on a baseline survey of 70 schools through random selection in two blocks of Faizabad, Uttar Pradesh these concerns were investigated in details for specific interventions. Results: Nutrition: Both Faizabad and MHRD’s all India data establish that net quantities consumed by a child (quantity served minus plate waste cannot provide prescribed nutrition. It reiterated the fact that mid-day meal is first and major meal for most rural children. Experiments conducted to standardize quantities, consistencies and splitting meal into snack plus meal improved nutritional delivery. Hygiene and food safety: In both blocks food was delivered at high temperature enabling food safety standards to be met with improved hygiene and Standard Operating Procedures (SOPs. Human Resource: A pictorial training manual was prepared to train master trainers as well as cooks. Location specific training using local idiom and practices were used and campaign was conducted to enhance community participation in 45 villages. Fuel efficiency: Low cost smokeless chullahs (stoves designed locally resulted in fuel savings. High efficiency cook stoves were also tested, however their cost limits reproduction. Conclusion: Accomplishing comprehensive improvement within existing cost of conversion per child is a challenge particularly since there are no economies of scale in rural areas. The methodologies created in the pilot for hygiene and food safety, awareness and capacity building through
As policy directives gather pace for service provision to be delivered in primary care, district nursing has not been recognised as a valuable asset to facilitate this agenda. Investment in district nursing and specialist district nursing education has fallen. This is concurrent with an ageing district nursing workforce, a lack of recruitment and growing caseloads, as district nursing adapts to meet the challenges of the complexities of contemporary healthcare in the community. The district nurse role is complex and multifaceted and includes working collaboratively and creatively to coordinate care. Redressing the shortages of specialist district nurse practitioners with increased numbers of health care support workers will not replace the skill, knowledge, experience required to meet the complex care needs of today's society. District nursing needs to be reinstated as the valuable asset it is, through renewed investment in the service, research development and in specialist practice education. To prevent extinction district nurses need to be able to demonstrate and articulate the complexities and dynamisms of the role to reinstate themselves to their commissioners as a valuable asset for contemporary practice that can meet current health and social care needs effectively. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.
Full Text Available Health care systems are faced with the challenge of resource scarcity and have insufficient resources to respond to all health problems and target groups simultaneously. Hence, priority setting is an inevitable aspect of every health system. However, priority setting is complex and difficult because the process is frequently influenced by political, institutional and managerial factors that are not considered by conventional priority-setting tools. In a five-year EU-supported project, which started in 2006, ways of strengthening fairness and accountability in priority setting in district health management were studied. This review is based on a PhD thesis that aimed to analyse health care organisation and management systems, and explore the potential and challenges of implementing Accountability for Reasonableness (A4R approach to priority setting in Tanzania. A qualitative case study in Mbarali district formed the basis of exploring the sociopolitical and institutional contexts within which health care decision making takes place. The study also explores how the A4R intervention was shaped, enabled and constrained by the contexts. Key informant interviews were conducted. Relevant documents were also gathered and group priority-setting processes in the district were observed. The study revealed that, despite the obvious national rhetoric on decentralisation, actual practice in the district involved little community participation. The assumption that devolution to local government promotes transparency, accountability and community participation, is far from reality. The study also found that while the A4R approach was perceived to be helpful in strengthening transparency, accountability and stakeholder engagement, integrating the innovation into the district health system was challenging. This study underscores the idea that greater involvement and accountability among local actors may increase the legitimacy and fairness of priority
Full Text Available This article focuses on those Estonian male migrants to ‘Old Europe’ who spend most of their time in the domestic realm as caring fathers and supportive spouses to their wives, who are meanwhile advancing their transnational careers. In this context, masculine identity talk can be understood in terms of strategies employed in response to the challenge to the men’s masculinity that this atypical life choice is likely to entail. Identity is viewed in this article as a processual phenomenon that is relentlessly, although not always deliberately, (reformulated in discourse, rather than determined by the assigned social roles. Analysis of in-depth interviews reveals that there are varied discourses in use that efficiently reconstruct the interviewees’ sense of personal significance. Interestingly, men predominantly combine ‘alternative’ discourses (‘caring father’, ‘supportive spouse’, ‘civilised adult’, which potentially undermine Estonian idealised masculinity, with the ‘conservative’ discourses (‘professional man’, the ‘well-off’, that reinforce the Estonian male norm. Men draw on a range of potentially oppositional and conflicting resources for constructing masculinity, without much reflexive selection from their part. Hence, the discourses men engage in position the men as much as the men appear to consciously position themselves in the discourses. This poststructuralist account of identity is located within a more structural historical context of transition and change in contemporary Europe.
Igoe, Joseph A.; DiRocco, Anthony P.
This booklet is designed to give practical and realistic advice to school district officials faced with the possibility of a teachers' strike. It is intended for use both by school district administrators and school board members. The booklet is organized into four sections that focus in turn on signs of a pending teachers' strike, union…
Brownstein, Barry; Brownstein, Deborah; Gerlowski, Daniel A.
The challenges of online learning include ensuring that the learning outcomes are at least as robust as in the face-to-face sections of the same course. At the University of Baltimore, both online sections and face-to-face sections of core MBA courses are offered. Once admitted to the MBA, students are free to enroll in any combination of…
Murtha, T., Jr.; Duffy, C.; Cook, B. D.; Schroder, W.; Webster, D.; French, K. D.; Alcover, O.; Golden, C.; Balzotti, C.; Shaffer, D.
Relying on a niche inheritance perspective, this paper discusses the long-term spatial and temporal dynamics of land-use management, agricultural decision making and patterns of resource availability in the tropical lowlands of Central America. We introduce and describe ongoing research that addresses a series of long standing questions about coupled natural and human history dynamics in the Central Maya lowlands, emphasizing the role of landscape and region to address these questions. First, we summarize the results of a CNH pilot study focused on the evolution of the regional landscape of Tikal, Guatemala. Particular attention is centered on how we integrated landscape survey, traditional archaeology and soil studies to understand the spatial and temporal dynamics of agricultural land use and intensification over a two thousand period. Additionally, we discuss how these results were integrated into remote sensing, hydrological and erosion models to better understand how past changes in available water and productive land compare to what we know about settlement patterns in the Tikal Region over that same time period. We not only describe how the Maya transformed this landscape, but also how the region influenced changing patterns of settlement and land use. We finish this section with a discussion of some of the unique challenges integrating archaeological information to study CNH dynamics during this pilot study. Second, we introduce a new project designed to `scale up' the pilot study for a macro-regional analysis of the lowland Maya landscape. The new project leverages a uniquely sampled LIDAR data set designed to refine measurements of above ground carbon storage. Our new project quantitatively examines these data for evidence for past human activity. Preliminary results offer a promising path for tightly integrating archaeology, natural science, remote sensing and modeling for studying CNH dynamics in the deep and recent past.
Kemp, Joanne L; Newton, Joshua D; White, Peta E; Finch, Caroline F
While guidelines outlining the appropriate management of sport-related concussion have been developed and adapted for use within community sport, it remains unknown how they are experienced by those responsible for implementing them. Longitudinal study. 111 coaches and sports trainers from community-level Australian Football and Rugby League teams completed pre- and post-season surveys assessing their attitudes towards using concussion guidelines. Participants also provided post-season feedback regarding their experiences in using the guidelines. 71% of participants reported using the guidelines in the preceding season. Post-season attitude was related to pre-season attitude (p=0.002), football code (p=0.015), and team role (p=0.045). An interaction between team role and guideline use (p=0.012) was also found, with coaches who had used the guidelines, and sports trainers who had not, reporting more positive post-season attitudes towards using the concussion guidelines. Implementation challenges included disputing of decisions about return-to-play by players, parents, and coaches, and a perceived lack of time. Recommendations for improved guideline materials included using larger fonts and providing for witnessing of advice given to players. This is the first study to examine the implementation of concussion guidelines in community sport. Training of coaches/sports trainers needs enhancement. In addition, new education should be developed for parents/players about the importance of the return-to-play advice given to them by those who follow these guidelines. Information provided by those who attempted to use the guidelines will assist the refinement of implementation and dissemination processes around concussion guidelines across sports. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.
Mshelia, C; Huss, R; Mirzoev, T; Elsey, H; Baine, S O; Aikins, M; Kamuzora, P; Bosch-Capblanch, X; Raven, J; Wyss, K; Green, A; Martineau, T
The single biggest barrier for countries in sub-Saharan Africa (SSA) to scale up the necessary health services for addressing the three health-related Millennium Development Goals and achieving Universal Health Coverage is the lack of an adequate and well-performing health workforce. This deficit needs to be addressed both by training more new health personnel and by improving the performance of the existing and future health workforce. However, efforts have mostly been focused on training new staff and less on improving the performance of the existing health workforce. The purpose of this paper is to disseminate the protocol for the PERFORM project and reflect on the key challenges encountered during the development of this methodology and how they are being overcome. The overall aim of the PERFORM project is to identify ways of strengthening district management in order to address health workforce inadequacies by improving health workforce performance in SSA. The study will take place in three districts each in Ghana, Tanzania and Uganda using an action research approach. With the support of the country research teams, the district health management teams (DHMTs) will lead on planning, implementation, observation, reflection and redefinition of the activities in the study. Taking into account the national and local human resource (HR) and health systems (HS) policies and practices already in place, 'bundles' of HR/HS strategies that are feasible within the context and affordable within the districts' budget will be developed by the DHMTs to strengthen priority areas of health workforce performance. A comparative analysis of the findings from the three districts in each country will add new knowledge on the effects of these HR/HS bundles on DHMT management and workforce performance and the impact of an action research approach on improving the effectiveness of the DHMTs in implementing these interventions. Different challenges were faced during the development of
California Natural Resource Agency — Private Water District boundaries are areas where private contracts provide water to the district in California. This database is designed as a regions polygon...
Vermont Center for Geographic Information — This dataset is a representation overlay of Lieutenant Chief Warden Districts (areas of responsibility). The Vermont Lieutenant Chief Warden Districts layer is part...
District heating has been used in Switzerland for more than 50 years. Its share of the heat market is less than 3% today. An analysis of the use of district heating in various European countries shows that a high share of district heating in the heat market is always dependent on ideal conditions for its use. Market prospects and possible future developments in the use of district heating in Switzerland are described in this paper. The main Swiss producers and distributors of district heating are members of the Association of District Heating Producers and Distributors. This association supports the installation of district heating facilities where ecological, energetical and economic aspects indicate that district heating would be a good solution. (author) 2 tabs., 6 refs
California Natural Resource Agency — This is a series of district layers pertaining to California'spolitical districts, that are derived from the California State Senateand State Assembly information....
California Natural Resource Agency — State Water Project District boundaries are areas where state contracts provide water to the district in California. This database is designed as a regions polygon...
Iowa State University GIS Support and Research Facility — The National Register Historic District layer is a shape file showing the boundaries of Historic Districts that are listed on the National Register of Historic Places.
Polly, Benjamin J [National Renewable Energy Laboratory (NREL), Golden, CO (United States)
This presentation shows how NREL is approaching Zero Energy Districts, including key opportunities, design strategies, and master planning concepts. The presentation also covers URBANopt, an advanced analytical platform for district that is being developed by NREL.
Sevene, Esperança; Mariano, Alda; Mehta, Ushma; Machai, Maria; Dodoo, Alexander; Vilardell, David; Patel, Sam; Barnes, Karen; Carné, Xavier
The roll out of various public health programmes involving mass administration of medicines calls for the deployment of responsive pharmacovigilance systems to permit identification of signals of rare or even common adverse reactions. In developing countries in Africa, these systems are mostly absent and their performance under any circumstance is difficult to predict given the known shortage of human, financial and technical resources. Nevertheless, the importance of such systems in all countries is not in doubt, and research to identify problems, with the aim of offering pragmatic solutions, is urgently needed. To examine the impact of training and monitoring of healthcare workers, making supervisory visits and the availability of telecommunication and transport facilities on the implementation of a pharmacovigilance system in Mozambique. This was a descriptive study enumerating the lessons learnt and challenges faced in implementing a spontaneous reporting system in two rural districts of Mozambique - Namaacha and Matutuíne - where remote location, poor telecommunication services and a low level of education of health professionals are ongoing challenges. A 'yellow card' system for spontaneous reporting of adverse drug reactions (ADRs) was instituted following training of health workers in the selected districts. Thirty-five health professionals (3 medical doctors, 2 technicians, 24 nurses, 4 basic healthcare agents and 2 pharmacy agents) in these districts were trained to diagnose, treat and report ADRs to all medicines using a standardized yellow card system. There were routine site visits to identify and clarify any problems in filling in and sending the forms. One focal person was identified in each district to facilitate communication between the health professionals and the National Pharmacovigilance Unit (NPU). The report form was assessed for quality and causality. The availability of telecommunications and transport was assessed. Fourteen months after
Andersen, Bengt; Skrede, Joar
Many cities today face challenges related to urban growth. This is also the case in Oslo, currently one of the fastest growing capitals in Europe. In order to prepare for the population growth, a new municipal master plan has been prepared. In this, sustainable development is a prominent concept, and the urban district is going to be densified as part of the strategy. This paper examines some obstacles of turning planning theory into practice. There is a lack of coherence between municipal...
Two national reform movements--one focused on creating small, autonomous schools, the other fixated on a standardization agenda--are basically in conflict. The standards movement is touting the traditional, top-down, centralized, bureaucratic system modeled after Frederick Taylor and his efficiency experts. Progressive, decentralized initiatives…
Elliott, Arnold; Freeling, Paul; Owen, John
Training for district nursing is being reviewed. By 1981 district nurses will have a new administrative structure, a new curriculum, and a new examination. Training for nursing, like that for general practice, is to become mandatory. The history of the development of district nurse training is briefly described.
Kolkman, PME; Luteijn, AJ; Nasiiro, RS; Bruney, [No Value; Smith, RJA; Meyboom-de Jong, B
District nurses constitute the basis of the primary health care services in Dominica. All encounters of three district nurses were registered using the international classification of primary care. Information on other aspects of district nursing was collected by participating observation and the
Through five cases from high-end fashion brands, this article explores the use of models in contemporary fashion marketing. The models represent subversive beauty ideals, and the aim of the analysis is to determine whether these ‘faces’ are intended to challenge stereotypes concerning age, gender......, body and sexuality or whether they are examples of marketing absorbing consumer behaviour to appeal to contemporary consumers. The research is based on fashion campaigns and runway shows in mainly luxury fashion brands in the Euro-American market in the period 2009–2012. The article concludes...
Richler, Jennifer J; Floyd, R Jackie; Gauthier, Isabel
Previous work found a small but significant relationship between holistic processing measured with the composite task and face recognition ability measured by the Cambridge Face Memory Test (CFMT; Duchaine & Nakayama, 2006). Surprisingly, recent work using a different measure of holistic processing (Vanderbilt Holistic Face Processing Test [VHPT-F]; Richler, Floyd, & Gauthier, 2014) and a larger sample found no evidence for such a relationship. In Experiment 1 we replicate this unexpected result, finding no relationship between holistic processing (VHPT-F) and face recognition ability (CFMT). A key difference between the VHPT-F and other holistic processing measures is that unique face parts are used on each trial in the VHPT-F, unlike in other tasks where a small set of face parts repeat across the experiment. In Experiment 2, we test the hypothesis that correlations between the CFMT and holistic processing tasks are driven by stimulus repetition that allows for learning during the composite task. Consistent with our predictions, CFMT performance was correlated with holistic processing in the composite task when a small set of face parts repeated over trials, but not when face parts did not repeat. A meta-analysis confirms that relationships between the CFMT and holistic processing depend on stimulus repetition. These results raise important questions about what is being measured by the CFMT, and challenge current assumptions about why faces are processed holistically.
Lander, Karen; Poyarekar, Siddhi
It has been previously established that extraverts who are skilled at interpersonal interaction perform significantly better than introverts on a face-specific recognition memory task. In our experiment we further investigate the relationship between extraversion and face recognition, focusing on famous face recognition and face matching. Results indicate that more extraverted individuals perform significantly better on an upright famous face recognition task and show significantly larger face inversion effects. However, our results did not find an effect of extraversion on face matching or inverted famous face recognition.
Sushama, Preeti; Ghergu, Cristian; Meershoek, Agnes; de Witte, Luc P; van Schayck, Onno C P; Krumeich, Anja
While any type of field-based research is challenging, building action-oriented, participatory research in resource-constrained settings can be even more so. In this article, we aim to examine and provide insights into some of the practical challenges that were faced during the course of a participatory project based in two non-notified slums in Bangalore, India, aiming to build solutions to indoor air pollution from cooking on traditional cook stoves. The article draws upon experiences of the authors as field researchers engaged in a community-based project that adopted an exploratory, iterative design to its planning and implementation, which involved community visits, semi-structured interviews, prioritization workshops, community forums, photo voice activities, chulha-building sessions and cooking trials. The main obstacles to field work were linked to fostering open, continued dialogue with the community, aimed at bridging the gap between the 'scientific' and the 'local' worlds. Language and cultural barriers led to a reliance on interpreters, which affected both the quality of the interaction as well as the relationship between the researchers and the community that was built out of that interaction. The transience in housing and location of members of the community also led to difficulties in following up on incomplete information. Furthermore, facilitating meaningful participation from the people within the context of restricted resources, differing priorities, and socio-cultural diversity was particularly challenging. These were further compounded by the constraints of time and finances brought on by the embeddedness of the project within institutional frameworks and conventional research requirements of a fixed, pre-planned and externally determined focus, timeline, activities and benchmarks for the project. This article calls for revisiting of scientific conventions and funding prerequisites, in order to create spaces that support flexible, emergent and
Haar, F.B. Ter; Veltkamp, R.C.
Morphable face models have proven to be an effective tool for 3D face modeling and face recognition, but the extension to 3D face scans with expressions is still a challenge. The two main difficulties are (1) how to build a new morphable face model that deals with expressions, and (2) how to fit
Fysh, Matthew C; Bindemann, Markus
This study presents the Kent Face Matching Test (KFMT), which comprises 200 same-identity and 20 different-identity pairs of unfamiliar faces. Each face pair consists of a photograph from a student ID card and a high-quality portrait that was taken at least three months later. The test is designed to complement existing resources for face-matching research, by providing a more ecologically valid stimulus set that captures the natural variability that can arise in a person's appearance over time. Two experiments are presented to demonstrate that the KFMT provides a challenging measure of face matching but correlates with established tests. Experiment 1 compares a short version of this test with the optimized Glasgow Face Matching Test (GFMT). In Experiment 2, a longer version of the KFMT, with infrequent identity mismatches, is correlated with performance on the Cambridge Face Memory Test (CFMT) and the Cambridge Face Perception Test (CFPT). The KFMT is freely available for use in face-matching research. © 2017 The British Psychological Society.
Starrfelt, Randi; Klargaard, Solja; Petersen, Anders
Traditionally, perceptual processing of faces and words is considered highly specialized, strongly lateralized, and largely independent. This has, however, recently been challenged by studies showing that learning to read may affect the perceptual and neural processes involved in face recognition......, a lower perceptual threshold, and higher processing speed for words compared to letters. In sum, we find no evidence that reading skills are abnormal in developmental prosopagnosia, a finding that may challenge the recently proposed hypothesis that reading development and face processing abilities...
Our work is based on the review of documents and interviews conducted at more than two dozen federal departments and agencies, including central management agencies such as OMB, the general Services Administration (GSA...
AI-Sebie, Madi M
This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University, 17/10/2005. A review of normative literature, in the field of e-government, indicates that the transactional stage of e-government is one of the most important to the implementation of an e-government system as it represents the highest level of interaction within organisations and between customers and government organisations. Due to the importance of the transactional stage of the e-govern...
Lecomte, M.; Bugat, A.; Vignon, D.
The Nuclear Renaissance is stumbling at the very same time it should speed up in order to help control the climate change and meet a fast growing energy need in a large part of the world. Rising costs of projects, uncertainties about their completion, rocketing safety requirements, and financial constraints are key factors which slow down the Nuclear Renaissance. Furthermore, the legal infrastructure required from any country to enter a commercial nuclear programme (safety authorities, fuel cycle, and waste disposal) is a major hurdle s which impedes consideration for small to mid size reactors, well suited for many countries. The paper prepared and presented by Alain Bugat (Chairman of NucAdvisor and former Head of the French Atomic Energy Commission), Dominique Vignon (CEO of NucAdvisor and former President and CEO of AREVA NP) and Michel Lecomte (Co-founder NucAdvisor) reviews the present status of the Nuclear Renaissance. Based on an analysis of initial versus actual plans for all projects announced during the last three years, it scrutinizes some key factors behind the postponements of start-up dates of construction, and cost increases. On each of the issues which jeopardize new projects, the paper will propose an adequate course of actions, to be taken by vendors, operators, governments and safety authorities as well as investors, financial institutions and banks. - Recommendations are developed with respect to: - A needed coordination between the Kyoto and post Kyoto mechanisms, and the nuclear industry; a financial assessment of the potential of such coordination will be presented; - A transformation of the national licensing processes, under a common International framework; it will take into consideration the experience of the Airspace industry, and a systematic mutual acceptance of licensing certificates; - An easier access for nuclear projects to the financial markets, based on the support of major Financial institutions (World Bank; BEI; etc..). (authors)
Kadam, Rashmi; Karandikar, Shashikant
The past few years have seen a tremendous rise in the number of clinical trials conducted in India. This is been attributed to the huge patient population, genetic diversity, and rich technical pool in our country. However, the economical upsurge in the clinical trial industry has also caused concerns pertaining to the efficiency of the Regulatory Agencies and Ethics Committees (EC). The EC plays an important role in the regulation of clinical research at the local level. However, it is seen that many ECs are oblivious to their roles and responsibilities. It is reported that ECs lack standard operating procedures, do not have a proper composition or adequate representation, thus affecting their functions in regulating clinical research. Moreover, ECs seem to function in isolation, as self-sufficient bodies, having no communication with the regulatory agency or other ECs. This brings forth the need for ECs to come together and share their experiences and observations, with the aim of updating themselves and refining their functions. Efforts also need to be focused on capacity building, centralized registration of ECs, and bringing an oversight mechanism in place. The Ethics Committees in India need to work in close association with forums such as the Forum for Ethics Review Committees in India and the Forum for Ethical Review Committees in Asia Pacific, in an effort towards empowering themselves.
Full Text Available The past few years have seen a tremendous rise in the number of clinical trials conducted in India. This is been attributed to the huge patient population, genetic diversity, and rich technical pool in our country. However, the economical upsurge in the clinical trial industry has also caused concerns pertaining to the efficiency of the Regulatory Agencies and Ethics Committees (EC. The EC plays an important role in the regulation of clinical research at the local level. However, it is seen that many ECs are oblivious to their roles and responsibilities. It is reported that ECs lack standard operating procedures, do not have a proper composition or adequate representation, thus affecting their functions in regulating clinical research. Moreover, ECs seem to function in isolation, as self-sufficient bodies, having no communication with the regulatory agency or other ECs. This brings forth the need for ECs to come together and share their experiences and observations, with the aim of updating themselves and refining their functions. Efforts also need to be focused on capacity building, centralized registration of ECs, and bringing an oversight mechanism in place. The Ethics Committees in India need to work in close association with forums such as the Forum for Ethics Review Committees in India and the Forum for Ethical Review Committees in Asia Pacific, in an effort towards empowering themselves.
.... Last spring, the House Majority Leader asked us to identify potential regulatory, tax, and liability barriers that concern private sector employers considering telecommuting programs for their employees...
...) and the Office of Personnel Management (OPM). Additionally, due to the dynamic and evolving nature of the government's homeland security activities, some of our work described in this report has already appeared in congressional testimony...
Cohen, Joshua P
The number of personalized medicines and companion diagnostics in use in the United States has gradually increased over the past decade, from a handful of medicines and tests in 2001 to several dozen in 2011. However, the numbers have not reached the potential hoped for when the human genome project was completed in 2001. Significant clinical, regulatory, and economic barriers exist and persist. From a regulatory perspective, therapeutics and companion diagnostics are ideally developed simultaneously, with the clinical significance of the diagnostic established using data from the clinical development program of the corresponding therapeutic. Nevertheless, this is not (yet) happening. Most personalized medicines are personalized post hoc, that is, a companion diagnostic is developed separately and approved after the therapeutic. This is due in part to a separate and more complex regulatory process for diagnostics coupled with a lack of clear regulatory guidance. More importantly, payers have placed restrictions on reimbursement of personalized medicines and their companion diagnostics, given the lack of evidence on the clinical utility of many tests. To achieve increased clinical adoption of diagnostics and targeted therapies through more favorable reimbursement and incorporation in clinical practice guidelines, regulators will need to provide unambiguous guidance and manufacturers will need to bring more and better clinical evidence to the market place. Copyright © 2012 Elsevier B.V. All rights reserved.