A systematic review of knowledge sharing challenges and practices in global software development

DEFF Research Database (Denmark)

Zahedi, Mansooreh; Shahin, Mojtaba; Babar, Muhammad Ali

2016-01-01

the data extracted from the reviewed primary studies. Results: Our findings revealed that knowledge sharing challenges and practices in GSD could be classi- fied in 6 main themes: management, team structure, work processes/practices, team cognition, social attributes and technology. In regard to contextual......Context: Global Software Development (GSD) presents significant challenges to share and understand knowledge required for developing software. Organizations are expected to implement appropriate practices to address knowledge-sharing challenges in GSD. With the growing literature on GSD and its...... and practices fall under the theme of “work practices”. (c) The technology related knowledge-sharing challenges are the least reported; we discussed the available technologies for sup- porting knowledge sharing needs in GSD. (d) The organizational contextual information is missing from a large number of studies...

Commentary: Pediatric eHealth Interventions: Common Challenges During Development, Implementation, and Dissemination

Science.gov (United States)

Steele, Ric G.; Connelly, Mark A.; Palermo, Tonya M.; Ritterband, Lee M.

2014-01-01

Objective To provide an overview of common challenges that pediatric eHealth researchers may encounter when planning, developing, testing, and disseminating eHealth interventions along with proposed solutions for addressing these challenges. Methods The article draws on the existing eHealth literature and the authors’ collective experience in pediatric eHealth research. Results and conclusions The challenges associated with eHealth interventions and their proposed solutions are multifaceted and cut across a number of areas from eHealth program development through dissemination. Collaboration with a range of individuals (e.g., multidisciplinary colleagues, commercial entities, primary stakeholders) is the key to eHealth intervention success. To ensure adequate resources for design, development, and planning for sustainability, a number of public and private sources of funding are available. A study design that addresses ethical concerns and security issues is critical to ensure scientific integrity and intervention dissemination. Table I summarizes key issues to consider during eHealth intervention development, testing, and dissemination. PMID:24816766

Prenatal stress challenge impairs fetal lung development and asthma severity sex-specifically in mice.

Science.gov (United States)

Zazara, Dimitra E; Perani, Clara V; Solano, María E; Arck, Petra C

2018-02-01

Allergic asthma is an increasing health problem worldwide. Interestingly, prenatal challenges such as stress have been associated with an increased risk for asthma during childhood. The underlying pathogenesis of how prenatal stress increases the risk for asthma still remains unclear. Potential targets could be that the fetal immune ontogeny or fetal lung development are compromised by prenatal challenges. Here, we aimed to identify whether prenatal stress challenge affects fetal lung development in mice. C57BL/6 pregnant mice were challenged with sound stress and fetal lung development was assessed histologically. Whilst prenatal stress challenge did not profoundly affect lung development in male fetuses, it resulted in less extensive terminal sacs, surrounded by thicker mesenchymal tissue in female fetuses. Thus, prenatal stress disrupted fetal lung development sex-specifically. Interestingly, upon prenatal stress challenge, the airway hyperresponsiveness and eosinophilic inflammation- two hallmarks of asthma - were significantly increased in adult female offspring, whilst regulatory CD4+ T cells were reduced. These findings strongly underpin the sex-specific association between s challenged fetal development and a sex-specific altered severity of asthma in adult offspring. Our model now allows to identify maternal markers through which the risk for asthma and possible other diseases is vertically transferred before birth in response to challenges. Such identification then opens avenues for primary disease prevention. Copyright © 2017 Elsevier B.V. All rights reserved.

Key technological challenges for JSFR development

International Nuclear Information System (INIS)

Morishita, Masaki; Nakai, Ryodai; Aoto, Kazumi

2008-01-01

JSFR is a sodium cooled loop type fast reactor on which a conceptual design study is now underway in the framework of 'Fast Reactor Cycle Technology Development Project (FaCT project)' of Japan. Achieving economic competitiveness with future light water reactors, along with assuring high level of safety and reliability, is among the most crucial development targets. A number of innovative technologies are pursued for these purposes. A two loop primary heat transfer system (PHTS) design, integration of a main circulation pump and an intermediate heat exchanger (IHX) into one single component, and adoption of high chrome ferritic steel as a structural material are typical technologies mainly for economic purposes. A passive shutdown system, decay heat removal by natural convection, and re-criticality free core configuration are those for mainly safety enhancement purposes. Technically challenging issues inevitably accompany these innovative technologies, and a systematic research and development program is undertaken for resolving these issues and realization of the plant design. An overall picture will be given in this paper on the design concept of JSFR that will be followed by descriptions on the major innovative technologies and their relevant research and development activities. (author)

School choice : challenge to Sharpeville public primary school principals

OpenAIRE

2012-01-01

M.Ed. This qualitative phenomenological study focuses on school choice as challenge to principals of Sharpeville public primary schools. Different aspects of these choices are explored. School choice is an important component of parental involvement in the education of their children. Parents and learners tend to be open about their right through the support of the Schools Act 84 of 1996. You may not discriminate on the basis of race trough the language policy at your school. This means th...

Resilience of primary healthcare professionals working in challenging environments: a focus group study.

Science.gov (United States)

Matheson, Catriona; Robertson, Helen D; Elliott, Alison M; Iversen, Lisa; Murchie, Peter

2016-07-01

The modern primary healthcare workforce needs to be resilient. Early research framed professional resilience as avoiding 'burnout'; however, more recent literature has introduced the concept of positive adaptation to professional challenges, which results in individuals thriving in their role. To explore what primary health professionals working in challenging environments consider to be characteristics of resilience and what promotes or challenges professional resilience. A qualitative focus group in north east Scotland. Five focus groups were held with 20 health professionals (six GPs, nine nurses, four pharmacists, and a practice manager) based in rural or deprived city areas in the north east of Scotland. Inductive thematic analysis identified emerging themes. Personal resilience characteristics identified were optimism, flexibility and adaptability, initiative, tolerance, organisational skills, being a team worker, keeping within professional boundaries, assertiveness, humour, and a sense of self-worth. Workplace challenges were workload, information overload, time pressures, poor communication, challenging patients, and environmental factors (rural location). Promoters of professional resilience were strong management support, teamwork, workplace buffers, and social factors such as friends, family, and leisure activities. A model of health professional resilience is proposed that concurs with existing literature but adds the concept of personal traits being synergistic with workplace features and social networks. These facilitate adaptability and enable individual health professionals to cope with adversity that is inevitably part of the everyday experience of those working in challenging healthcare environments. © British Journal of General Practice 2016.

Health system challenges to integration of mental health delivery in primary care in Kenya--perspectives of primary care health workers.

Science.gov (United States)

Jenkins, Rachel; Othieno, Caleb; Okeyo, Stephen; Aruwa, Julyan; Kingora, James; Jenkins, Ben

2013-09-30

Health system weaknesses in Africa are broadly well known, constraining progress on reducing the burden of both communicable and non-communicable disease (Afr Health Monitor, Special issue, 2011, 14-24), and the key challenges in leadership, governance, health workforce, medical products, vaccines and technologies, information, finance and service delivery have been well described (Int Arch Med, 2008, 1:27). This paper uses focus group methodology to explore health worker perspectives on the challenges posed to integration of mental health into primary care by generic health system weakness. Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 20 health workers drawn from a randomised controlled trial to evaluate the impact of a mental health training programme for primary care, 10 from the intervention group clinics where staff had received the training programme, and 10 health workers from the control group where staff had not received the training). These focus group discussions suggested that there are a number of generic health system weaknesses in Kenya which impact on the ability of health workers to care for clients with mental health problems and to implement new skills acquired during a mental health continuing professional development training programmes. These weaknesses include the medicine supply, health management information system, district level supervision to primary care clinics, the lack of attention to mental health in the national health sector targets, and especially its absence in district level targets, which results in the exclusion of mental health from such district level supervision as exists, and the lack of awareness in the district management team about mental health. The lack of mental health coverage included in HIV training courses experienced by the health workers was also striking, as was the intensive focus during district supervision on HIV to the detriment of other

Approaches and challenges to optimising primary care teams’ electronic health record usage

Directory of Open Access Journals (Sweden)

Nancy Pandhi

2014-07-01

Full Text Available Background Although the presence of an electronic health record (EHR alone does not ensure high quality, efficient care, few studies have focused on the work of those charged with optimising use of existing EHR functionality.Objective To examine the approaches used and challenges perceived by analysts supporting the optimisation of primary care teams’ EHR use at a large U.S. academic health care system.Methods A qualitative study was conducted. Optimisation analysts and their supervisor were interviewed and data were analysed for themes.Results Analysts needed to reconcile the tension created by organisational mandates focused on the standardisation of EHR processes with the primary care teams’ demand for EHR customisation. They gained an understanding of health information technology (HIT leadership’s and primary care team’s goals through attending meetings, reading meeting minutes and visiting with clinical teams. Within what was organisationally possible, EHR education could then be tailored to fit team needs. Major challenges were related to organisational attempts to standardise EHR use despite varied clinic contexts, personnel readiness and technical issues with the EHR platform. Forcing standardisation upon clinical needs that current EHR functionality could not satisfy was difficult.Conclusions Dedicated optimisation analysts can add value to health systems through playing a mediating role between HIT leadership and care teams. Our findings imply that EHR optimisation should be performed with an in-depth understanding of the workflow, cognitive and interactional activities in primary care.

Management of primary adrenal insufficiency: Review of current clinical practice in a developed and a developing country

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Uzma Khan

2017-01-01

Full Text Available Treatment of primary adrenal insufficiency (PAI requires lifelong hormone replacement with glucocorticoids (GCs and mineralocorticoids. Impaired quality of life and increased standardized mortality ratio in these patients emphasize the importance of tailoring therapy to individual needs. Role of education is paramount in improving patient compliance and in anticipating and preventing adrenal crises. Although discovery of synthetic GCs was a major breakthrough in treatment of patients with this life-threatening condition, management of PAI continues to be challenging. The obstacles for clinicians appear to vary widely across the globe. While optimization and individualization of therapy after diagnosis of PAI remain the main challenges for clinicians in the developed world, doctors in a developing country face problems at almost every stage from the diagnosis to the treatment and follow-up of these patients; cost of therapy, lack of resources, and funding are the main hindrances. Adherence to therapy and patient education are found to be common issues in most parts of the world. This commentary highlights the challenges from both developed and developing country's perspective in treating PAI; it also provides an update on current management scenario and future treatment options.

Management of Primary Adrenal Insufficiency: Review of Current Clinical Practice in a Developed and a Developing Country.

Science.gov (United States)

Khan, Uzma; Lakhani, Om J

2017-01-01

Treatment of primary adrenal insufficiency (PAI) requires lifelong hormone replacement with glucocorticoids (GCs) and mineralocorticoids. Impaired quality of life and increased standardized mortality ratio in these patients emphasize the importance of tailoring therapy to individual needs. Role of education is paramount in improving patient compliance and in anticipating and preventing adrenal crises. Although discovery of synthetic GCs was a major breakthrough in treatment of patients with this life-threatening condition, management of PAI continues to be challenging. The obstacles for clinicians appear to vary widely across the globe. While optimization and individualization of therapy after diagnosis of PAI remain the main challenges for clinicians in the developed world, doctors in a developing country face problems at almost every stage from the diagnosis to the treatment and follow-up of these patients; cost of therapy, lack of resources, and funding are the main hindrances. Adherence to therapy and patient education are found to be common issues in most parts of the world. This commentary highlights the challenges from both developed and developing country's perspective in treating PAI; it also provides an update on current management scenario and future treatment options.

Orphan drugs in development for primary biliary cirrhosis: challenges and progress

Directory of Open Access Journals (Sweden)

Ali AH

2015-09-01

Full Text Available Ahmad H Ali,1 Thomas J Byrne,1 Keith D Lindor1,21Division of Gastroenterology and Hepatology, Mayo Clinic, 2College of Health Solutions, Arizona State University, Phoenix, AZ, USAAbstract: Primary biliary cirrhosis (PBC is a chronic progressive liver disease that often leads to fibrosis, cirrhosis, and end-stage liver disease. The diagnosis is made when there is evidence of cholestasis and reactivity to the antimitochondrial antibody. The etiology of PBC is poorly understood; however, several lines of evidence suggest an environmental factor that triggers a series of immune-mediated inflammatory reactions in the bile ducts in a genetically susceptible individual. Fatigue and pruritus are the most common symptoms of PBC; however, many patients are diagnosed with PBC only based on laboratory abnormalities. The only pharmacological treatment approved for PBC is ursodeoxycholic acid (UDCA. Several controlled studies have shown that UDCA improves liver biochemistries and prolongs transplant-free survival in PBC patients. Nearly 40% of PBC patients do not respond to UDCA, and those patients are at high risk of serious adverse events, such as the development of liver failure. Therefore, newer alternative therapeutic options for PBC are needed. Obeticholic acid is a first-in-class farnesoid X receptor agonist that has been recently evaluated in PBC patients with inadequate response to UDCA, and demonstrated beneficial results in improving liver biochemistries. Several other agents (fibrates and glucocorticoids have been previously examined in PBC patients with inadequate response to UDCA, and preliminary results showed biochemical improvement. However, large-scale controlled clinical trials are needed to determine the long-term effects of fibrates and glucocorticoids on the clinical outcomes of PBC. Clinical trials of NGM282 (a fibroblast growth factor-19 analog and Abatacept (a fusion protein composed of the Fc portion of immunoglobulin G1 fused to

Sustainable Development: The Challenge for Community Development.

Science.gov (United States)

Gamble, Dorothy N.; Weil, Marie O.

1997-01-01

Five areas of inquiry shape the sustainable development movement: environmental movement, women's movement, overpopulation concerns, critique of development models, and new indicators of social progress. Community development workers are challenged to prepare local development projects within a sustainable development framework. (SK)

Commentary: pediatric eHealth interventions: common challenges during development, implementation, and dissemination.

Science.gov (United States)

Wu, Yelena P; Steele, Ric G; Connelly, Mark A; Palermo, Tonya M; Ritterband, Lee M

2014-07-01

To provide an overview of common challenges that pediatric eHealth researchers may encounter when planning, developing, testing, and disseminating eHealth interventions along with proposed solutions for addressing these challenges. The article draws on the existing eHealth literature and the authors' collective experience in pediatric eHealth research. The challenges associated with eHealth interventions and their proposed solutions are multifaceted and cut across a number of areas from eHealth program development through dissemination. Collaboration with a range of individuals (e.g., multidisciplinary colleagues, commercial entities, primary stakeholders) is the key to eHealth intervention success. To ensure adequate resources for design, development, and planning for sustainability, a number of public and private sources of funding are available. A study design that addresses ethical concerns and security issues is critical to ensure scientific integrity and intervention dissemination. Table I summarizes key issues to consider during eHealth intervention development, testing, and dissemination. © The Author 2014. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Opportunities and Challenges for Public Primary School Head Teachers in the Implementation of Free Primary Education in Kisumu Municipality, Kenya: An Analytical Assessment

Science.gov (United States)

Akech, Benta Achieng' Opul; Simatwa, Enose M. W.

2010-01-01

This study investigated opportunities and challenges for public primary school head teachers in the implementation of Free Primary Education in Kisumu municipality. Being a descriptive research, the study population consisted of 114 head teachers, 17,100 class seven and eight pupils in the municipality. Out of this, a sample of 37 head teachers…

[Primary malignant melanoma of the central nervous system: A diagnostic challenge].

Science.gov (United States)

Quillo-Olvera, Javier; Uribe-Olalde, Juan Salvador; Alcántara-Gómez, Leopoldo Alberto; Rejón-Pérez, Jorge Dax; Palomera-Gómez, Héctor Guillermo

2015-01-01

The rare incidence of primary malignant melanoma of the central nervous system and its ability to mimic other melanocytic tumors on images makes it a diagnostic challenge for the neurosurgeon. A 51-year-old patient, with a tumor located in the right forniceal callosum area. Total surgical excision was performed. Histopathological result was consistent with the diagnosis of primary malignant melanoma of the central nervous system, after ruling out extra cranial and extra spinal melanocytic lesions. The primary malignant melanoma of the central nervous system is extremely rare. There are features in magnetic resonance imaging that increase the diagnostic suspicion; nevertheless there are other tumors with more prevalence that share some of these features through image. Since there is not an established therapeutic standard its prognosis is discouraging. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

Community participation in health service reform: the development of an innovative remote Aboriginal primary health-care service.

Science.gov (United States)

Reeve, Carole; Humphreys, John; Wakerman, John; Carroll, Vicki; Carter, Maureen; O'Brien, Tim; Erlank, Carol; Mansour, Rafik; Smith, Bec

2015-01-01

The aim of this study was to describe the reorientation of a remote primary health-care service, in the Kimberley region of Australia, its impact on access to services and the factors instrumental in bringing about change. A unique community-initiated health service partnership was developed between a community-controlled Aboriginal health organisation, a government hospital and a population health unit, in order to overcome the challenges of delivering primary health care to a dispersed, highly disadvantaged Aboriginal population in a very remote area. The shared goals and clear delineation of responsibilities achieved through the partnership reoriented an essentially acute hospital-based service to a prevention-focussed comprehensive primary health-care service, with a focus on systematic screening for chronic disease, interdisciplinary follow up, health promotion, community advocacy and primary prevention. This formal partnership enabled the primary health-care service to meet the major challenges of providing a sustainable, prevention-focussed service in a very remote and socially disadvantaged area.

Opportunities and challenges to promoting oral health in primary schools.

Science.gov (United States)

Gill, P; Chestnutt, I G; Channing, D

2009-09-01

Inequalities in oral health in areas of socio-economic disadvantage are well recognised. As children spend a considerable proportion of their lives in education, schools can play a significant role in promoting children's health and oral health. However, to what extent schools are able to do this is unclear. The aim of this study was therefore to investigate opportunities and challenges to promoting oral health in primary schools. A purposive sample of 20 primary schools from socially and economically disadvantaged areas of Cardiff, UK were selected to participate in this qualitative study. Data were collected through semi-structured interviews conducted with head teachers or their nominated deputies. General awareness of health and oral health was good, with all schools promoting the consumption of fruit, water and milk and discouraging products such as carbonated drinks and confectionaries. Health promotion schemes wereimplemented primarily to improve the health of the children, although schools felt they also offered the potential to improve classroom behaviour and attendance. However, oral health was viewed as a separate entity to general health and perceived to be inadequately promoted. Successful health promotion schemes were also influenced by the attitudes of headteachers. Most schools had no or limited links with local dental services and, or oral health educators, although such input, when it occurred, was welcomed and highly valued. Knowledge of how to handle dental emergencies was limited and only two schools operated toothbrushing schemes, although all expressed an interest in such programmes. This study identified a positive predisposition to promoting health in primary schools. The challenge for the dental team, however, is to promote and integrate oral health into mainstream health promotion activities in schools. The paper also makes recommendations for further research.

Primary care reforms in countries of the former soviet union: success and challenges.

NARCIS (Netherlands)

Kühlbrandt, C.; Boerma, W.

2015-01-01

Summary: This article examines primary care reforms in countries of the former Soviet Union. It places reforms in their wider political context and points to infrastructural, human and economic successes and challenges. There is great heterogeneity between countries regarding the effectiveness of

General practitioners' views on leadership roles and challenges in primary health care: a qualitative study

OpenAIRE

Spehar, Ivan; Sjøvik, Hege; Karevold, Knut Ivar; Rosvold, Elin Olaug; Frich, Jan C

2017-01-01

Objective To explore general practitioners? (GPs) views on leadership roles and leadership challenges in general practice and primary health care. Design We conducted focus groups (FGs) with 17 GPs. Setting Norwegian primary health care. Subjects 17 GPs who attended a 5 d course on leadership in primary health care. Results Our study suggests that the GPs experience a need for more preparation and formal training for the leadership role, and that they experienced tensions between the clinical...

Addressing the challenges of improving primary care quality in Uzbekistan: a qualitative study of chronic heart failure management.

Science.gov (United States)

Ahmedov, Mohir; Green, Judith; Azimov, Ravshan; Avezova, Guloyim; Inakov, Sherzod; Mamatkulov, Bahrom

2013-08-01

Uzbekistan has a well-developed primary care system, with universal access to care, but faces challenges in improving the quality of clinical care provided. This study aimed to identify barriers to quality improvement by focusing on one common condition, Chronic Heart Failure (CHF), for which there are evidence-based international guidelines for management. To identify the challenges to improving the quality of care for CHF in line with such guidelines we took a qualitative approach, interviewing 15 physicians and 30 patients in detail about their experiences of CHF management. Despite recent improvements to the training of primary care physicians, their access to up-to-date information was limited, and they were disproportionately reliant on information from pharmaceutical companies. The main barriers to implementing international standards of care were: reluctance of physicians (and patients) to abandon ineffective interventions; enduring, system-wide incentives for clinically unnecessary hospitalization; and the lack of structural support for evidence-based health services improvement. Patients were in general positive about adherence to medications, but faced some problems in affording drugs and hospital care. Future interventions to strengthen primary care should be implemented with evaluations of their impact on the processes and outcomes of care for chronic conditions.

General practitioners’ views on leadership roles and challenges in primary health care: a qualitative study

Science.gov (United States)

Spehar, Ivan; Sjøvik, Hege; Karevold, Knut Ivar; Rosvold, Elin Olaug; Frich, Jan C.

2017-01-01

Objective To explore general practitioners’ (GPs) views on leadership roles and leadership challenges in general practice and primary health care. Design We conducted focus groups (FGs) with 17 GPs. Setting Norwegian primary health care. Subjects 17 GPs who attended a 5 d course on leadership in primary health care. Results Our study suggests that the GPs experience a need for more preparation and formal training for the leadership role, and that they experienced tensions between the clinical and leadership role. GPs recognized the need to take on leadership roles in primary care, but their lack of leadership training and credentials, and the way in which their practices were organized and financed were barriers towards their involvement. Conclusions GPs experience tensions between the clinical and leadership role and note a lack of leadership training and awareness. There is a need for a more structured educational and career path for GPs, in which doctors are offered training and preparation in advance. Key points Little is known about doctors’ experiences and views about leadership in general practice and primary health care. Our study suggests that: There is a lack of preparation and formal training for the leadership role. GPs experience tensions between the clinical and leadership role. GPs recognize leadership challenges at a system level and that doctors should take on leadership roles in primary health care. PMID:28277051

General practitioners' views on leadership roles and challenges in primary health care: a qualitative study.

Science.gov (United States)

Spehar, Ivan; Sjøvik, Hege; Karevold, Knut Ivar; Rosvold, Elin Olaug; Frich, Jan C

2017-03-01

To explore general practitioners' (GPs) views on leadership roles and leadership challenges in general practice and primary health care. We conducted focus groups (FGs) with 17 GPs. Norwegian primary health care. 17 GPs who attended a 5 d course on leadership in primary health care. Our study suggests that the GPs experience a need for more preparation and formal training for the leadership role, and that they experienced tensions between the clinical and leadership role. GPs recognized the need to take on leadership roles in primary care, but their lack of leadership training and credentials, and the way in which their practices were organized and financed were barriers towards their involvement. GPs experience tensions between the clinical and leadership role and note a lack of leadership training and awareness. There is a need for a more structured educational and career path for GPs, in which doctors are offered training and preparation in advance. KEY POINTS Little is known about doctors' experiences and views about leadership in general practice and primary health care. Our study suggests that: There is a lack of preparation and formal training for the leadership role. GPs experience tensions between the clinical and leadership role. GPs recognize leadership challenges at a system level and that doctors should take on leadership roles in primary health care.

Challenges in participatory primary stress management interventions in knowledge intensive SMEs

DEFF Research Database (Denmark)

Gish, Liv; Ipsen, Christine

2013-01-01

relevant change processes. This paper presents the outline of our research and development project on participatory primary stress management interventions in knowledge intensive SMEs, as well as the preliminary results and related implications. The research and development project is conducted in order...... to develop an operational model which SMEs can use when they want to initiate participatory primary stress management interventions in their company. The development project builds on a process model for participatory primary interventions in larger knowledge intensive companies and the premises behind......While knowledge intensive SMEs have recognized the need for change with respect to productivity and wellbeing, and to some extend have access to tools and methods for enabling this, they still lack process competences and are uncertain about how to approach primary stress interventions and initiate...

Inequality and Development Challenges | IDRC - International ...

International Development Research Centre (IDRC) Digital Library (Canada)

2013-08-30

Inequality and Development Challenges. Couverture du livre Inequality and Development Challenges. Editor(s):. Maria Clara Couto Soares, Mario Scerri et Rasigan Maharajh. Publisher(s):. Routledge, CRDI. August 30, 2013. ISBN: 9780415710329. 372 pages. e-ISBN: 9781552505571. Download PDF · Read the e-book.

Developing a research agenda for patient safety in primary care. Background, aims and output of the LINNEAUS collaboration on patient safety in primary care.

Science.gov (United States)

Esmail, Aneez; Valderas, Jose M; Verstappen, Wim; Godycki-Cwirko, Maciek; Wensing, Michel

2015-09-01

This paper is an introduction to a supplement to The European Journal of General Practice, bringing together a body of research focusing on the issue of patient safety in relation to primary care. The supplement represents the outputs of the LINNEAUS collaboration on patient safety in primary care, which was a four-year (2009-2013) coordination and support action funded under the Framework 7 programme by the European Union. Being a coordination and support action, its aim was not to undertake new research, but to build capacity through engaging primary care researchers and practitioners in identifying some of the key challenges in this area and developing consensus statements, which will be an essential part in developing a future research agenda. This introductory article describes the aims of the LINNEAUS collaboration, provides a brief summary of the reasons to focus on patient safety in primary care, the epidemiological and policy considerations, and an introduction to the papers included in the supplement.

General practice education and training in southern China: recent development and ongoing challenges under the health care reform

Directory of Open Access Journals (Sweden)

Wang Jia-Ji

2013-12-01

Full Text Available China has launched a general practice (GP-orientated primary care reform in 2009 to develop a more productive, coordinated, and cost-effective system to maintain and improve the health and wellbeing of one-fifth of the world population. The restructure of the health care system with a focus on primary care requires practitioners working on GP as gatekeepers for service delivery that is responsive to the needs of people. It is particularly prioritised to establish a sound education and training system to ensure that the competencies of practitioners are aligned with local health care needs. This article aims to provide a brief review of the development of GP, including exemplary model of education and training currently implemented in southern China, as well as the challenges to be addressed in the next step. There is a shortage of well-trained and qualified general practitioners in China where more than half of the licensed clinicians in primary care are educated below the undergraduate level. Although there is a stepwise increase in recognition that the capacity of GP is pivotal to the success of primary care development in China, challenges coming from resource restriction, rural and urban disparity, social attitude, and community involvement are highlighted as major bottlenecks that currently hinder the rapid development of GP in China. Supportive policy and guidelines are necessary to build up strong GP recognition and ensure adequate resources to underpin a robust primary care system to deliver affordable and effective health care services for the world’s largest population. It might share some similar experiences with other countries that are struggling to develop a GP-based primary care system.

General practice education and training in southern China: recent development and ongoing challenges under the health care reform.

Science.gov (United States)

Wang, H H X; Wang, J J; Zhou, Z H; Wang, X W; Xu, L

2013-01-01

China has launched a general practice (GP)-orientated primary care reform in 2009 to develop a more productive, coordinated, and cost-effective system to maintain and improve the health and well-being of one-fifth of the world population. The restructure of the health care system with a focus on primary care requires practitioners working on GP as gatekeepers for service delivery that is responsive to the needs of people. It is particularly prioritised to establish a sound education and training system to ensure that the competencies of practitioners are aligned with local health care needs. This article aims to provide a brief review of the development of GP, including exemplary model of education and training currently implemented in southern China, as well as the challenges to be addressed in the next step. There is a shortage of well-trained and qualified general practitioners in China where more than half of the licensed clinicians in primary care are educated below the undergraduate level. Although there is a stepwise increase in recognition that the capacity of GP is pivotal to the success of primary care development in China, challenges coming from resource restriction, rural and urban disparity, social attitude, and community involvement are highlighted as major bottlenecks that currently hinder the rapid development of GP in China. Supportive policy and guidelines are necessary to build up strong GP recognition and ensure adequate resources to underpin a robust primary care system to deliver affordable and effective health care services for the world's largest population. It might share some similar experiences with other countries that are struggling to develop a GP-based primary care system.

Mobile health data collection at primary health care in Ethiopia: a feasible challenge.

Science.gov (United States)

Medhanyie, Araya Abrha; Moser, Albine; Spigt, Mark; Yebyo, Henock; Little, Alex; Dinant, GeertJan; Blanco, Roman

2015-01-01

Feasibility assessment of mobile health (mHealth) data collection at primary health care in Ethiopia. A total of 14 health workers were recruited from 12 primary health care facilities to use smartphones, installed with customized data collection application and electronic maternal health care forms for assessing pregnant women's health for 6 months. Qualitative approaches comprising in-depth interviews and field notes were used to document the users' perception and experience in using the application and forms. All health workers had never had previous exposure to smartphones and electronic forms, but they got used to them easily. Over 6 months, all health workers completed a total of 952 patient records using the forms on smartphones. Health workers' acceptability and demand for the application and forms were high. In introducing the application, nontechnical challenges were more difficult to solve than technical challenges. Introducing an mHealth application at primary health care for routine collection of health data relevant to maternal health at a small scale was feasible. Nonetheless, implementing a system of assigning unique and consistent patient identifier, standardization of health services, and improving mobile network coverage would be prerequisites for scaled-up usage of such an application. Copyright © 2015 Elsevier Inc. All rights reserved.

Promoting Reflexive Thinking and Adaptive Expertise through Video Capturing to Challenge Postgraduate Primary Student Teachers to Think, Know, Feel, and Act Like a Teacher

Science.gov (United States)

Sexton, Steven S.; Williamson-Leadley, Sandra

2017-01-01

This article reports on a study of how a 1-year, course-taught, master's level initial teacher education (ITE) program challenged primary student teachers (n = 4) in developing their sense of self-as-teacher. This study examined how the program's incorporation of video capturing technology impacted on these student teachers' development of…

Universal Primary Education in Kenya: Advancement and Challenges

Science.gov (United States)

Ngugi, Margaret; Mumiukha, Catherine; Fedha, Flora; Ndiga, Beatrice

2015-01-01

Universalisation of primary education (UPE) has been a global issue since the early sixties, yet several decades later and even in the 21st century, many countries in Sub-Saharan Africa are still grappling with it. Unlike their counterparts in the developed world, its realisation in developing countries has been faced with a myriad of constraints.…

Challenges and opportunities for primary, secondary, and tertiary prevention of Chagas' disease.

Science.gov (United States)

Rassi, A; Dias, J C P; Marin-Neto, J A; Rassi, A

2009-04-01

A century after its discovery, Chagas' disease still represents a major public health challenge in Latin America. Moreover, because of growing population movements, an increasing number of cases of imported Chagas' disease have now been detected in non-endemic areas, such as North America and some European countries. This parasitic zoonosis, caused by Trypanosoma cruzi, is transmitted to humans by infected Triatominae insects, or occasionally by non-vectorial mechanisms, such as blood transfusion, mother to fetus, or oral ingestion of materials contaminated with parasites. Following the acute phase of the infection, untreated individuals enter a chronic phase that is initially asymptomatic or clinically unapparent. Usually, a few decades later, 40-50% of patients develop progressive cardiomyopathy and/or motility disturbances of the oesophagus and colon. In the last decades several interventions targeting primary, secondary and tertiary prevention of Chagas' disease have been attempted. While control of both vectorial and blood transfusion transmission of T cruzi (primary prevention) has been successful in many regions of Latin America, early detection and aetiological treatment of asymptomatic subjects with Chagas' disease (secondary prevention) have been largely underutilised. At the same time, in patients with established chronic disease, several pharmacological and non-pharmacological interventions are currently available and have been increasingly used with the intention of preventing or delaying complications of the disease (tertiary prevention). In this review we discuss in detail each of these issues.

Program Development for Primary School Teachers' Critical Thinking

Science.gov (United States)

Boonjeam, Waraporn; Tesaputa, Kowat; Sri-ampai, Anan

2017-01-01

The objectives of this research were: 1) to study the elements and indicators of primary school teachers' critical thinking, 2) to study current situation, desirable situation, development technique, and need for developing the primary school teachers' critical thinking, 3) to develop the program for developing the primary school teachers'…

The Fit Family Challenge: A Primary Care Childhood Obesity Pilot Intervention.

Science.gov (United States)

Jortberg, Bonnie T; Rosen, Raquel; Roth, Sarah; Casias, Luke; Dickinson, L Miriam; Coombs, Letoynia; Awadallah, Nida S; Bernardy, Meaghann K; Dickinson, W Perry

2016-01-01

Childhood obesity has increased dramatically over several decades, and the American Academy of Pediatrics has recommended primary care practices as ideal sites for the identification, education, and implementation of therapeutic interventions. The objective of this study was to describe the implementation and results for the Fit Family Challenge (FFC), a primary care-based childhood obesity intervention. A single-intervention pilot project that trains primary care practices on childhood obesity guidelines and implementation of a family-focused behavior modification curriculum. A total of 29 family medicine and pediatric community practices in Colorado participated. Participants included 290 patients, aged 6 to 12 years, with a body mass index (BMI) above the 85th percentile. The main outcome measure included the feasibility of implementation of a childhood obesity program in primary care; secondary outcomes were changes in BMI percentile, BMI z-scores, blood pressure, and changes in lifestyle factors related to childhood obesity. Implementation of FFC is feasible, statically significant changes were seen for decreases in BMI percentile and BMI z-scores for participants who completed 9 to 15 months of follow-up; lifestyle factors related to childhood obesity in proved Spanish-speaking families and food insecurity were associated with less follow-up time (P childhood obesity intervention may result in significant clinical and lifestyle changes. © Copyright 2016 by the American Board of Family Medicine.

13 CFR 108.120 - Economic development primary mission.

Science.gov (United States)

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Economic development primary mission. 108.120 Section 108.120 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS... Economic development primary mission. The primary mission of a NMVC Company must be economic development of...

Educational challenges of internal migrant girls: a case study among primary school children in Turkey

NARCIS (Netherlands)

Altinyelken, H.K.

2009-01-01

This article seeks to investigate education-related challenges encountered by internal migrant girls studying at primary schools in Turkey. From the perspectives of participants, the emerging themes included adaptation, language, low socio-economic status, peer relations, discrimination and

The Teaching of African Traditional Religion in Primary Schools in Zimbabwe: Challenges and Opportunities

Science.gov (United States)

Marashe, Joel; Ndamba, Gamuchirai Tsitsiozashe; Chireshe, Excellent

2009-01-01

Zimbabwe's Education Ministry recommended the teaching of African Traditional Religion in recognition of its multi-religious society. This study sought to establish the extent to which African Traditional Religion is taught in primary schools, the challenges faced by teachers, and opportunities for promoting its teaching. A descriptive survey…

Rural Teachers' Views: What Are Gender-Based Challenges Facing Free Primary Education in Lesotho?

Science.gov (United States)

Morojele, Pholoho

2013-01-01

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…

Palestinian Refugees : Challenges of Repatriation and Development

International Development Research Centre (IDRC) Digital Library (Canada)

Palestinian Refugees : Challenges of Repatriation and Development. Couverture du livre Palestinian Refugees : Challenges of Repatriation and Development. Directeur(s):. Rex Brynen et Roula El-Rifai. Maison(s) d'édition: I.B. Tauris, CRDI. 14 avril 2007. ISBN : 9781845113117. 224 pages. e-ISBN : 9781552502310.

LA GEOGRAFÍA DE CUBA EN LA ESCUELA PRIMARIA ANTE LOS RETOS DE LA EDUCACIÓN AMBIENTAL PARA EL DESARROLLO SOSTENIBLE | THE GEOGRAPHY OF CUBA IN THE PRIMARY SCHOOL BEFORE THE CHALLENGES OF THE ENVIRONMENTAL EDUCATION FOR THE SUSTAINABLE DEVELOPMENT

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Mavel Moré Estupiñan

2016-08-01

Full Text Available The inclusion of environmental education for sustainable development to the teaching - learning process becomes a challenge for the educational systems in the XXI century. This study is aimed to support this challenge from the didactics of the Geography of Cuba in the elementary school. In this sense, both investigation action participation and systematization of experiences are used to carry out a critical analysis of the Primary School Model, the program and the textbook of this subject. Didactic recommendations for the inclusion of environmental education for the sustainable development to the teaching learning process of Geography of Cuba in the primary school have been provided, as well as dimensions, indicators for their evaluation and models of exercises. These results of the educational science are a valuable tool for updating school curricula and also for the teachers’ continuous formation. Their introduction in selected schools of Villa Clara province achieved positive impacts in the environmental education for the sustainable development, among students and at the same time, in the professional behavior and environmental awareness of teachers.

Inequality and Development Challenges | CRDI - Centre de ...

International Development Research Centre (IDRC) Digital Library (Canada)

Inequality and Development Challenges. Couverture du livre Inequality and Development Challenges. Directeur(s):. Maria Clara Couto Soares, Mario Scerri et Rasigan Maharajh. Maison(s) d'édition: Routledge, CRDI. 30 août 2013. ISBN : 9780415710329. 372 pages. e-ISBN : 9781552505571. Téléchargez le PDF.

The Challenges of Malaysian Dry Ports Development

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Jagan Jeevan

2015-03-01

Full Text Available This paper examines the functions and challenges of dry ports development in Malaysia through 11 face-to-face interviews with dry port stakeholders. The findings reveal that Malaysian dry ports are developed to accelerate national and international business, to activate intermodalism in the nation, to promote regional economic development and to enhance seaport competitiveness. Malaysian dry ports perform the function of transport and logistics, information processing, seaports and value-added services. Challenges facing Malaysian dry ports include insufficient railway tracks, unorganized container planning on the rail deck, highly dependent on single mode of transportation, poor recognition from the seaport community, and competition from localized seaports. This paper further indicates strategies for coping with these challenges and identifies future opportunities for Malaysian dry ports development.

The Role and Challenges of Rural Tourism Development in Transition Countries: Montenegro Experiences

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Ilija Moric

2013-04-01

Full Text Available Rural tourism is widely promoted as an efficient means of counteracting the social, economic and environmental challenges facing rural areas, primarily those associated with the decline of traditional agrarian industries. In line with this, the objective of this paper is to investigate the role and key challenges of rural tourism development in Montenegro as typical transitional economy. Using the extensive literature, available secondary and primary data collected from rural tourism operators, this paper throws light on the main components and issues about current situation in rural areas and rural tourism in Montenegro. Key findings indicate that three key factors of future success should be pulled out, as follows: support from government and international and/or national bodies/organizations, development of new and diversification of present tourist offers in rural areas and enhancement of government policy in the area of entrepreneurship and starting-up of new businesses in rural areas. Regarding practical implications, this paper provide the guidance and ideas for further rural and tourism development in Montenegro.

Panoramic view of challenges and opportunities for primary healthcare systems in Pakistan

International Nuclear Information System (INIS)

Sharif, H.; Sughra, U.; Butt, Z.

2016-01-01

Pakistan has a broad system of primary health care facilities to achieve mission of Health for all. Over the last seven years health expenditure by government of Pakistan has been increased to attain this goal. This study was conducted with the aim to assess all blocks of service readiness (basic equipment, basic amenities, laboratory capacity, standard precautions and essential medicines) in public-primary health care facilities of tehsil Rawalpindi, Pakistan. Methods: A cross-sectional survey was carried out utilizing two separate structured questionnaires for basic health units and rural health centres. Information was collected from administrative heads along with other staff where required, of all public-primary health care facilities of Tehsil Rawalpindi. Data were analysed by using SPSS version17. Results: A total of 26 health facilities were assessed; only 56% BHUs had a sign board that was available in readable form. BHUs with women medical officer as administrative head constituted 52%. Backup for electricity and toilet were the most neglected areas. Basic amenities, standard precautions and laboratory capacity of Basic Health Units (BHUs) showed a clear deviation from standards and is thus a challenge for Pakistan's Primary Health care (PHC). On the other hand for Rural Health Centres (RHCs), most were on the way to meet expectations. Conclusion: Pakistan's government is undoubtedly putting efforts in order to achieve targets of primary healthcare but it needs better mainstreaming of political, institutional and social commitments with modified standards for PHC. (author)

relevance and challenges of primary education to the overall

African Journals Online (AJOL)

PROF EKWUEME

The study buttresses that primary education is useful to the development of the child and the society at large in various .... modern Nigerian society if there is no childhood education. .... traditional Nigerian society, the way the child is treated or ...

Developing a response to family violence in primary health care: the New Zealand experience.

Science.gov (United States)

Gear, Claire; Koziol-McLain, Jane; Wilson, Denise; Clark, Faye

2016-08-20

Despite primary health care being recognised as an ideal setting to effectively respond to those experiencing family violence, responses are not widely integrated as part of routine health care. A lack of evidence testing models and approaches for health sector integration, alongside challenges of transferability and sustainability, means the best approach in responding to family violence is still unknown. The Primary Health Care Family Violence Responsiveness Evaluation Tool was developed as a guide to implement a formal systems-led response to family violence within New Zealand primary health care settings. Given the difficulties integrating effective, sustainable responses to family violence, we share the experience of primary health care sites that embarked on developing a response to family violence, presenting the enablers, barriers and resources required to maintain, progress and sustain family violence response development. In this qualitative descriptive study data were collected from two sources. Firstly semi-structured focus group interviews were conducted during 24-month follow-up evaluation visits of primary health care sites to capture the enablers, barriers and resources required to maintain, progress and sustain a response to family violence. Secondly the outcomes of a group activity to identify response development barriers and implementation strategies were recorded during a network meeting of primary health care professionals interested in family violence prevention and intervention; findings were triangulated across the two data sources. Four sites, representing three PHOs and four general practices participated in the focus group interviews; 35 delegates from across New Zealand attended the network meeting representing a wider perspective on family violence response development within primary health care. Enablers and barriers to developing a family violence response were identified across four themes: 'Getting started', 'Building effective

System Engineering and Technical Challenges Overcome in the J-2X Rocket Engine Development Project

Science.gov (United States)

Ballard, Richard O.

2012-01-01

Beginning in 2006, NASA initiated the J-2X engine development effort to develop an upper stage propulsion system to enable the achievement of the primary objectives of the Constellation program (CxP): provide continued access to the International Space Station following the retirement of the Space Station and return humans to the moon. The J-2X system requirements identified to accomplish this were very challenging and the time expended over the five years following the beginning of the J- 2X effort have been noteworthy in the development of innovations in both the fields for liquid rocket propulsion and system engineering.

Precise chronology of differentiation of developing human primary dentition.

Science.gov (United States)

Hu, Xuefeng; Xu, Shan; Lin, Chensheng; Zhang, Lishan; Chen, YiPing; Zhang, Yanding

2014-02-01

While correlation of developmental stage with embryonic age of the human primary dentition has been well documented, the available information regarding the differentiation timing of the primary teeth was largely based on the observation of initial mineralization and varies significantly. In this study, we aimed to document precise differentiation timing of the developing human primary dentition. We systematically examined the expression of odontogenic differentiation markers along with the formation of mineralized tissue in each developing maxillary and mandibular teeth from human embryos with well-defined embryonic age. We show that, despite that all primary teeth initiate development at the same time, odontogenic differentiation begins in the maxillary incisors at the 15th week and in the mandibular incisors at the 16th week of gestation, followed by the canine, the first primary premolar, and the second primary premolar at a week interval sequentially. Despite that the mandibular primary incisors erupt earlier than the maxillary incisors, this distal to proximal sequential differentiation of the human primary dentition coincides in general with the sequence of tooth eruption. Our results provide an accurate chronology of odontogenic differentiation of the developing human primary dentition, which could be used as reference for future studies of human tooth development.

KNOWLEDGE MANAGEMENT CHALLENGES IN NEW BUSINESS DEVELOPMENT

DEFF Research Database (Denmark)

Jensen, Ole Kjeldal; Ahmed-Kristensen, Saeema; Jensen, Nevena

2011-01-01

The empirical study this paper is based upon, aimed to identify and describe knowledge management challenges, throughout the new business development process. This paper reports findings from the study, as well as the framework used for analysing the KM challenges, which can be applied to other...... in the early phases. Furthermore, two new roles of the early phase, besides instigating projects, were found. This study contributes to the development of support tools for knowledge management in industry and to research with a deeper understanding of the new business development process....... case studies for comparison. Six interviews and 2 full-day workshops, gathering the perspectives of 76 people from an energy-utilities company forms the empirical background of the study. Six categories of knowledge management challenges were identified and, within each, central issues were extracted...

Development of indigenous irradiator - current progress and challenges

International Nuclear Information System (INIS)

Anwar A Rahman; Mohd Arif Hamzah; Muhd Nor Atan; Aznor Hassan; Fadil Ismail; Julia A Karim; Rosli Darmawan

2009-01-01

The development of indigenous irradiator is one of Prototype Development Center main project to support Nuclear Malaysia services. Three (3) projects have been identified and currently the status is in final stage of design. There are some issues and challenges encountered, which delayed the project progress. The paper will discuss the current progress of development and challenges faced in designing the irradiator. (Author)

Building an international network for a primary care research program: reflections on challenges and solutions in the set-up and delivery of a prospective observational study of acute cough in 13 European countries

Directory of Open Access Journals (Sweden)

Veen Robert ER

2011-07-01

Full Text Available Abstract Background Implementing a primary care clinical research study in several countries can make it possible to recruit sufficient patients in a short period of time that allows important clinical questions to be answered. Large multi-country studies in primary care are unusual and are typically associated with challenges requiring innovative solutions. We conducted a multi-country study and through this paper, we share reflections on the challenges we faced and some of the solutions we developed with a special focus on the study set up, structure and development of Primary Care Networks (PCNs. Method GRACE-01 was a multi-European country, investigator-driven prospective observational study implemented by 14 Primary Care Networks (PCNs within 13 European Countries. General Practitioners (GPs recruited consecutive patients with an acute cough. GPs completed a case report form (CRF and the patient completed a daily symptom diary. After study completion, the coordinating team discussed the phases of the study and identified challenges and solutions that they considered might be interesting and helpful to researchers setting up a comparable study. Results The main challenges fell within three domains as follows: i selecting, setting up and maintaining PCNs; ii designing local context-appropriate data collection tools and efficient data management systems; and iii gaining commitment and trust from all involved and maintaining enthusiasm. The main solutions for each domain were: i appointing key individuals (National Network Facilitator and Coordinator with clearly defined tasks, involving PCNs early in the development of study materials and procedures. ii rigorous back translations of all study materials and the use of information systems to closely monitor each PCNs progress; iii providing strong central leadership with high level commitment to the value of the study, frequent multi-method communication, establishing a coherent ethos

Nanotechnology: Development and challenges in Indonesia

Science.gov (United States)

Joni, I. Made; Muthukannan, Vanitha; Hermawan, Wawan; Panatarani, Camellia

2018-02-01

Nanotechnology today is regarded as a revolutionary technology that can help to address the key needs related to energy, environment, health and agriculture in developing countries. This paper is a short review on the development and challenges of nanotechnology in Indonesia. Nanotechnology offers great potential benefits, there is emerging concerns arising from its novel physicochemical properties. The main applications of nanotechnology in the different sectors which is vital and its economic impact in Indonesia is also discussed. The achievment and development of nanotechnology including synthesis and dispersion of nanoparticles (NPs) and its applications in various fields is briefly addressed in Nanotehcnology and Graphene Research Center, Universitas Padjadjaran (Unpad). Despite significant progress in developmental goals, many challenges in the development of nanotechnology proccesing need to be resolved such as support infrastructure and evolution of new form of collaborative arrangements between various sectors and policies which is emerged as an important factor enabling development.

A medical student in private practice for a 1-month clerkship: a qualitative exploration of the challenges for primary care clinical teachers

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Muller-Juge V

2017-12-01

Full Text Available Virginie Muller-Juge, Anne Catherine Pereira Miozzari, Arabelle Rieder, Jennifer Hasselgård-Rowe, Johanna Sommer, Marie-Claude Audétat Unit of Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland Purpose: The predicted shortage of primary care physicians emphasizes the need to increase the family medicine workforce. Therefore, Swiss universities develop clerkships in primary care physicians’ private practices. The objective of this research was to explore the challenges, the stakes, and the difficulties of clinical teachers who supervised final year medical students in their primary care private practice during a 1-month pilot clerkship in Geneva.Methods: Data were collected via a focus group using a semistructured interview guide. Participants were asked about their role as a supervisor and their difficulties and positive experiences. The text of the focus group was transcribed and analyzed qualitatively, with a deductive and inductive approach.Results: The results show the nature of pressures felt by clinical teachers. First, participants experienced the difficulty of having dual roles: the more familiar one of clinician, and the new challenging one of teacher. Second, they felt compelled to fill the gap between the academic context and the private practice context. Clinical teachers were surprised by the extent of the adaptive load, cognitive load, and even the emotional load involved when supervising a trainee in their clinical practice. The context of this rotation demonstrated its utility and its relevance, because it allowed the students to improve their knowledge about the outpatient setting and to develop their professional autonomy and their maturity by taking on more clinical responsibilities.Conclusion: These findings show that future training programs will have to address the needs of clinical teachers as well as bridge the gap between students’ academic training and the skills needed for

Fragile X premutation in women: recognizing the health challenges beyond primary ovarian insufficiency.

Science.gov (United States)

Hoyos, Luis R; Thakur, Mili

2017-03-01

Fragile X premutation carriers have 55-200 CGG repeats in the 5' untranslated region of the FMR1 gene. Women with this premutation face many physical and emotional challenges in their life. Approximately 20% of these women will develop fragile X-associated primary ovarian insufficiency (FXPOI). In addition, they suffer from increased rates of menstrual dysfunction, diminished ovarian reserve, reduction in age of menopause, infertility, dizygotic twinning, and risk of having an offspring with a premutation or full mutation. Consequent chronic hypoestrogenism may result in impaired bone health and increased cardiovascular risk. Neuropsychiatric issues include risk of developing fragile X-associated tremor/ataxia syndrome, neuropathy, musculoskeletal problems, increased prevalence of anxiety, depression, and sleep disturbances independent of the stress of raising an offspring with fragile X syndrome and higher risk of postpartum depression. Some studies have reported a higher prevalence of thyroid abnormalities and hypertension in these women. Reproductive health providers play an important role in the health supervision of women with fragile X premutation. Awareness of these risks and correlation of the various manifestations could help in early diagnosis and coordination of care and services for these women and their families. This paper reviews current evidence regarding the possible conditions that may present in women with premutation-sized repeats beyond FXPOI.

Past and future challenges in developing remote systems technology

International Nuclear Information System (INIS)

Ferguson, K.R.

1978-01-01

During the early development of remote systems for processing and examining fuel and materials from nuclear reactors, the facility designer and operator worked closely together to meet the challenges of this new field. Numerous challenges still face the nuclear remote systems engineer, e.g., the development of systems that reduce the exposure of workers, the need for advances in basic technology, and the development of cost-effective facilities. The solution to these and other challenges can be accelerated by an expanded program of information exchange, an aggressive development program, and improved project management procedures

Challenging the Science Curriculum Paradigm: Teaching Primary Children Atomic-Molecular Theory

Science.gov (United States)

Haeusler, Carole; Donovan, Jennifer

2017-11-01

Solutions to global issues demand the involvement of scientists, yet concern exists about retention rates in science as students pass through school into University. Young children are curious about science, yet are considered incapable of grappling with abstract and microscopic concepts such as atoms, sub-atomic particles, molecules and DNA. School curricula for primary (elementary) aged children reflect this by their limitation to examining only what phenomena are without providing any explanatory frameworks for how or why they occur. This research challenges the assumption that atomic-molecular theory is too difficult for young children, examining new ways of introducing atomic theory to 9 year olds and seeks to verify their efficacy in producing genuine learning in the participants. Early results in three cases in different schools indicate these novel methods fostered further interest in science, allowed diverse children to engage and learn aspects of atomic theory, and satisfied the children's desire for intellectual challenge. Learning exceeded expectations as demonstrated in the post-interview findings. Learning was also remarkably robust, as demonstrated in two schools 8 weeks after the intervention and, in one school, 1 year after their first exposure to ideas about atoms, elements and molecules.

Challenges in Translational Development of Pharmaceutical Cocrystals.

Science.gov (United States)

Kale, Dnyaneshwar P; Zode, Sandeep S; Bansal, Arvind K

2017-02-01

The last 2 decades have witnessed increased research in the area of cocrystals resulting in deeper scientific understanding, increase in intellectual property landscape, and evolution in the regulatory environment. Pharmaceutical cocrystals have received significant attention as a new solid form on account of their ability to modulate poor physicochemical properties of drug molecules. However, pharmaceutical development of cocrystals could be challenging, thus limiting their translation into viable drug products. In the present commentary, the role of cocrystals in the modulation of material properties and challenges involved in the pharmaceutical development of cocrystals have been discussed. The major hurdles encountered in the development of cocrystals such as safety of coformers, unpredictable performance during dissolution and solubility in different media, difficulties in establishing in vitro-in vivo correlation, and polymorphism have been extensively discussed. The influence of selecting appropriate formulation and process design on these challenges has been discussed. Finally, a brief outline of cocrystals that are undergoing clinical development has also been presented. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

The challenges of developing an instrument to assess health provider motivation at primary care level in rural Burkina Faso, Ghana, and Tanzania

Directory of Open Access Journals (Sweden)

Helen Prytherch

2012-10-01

Full Text Available Background: The quality of health care depends on the competence and motivation of the health workers that provide it. In the West, several tools exist to measure worker motivation, and some have been applied to the health sector. However, none have been validated for use in sub-Saharan Africa. The complexity of such tools has also led to concerns about their application at primary care level. Objective: To develop a common instrument to monitor any changes in maternal and neonatal health (MNH care provider motivation resulting from the introduction of pilot interventions in rural, primary level facilities in Ghana, Burkina Faso, and Tanzania. Design: Initially, a conceptual framework was developed. Based upon this, a literature review and preliminary qualitative research, an English-language instrument was developed and validated in an iterative process with experts from the three countries involved. The instrument was then piloted in Ghana. Reliability testing and exploratory factor analysis were used to produce a final, parsimonious version. Results and discussion: This paper describes the actual process of developing the instrument. Consequently, the concepts and items that did not perform well psychometrically at pre-test are first presented and discussed. The final version of the instrument, which comprises 42 items for self-assessment and eight for peer-assessment, is then shown. This is followed by a presentation and discussion of the findings from first use of the instrument with MNH providers from 12 rural, primary level facilities in each of the three countries. Conclusions: It is possible to undertake work of this nature at primary health care level, particularly if the instruments are kept as straightforward as possible and well introduced. However, their development requires very lengthy preparatory periods. The effort needed to adapt such instruments for use in different countries within the region of sub-Saharan Africa should not

The challenges of developing an instrument to assess health provider motivation at primary care level in rural Burkina Faso, Ghana and Tanzania

Science.gov (United States)

Prytherch, Helen; Leshabari, Melkidezek T.; Wiskow, Christiane; Aninanya, Gifty A.; Kakoko, Deodatus C.V.; Kagoné, Moubassira; Burghardt, Juliane; Kynast-Wolf, Gisela; Marx, Michael; Sauerborn, Rainer

2012-01-01

Background The quality of health care depends on the competence and motivation of the health workers that provide it. In the West, several tools exist to measure worker motivation, and some have been applied to the health sector. However, none have been validated for use in sub-Saharan Africa. The complexity of such tools has also led to concerns about their application at primary care level. Objective To develop a common instrument to monitor any changes in maternal and neonatal health (MNH) care provider motivation resulting from the introduction of pilot interventions in rural, primary level facilities in Ghana, Burkina Faso, and Tanzania. Design Initially, a conceptual framework was developed. Based upon this, a literature review and preliminary qualitative research, an English-language instrument was developed and validated in an iterative process with experts from the three countries involved. The instrument was then piloted in Ghana. Reliability testing and exploratory factor analysis were used to produce a final, parsimonious version. Results and discussion This paper describes the actual process of developing the instrument. Consequently, the concepts and items that did not perform well psychometrically at pre-test are first presented and discussed. The final version of the instrument, which comprises 42 items for self-assessment and eight for peer-assessment, is then shown. This is followed by a presentation and discussion of the findings from first use of the instrument with MNH providers from 12 rural, primary level facilities in each of the three countries. Conclusions It is possible to undertake work of this nature at primary health care level, particularly if the instruments are kept as straightforward as possible and well introduced. However, their development requires very lengthy preparatory periods. The effort needed to adapt such instruments for use in different countries within the region of sub-Saharan Africa should not be underestimated. PMID

Challenge Problem Development and Evaluation Management

National Research Council Canada - National Science Library

Schrag, Robert

2001-01-01

This final report describes work performed by Information Extraction & Transport (IET), Inc. on Challenge Problem Development and Evaluation Management for the Defense Advanced Research Projects Agency's...

Development of Educational Management System in Small Primary School

Science.gov (United States)

Alsammarry, Yupayao; Sirisuthi, Chaiyuth; Duangcharthom, Surat

2016-01-01

The purposes of the research were: (1) to study the factors of Educational Management System in Small Primary School; (2) to investigate current situations problems and guidelines of developing educational management in small primary school; (3) to develop Educational Management System in Small Primary School; and (4) to examine the results of…

Vision first? The development of primary visual cortical networks is more rapid than the development of primary motor networks in humans.

Directory of Open Access Journals (Sweden)

Patricia Gervan

Full Text Available The development of cortical functions and the capacity of the mature brain to learn are largely determined by the establishment and maintenance of neocortical networks. Here we address the human development of long-range connectivity in primary visual and motor cortices, using well-established behavioral measures--a Contour Integration test and a Finger-tapping task--that have been shown to be related to these specific primary areas, and the long-range neural connectivity within those. Possible confounding factors, such as different task requirements (complexity, cognitive load are eliminated by using these tasks in a learning paradigm. We find that there is a temporal lag between the developmental timing of primary sensory vs. motor areas with an advantage of visual development; we also confirm that human development is very slow in both cases, and that there is a retained capacity for practice induced plastic changes in adults. This pattern of results seems to point to human-specific development of the "canonical circuits" of primary sensory and motor cortices, probably reflecting the ecological requirements of human life.

Interlibrary loan in primary access libraries: challenging the traditional view.

Science.gov (United States)

Dudden, R F; Coldren, S; Condon, J E; Katsh, S; Reiter, C M; Roth, P L

2000-10-01

Primary access libraries serve as the foundation of the National Network of Libraries of Medicine (NN/LM) interlibrary loan (ILL) hierarchy, yet few published reports directly address the important role these libraries play in the ILL system. This may reflect the traditional view that small, primary access libraries are largely users of ILL, rather than important contributors to the effectiveness and efficiency of the national ILL system. This study was undertaken to test several commonly held beliefs regarding ILL system use by primary access libraries. Three hypotheses were developed. HI: Colorado and Wyoming primary access libraries comply with the recommended ILL guideline of adhering to a hierarchical structure, emphasizing local borrowing. H2: The closures of two Colorado Council of Medical Librarians (CCML) primary access libraries in 1996 resulted in twenty-three Colorado primary access libraries' borrowing more from their state resource library in 1997. H3: The number of subscriptions held by Colorado and Wyoming primary access libraries is positively correlated with the number of items they loan and negatively correlated with the number of items they borrow. The hypotheses were tested using the 1992 and 1997 DOCLINE and OCLC data of fifty-four health sciences libraries, including fifty primary access libraries, two state resource libraries, and two general academic libraries in Colorado and Wyoming. The ILL data were obtained electronically and analyzed using Microsoft Word 98, Microsoft Excel 98, and JMP 3.2.2. CCML primary access libraries comply with the recommended guideline to emphasize local borrowing by supplying each other with the majority of their ILLs, instead of overburdening libraries located at higher levels in the ILL hierarchy (H1). The closures of two CCML primary access libraries appear to have affected the entire ILL system, resulting in a greater volume of ILL activity for the state resource library and other DOCLINE libraries higher

A medical student in private practice for a 1-month clerkship: a qualitative exploration of the challenges for primary care clinical teachers.

Science.gov (United States)

Muller-Juge, Virginie; Pereira Miozzari, Anne Catherine; Rieder, Arabelle; Hasselgård-Rowe, Jennifer; Sommer, Johanna; Audétat, Marie-Claude

2018-01-01

The predicted shortage of primary care physicians emphasizes the need to increase the family medicine workforce. Therefore, Swiss universities develop clerkships in primary care physicians' private practices. The objective of this research was to explore the challenges, the stakes, and the difficulties of clinical teachers who supervised final year medical students in their primary care private practice during a 1-month pilot clerkship in Geneva. Data were collected via a focus group using a semistructured interview guide. Participants were asked about their role as a supervisor and their difficulties and positive experiences. The text of the focus group was transcribed and analyzed qualitatively, with a deductive and inductive approach. The results show the nature of pressures felt by clinical teachers. First, participants experienced the difficulty of having dual roles: the more familiar one of clinician, and the new challenging one of teacher. Second, they felt compelled to fill the gap between the academic context and the private practice context. Clinical teachers were surprised by the extent of the adaptive load, cognitive load, and even the emotional load involved when supervising a trainee in their clinical practice. The context of this rotation demonstrated its utility and its relevance, because it allowed the students to improve their knowledge about the outpatient setting and to develop their professional autonomy and their maturity by taking on more clinical responsibilities. These findings show that future training programs will have to address the needs of clinical teachers as well as bridge the gap between students' academic training and the skills needed for outpatient care. Professionalizing the role of clinical teachers should contribute to reaching these goals.

[The Articulator of Primary Health Care Program: an innovative proposal for qualification of Primary Health Care].

Science.gov (United States)

Doricci, Giovanna Cabral; Guanaes-Lorenzi, Carla; Pereira, Maria José Bistafa

2017-06-01

In 2009, the Secretary of State for Health of Sao Paulo created a Program with a view to qualify the primary care in the state. This proposal includes a new job function, namely the articulator of primary care. Due to the scarcity of information about the practice of these new professionals in the scientific literature, this article seeks to analyze how articulators interpret their function and how they describe their daily routines. Thirteen articulators were interviewed. The interviews were duly analyzed by qualitative delineation. The results describe three themes: 1)Roles of the articulator: technical communicator and political advisor; 2) Activities performed to comply with the expected roles, examples being diagnosis of the municipalities, negotiation of proposals, participation in meetings, visits to municipalities; and 3) Challenges of the role, which are configured as challenges to the health reform process, examples being the lack of physical and human resources, activities of professionals in the medical-centered model, among others. The conclusion drawn is that the Program has great potential to provide input for the development and enhancement of Primary Care. Nevertheless, there are a series of challenges to be overcome, namely challenges to the context per se.

Challenges facing the development of the Arabic chatbot

Science.gov (United States)

AlHagbani, Eman Saad; Khan, Muhammad Badruddin

2016-07-01

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.

[Primary Health Care in Austria - Tu Felix Austria nube - Concept for networking in the primary care of Upper Austria].

Science.gov (United States)

Kriegel, Johannes; Rebhandl, Erwin; Hockl, Wolfgang; Stöbich, Anna-Maria

2017-10-01

The primary health care in rural areas in Austria is currently determined by challenges such as ageing of the population, the shift towards chronic and age-related illnesses, the specialist medical and hospital-related education and training of physicians' as well growing widespread difficulty of staffing doctor's office. The objective is to realize a general practitioner centered and team-oriented primary health care (PHC) approach by establishing networked primary health care in rural areas of Austria. Using literature research, online survey, expert interviews and expert workshops, we identified different challenges in terms of primary health care in rural areas. Further, current resources and capacities of primary health care in rural areas were identified using the example of the district of Rohrbach. Twelve design dimensions and 51 relevant measurement indicators of a PHC network were delineated and described. Based on this, 12 design approaches of PHC concept for the GP-centered and team-oriented primary health care in rural areas have been developed.

Challenges to the Israeli healthcare system: attracting medical students to primary care and to the periphery.

Science.gov (United States)

Weissman, Charles; Zisk-Rony, Rachel Yaffa; Avidan, Alexander; Elchalal, Uriel; Tandeter, Howard

2018-05-29

The greatest challenges facing healthcare systems include ensuring a sufficient supply of primary care physicians and physicians willing to work in rural or peripheral areas. Especially challenging is enticing young physicians to practice primary care in rural/peripheral areas. Identifying medical students interested in primary care and in residencies in Israel's periphery should aid the healthcare leadership. It may be particularly important to do so during the clinical years, as this is the stage at which many future physicians begin to crystallize their specialty and location preferences. Questionnaires, distributed to 6 consecutive 5th-year classes of the Hebrew University - Hadassah School of Medicine, from 2010 to 2016, elicited information on criteria for choosing a career specialty, criteria for choosing a residency program and whether one-time monetary grants authorized in the 2011 physicians' union contract would attract students to residencies in the periphery. Completed questionnaires were returned by 511 of 740 (69%) students. Ninety-eight (19%) were interested in a primary care residency, 184 (36%) were unsure and 229 (45%) were not interested. Students interested in primary care were significantly less interested in specialties that perform procedures/surgeries and in joining a medical school faculty, while being more inclined towards specialties dealing with social problems, controllable lifestyles and working limited hours. The percentage of students interested in primary care was stable during the study period. Forty-eight of the students indicated interest in residencies in the country's periphery, and 42% of them were also interested in primary care residencies. Overall, only 3.7% of students were interested in both a primary care residency and a residency in the periphery. Thirty percent of the students indicated that the monetary incentives tempted them to consider a residency in the periphery. Fifty-three percent of these students reported

[Challenges in primary health care: the experience in Vila Mariana District, São Paulo, Brazil].

Science.gov (United States)

Villela, Wilza Vieira; Araújo, Eliane Cardoso de; Ribeiro, Sandra Aparecida; Cuginotti, Aloísio Punhagui; Hayana, Eliana Tiemi; Brito, Francisco Carlos de; Ramos, Luiz Roberto

2009-06-01

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.

INVESTIGATING THE MANAGEMENT OF CARIOUS PRIMARY TEETH IN GENERAL DENTAL PRACTICE: AN OVERVIEW OF THE DEVELOPMENT AND CONDUCT OF THE FICTION TRIAL.

Science.gov (United States)

Stewart, Matthew; Keightley, Alexander; Maguire, Anne; Chadwick, Barbara; Vale, Luke; Homer, Tara; Douglas, Gail; Deery, Chris; Marshman, Zoe; Ryan, Vicky; Innes, Nicola

2015-11-01

The management of carious primary teeth is a challenge for patients, parents and clinicians. Most evidence supporting different management strategies originates from a specialist setting and therefore its relevance to the primary care setting is questionable. The UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) has commissioned the FiCTION (Filling Children's Teeth: Indicated Or Not?) trial; a multi-centre primary dental care randomised controlled trial (RCT) to determine the most clinically and cost- effective approach to managing caries in the primary dentition in the UK. This large trial began in 2012, is due to be completed in late 2017 and involves 72 practices and 1,124 children initially aged three to seven years with dentine caries, following randomisation to one of three caries management strategies. Clinical, radiographic, quality of life, treatment acceptability and health economics data are collected during the three-year follow up period. This article provides an overview of the development and conduct of FiCTION and discusses some approaches adopted to manage challenges and achieve the patient recruitment target.

"All We Did Was Things Like Forces and Motion?…": Multiple Discourses in the Development of Primary Science Teachers

Science.gov (United States)

Danielsson, Anna; Warwick, Paul

2014-01-01

Previous research has highlighted challenges associated with embracing an inquiry approach to science teaching for primary teachers, often associating these challenges with insecurity linked to the lack of content knowledge. We argue that in order to understand the extent to which primary student teachers are able to embrace science teaching…

Managing anemia in low-income toddlers: barriers, challenges and context in primary care.

Science.gov (United States)

Crowell, Rebecca; Pierce, Michelle B; Ferris, Ann M; Slivka, Hilda; Joyce, Patricia; Bernstein, Bruce A; Russell-Curtis, Suzanne

2005-11-01

Iron-deficiency remains a concern among low-income toddlers in the U.S. This formative study describes how primary care providers serving high-risk 1- to 3-year-old children in an urban ambulatory care setting approach anemia. Data collection included a retrospective review of randomly selected medical records (n=264) and semi-structured interviews with clinicians (n=41). Thirty-eight percent of the children presented with anemia (Hgb variable. While providers felt clinically comfortable with anemia, they felt burdened and challenged by follow-up. Communication and system barriers weighed most heavily on perceived treatment outcomes.

Burnout among primary care physicians in Jos-Plateau, north ...

African Journals Online (AJOL)

Background: Developing countries health systems are bedeviled with numerous challenges including resource scarcity, high workload, unfavourable working conditions, Physical and Psychosocial stress. The Aim of this study was to assess the burden of burnout among primary care physicians working in such challenging ...

Challenges to the Implementation of PLAP in Primary Schools: Perceptions of ZOU Bachelor of Educational Management Students

Science.gov (United States)

Mercy, Kurebwa; Mabhanda, Wilson

2015-01-01

The study explored the challenges that impact on the implementation of PLAP in the Primary schools. The research was conducted with teachers who study towards the BEd Management degree with Zimbabwe Open University (ZOU) in the Midlands Region. The study used a qualitative research approach and collected data through open ended questionnaires and…

The use of Museum Based Science Centres to Expose Primary School Students in Developing Countries to Abstract and Complex Concepts of Nanoscience and Nanotechnology

Science.gov (United States)

Saidi, Trust; Sigauke, Esther

2017-10-01

Nanotechnology is an emerging technology, and it is regarded as the basis for the next industrial revolution. In developing countries, nanotechnology promises to solve everyday challenges, such as the provision of potable water, reliable energy sources and effective medication. However, there are several challenges in the exploitation of nanotechnology. One of the notable challenges is the lack of adequate knowledge about how materials behave at the nanoscale. As nanotechnology is relatively new, the current generation of scientists have not had the opportunity to learn the fundamentals of the technology at an early stage. Young students who are at the primary school level may follow the same trajectory if they are not exposed to the technology. There is a need to lay a strong foundation by introducing nanoscience and nanotechnology to students at the primary school level. It is during the early stages of child development that students master basic concepts for life long learning. Nevertheless, many primary school children, particularly those in developing countries are missing the chance of learning about nanoscience and nanotechnology because it is regarded as being abstract and complex. In this paper, we argue that despite the complexity of nanoscience and nanotechnology, science centres can be used as one of the platforms for exposing young students to the discipline. We use a case study of a museum-based science centre as an example to illustrate that young students can be exposed to nanoscience and nanotechnology using tactile and hands-on experience. The early engagement of primary school children with nanoscience and nanotechnology is important in raising the next generation of scientists who are firmly grounded in the discipline.

The Development of Visionary Leadership Administrators in Thai Primary School

Science.gov (United States)

Yordsala, Suwit; Tesaputa, Kowat; Sri-Ampai, Anan

2014-01-01

This research aimed: 1) to investigate the current situations and needs in developing visionary leadership of Thai primary school administrators; 2) to develop visionary leadership development program of Thai primary school administrators, and; 3) to evaluate the implementation of the developed program of administrators visionary leadership…

Primary unclassified sarcoma of the parotid gland: a case of diagnostic and therapeutic challenge.

Science.gov (United States)

Saravakos, Panagiotis; Hartwein, Joerg; Fayyazi, Afshin

2017-05-01

Malignant salivary gland sarcomas represent a clinically and histologically diagnostic challenge. Primary unclassified sarcomas of the parotid gland consist a rare salivary gland tumor. We report an unusual case of such a tumor, which occurred in the right parotid gland of a 54-year-old male and presented as an asymptomatic painless mass. The pathologoanatomical examination revealed a rhabdoid large-cell unclassified sarcoma. The patient was treated with superficial parotidectomy and adjuvant radiotherapy. No recurrence was noted in a 10-year follow-up period. Due to the rare occurrence of primary unclassified sarcomas, there is no evidence-based treatment of choice. An optimal approach is best planned in a multidisciplinary setting, taking into consideration the resectability of the tumor, individual patient characteristics, presence of local or distant metastatic activity, local infiltrative behavior and tumor stage. A close follow-up of the patient is strongly recommended.

Challenges and Strategies in Providing Home Based Primary Care for Refugees in the US.

Science.gov (United States)

Febles, C; Nies, M A; Fanning, K; Tavernier, S S

2017-12-01

The recent crisis in the Middle East has prompted the exodus of millions of refugees from the region who are at present seeking shelter across Europe and in the United States. Among the most immediate needs of refugees upon arrival in a host country is health care, and it is one of the most sustained interactions they experience. Home visits are a common form of primary care for refugees. The authors review the literature to identify themes related to challenges and strategies for providing home based primary care to refugees. The literature review was performed by searching cross-disciplinary databases utilizing Onesearch, but focusing primarily on results produced through CINAHL, EBSCOHOST, and Pub Med databases. To maximize the number of studies included, there was no time frame placed upon publication dates of articles within the search. A total of 55 articles were included in this paper.

CHALLENGES AND STRATEGIES FOR E-LEARNING DEVELOPMENT IN THE PAYAME NOOR UNIVERSITY OF IRAN

Directory of Open Access Journals (Sweden)

Mahnaz MOHAMADZADEH

2012-01-01

Full Text Available Higher education in Iran is confronting with several challenges; some of them are increasing demand for education and insufficiency of current programs to meet the growing needs, emerging information age and the necessity of achieving information literacy, and extending educational justice. It is assumes that a high performance e-learning system can overcome to the mentioned problems. It removes time and place restrictions and creates economical benefits, and makes available lifelong learning opportunity for all. The primary purpose of this study was to identify challenges of electronic learning development in Payame Noor University of Iran to present feasible solutions for establishing a suitable e-learning system. Descriptive survey design for data collection was adopted in this study. The population of this study was consisted of 600 instructors and faculty members. A sample of 160 faculty member was selected by using random sampling method. Results show that barriers such as incompatibility of contents and methods, skill unavailability, attitudinal hampering, cultural barriers, infrastructural obstacles, encouraging and credit barriers as well as barriers related to incorporating e- learning into traditional education systems were the main challenges of e-learning in the Payame Noor University. Also results revealed that factors such as educational effectiveness in e- learning, policy making, university's technical and social support of e- learning, financial support and expansion of income earning for instructors and faculty members, improving working conditions, foreign language skill and faculty members interest in professional development were the most important factors in developing e-learning in Payame Noor university of Iran.

Deepwater development - the metocean challenges

International Nuclear Information System (INIS)

Graham, C.

1998-01-01

As the focus of the offshore industry moves increasingly towards deepwater, attention is concentrating more and more on life-cycle field development costs. Key elements are reducing development lead times, equipment standardisation and efficient use of scarce resources. An essential precursor is a clear definition of the metocean environment. Without it, engineering design may be unnecessarily conservative or inadequate. Either way the consequences will be expensive. It is the metocean challenge to help bring down costs, while maintaining adequate safety levels by providing the necessary answers, but most important of all, to do this in sufficient time to be in step with the engineering requirements at each stage of a planned development. (author)

Refugee Children in South Africa: Access and Challenges to Achieving Universal Primary Education

Science.gov (United States)

Meda, L.; Sookrajh, R.; Maharaj, B.

2012-01-01

This paper questions whether the second Millennium Development Goal of achieving universal primary education targets by 2015 for all children to complete a full course of primary schooling, can be realised. A key contention of this paper is that this forecast is far-fetched when we take into cognizance refugee children's accessibility to…

The skill development temporary location with focus professional on the formation of the primary master

Directory of Open Access Journals (Sweden)

Carlos Alberto Rojas González

2018-01-01

Full Text Available The development of skills as part of the integral formation of the primary teacher is today one of the main challenges in initial formation. In particular, to promote the development of the temporal location skill, it becomes a learning problem at the same time as a professional problem, so that they can understand the past, to understand the present and project the future, with modes of action consistent with social demands. The objective of this paper is to present the results of the study carried out on the current state of this process of development of the temporary location skill with a professional focus in the career Degree in Primary Education, at the University of Pinar del Río. For this, methods such as the historical-logical, the documentary analysis, the interview with teachers, the survey of teachers in training and the observation of classes were used, which allowed to verify the current state of said process in the initial formation of the primary teacher, taking as a methodological basis the dialectical-materialist method. From the systematization carried out it was possible to know that the subject has been little addressed, in the particular context of this professional in the undergraduate. In the historical evolution of the various curricula, the appropriation of the internal structure of this skill on the part of the students has not yet been achieved, which significantly limits the pertinence of the training process, negatively affecting the fact that students appropriate historical content and develop historical reasoning.

Exploring informal workplace learning in primary healthcare for continuous professional development.

Science.gov (United States)

Joynes, Viktoria; Kerr, Micky; Treasure-Jones, Tamsin

2017-07-01

All health and social care professionals learn on the job through both formal and informal learning processes, which contributes to continuous professional development (CPD). This study explored workplace learning in General Practices, specifically looking at the role of informal learning and the workplace practices that appear to support or restrict that learning, as well as how technology was integrated into these learning processes. Three focus groups with general practitioners, practice nurses, managerial and administrative staff were conducted followed by twelve individual semi-structured interviews with participants drawn from the focus groups. Three observations of multi-disciplinary team meetings were used to establish potential team-based learning activities. Triggers for informal workplace learning included patients presenting challenging or unusual conditions; exposure to others' professional practice; and policy driven changes through revised guidance and protocols. By exploring how these triggers were acted upon, we identified mechanisms through which the primary care workplace supports or restricts informal learning through working practices, existing technologies and inter-professional structures. Informal workplace learning was identified as arising from both opportunistic encounters and more planned activities, which are both supported and restricted through a variety of mechanisms. Maximising informal learning opportunities and removing barriers to doing so should be a priority for primary care practitioners, managers and educators.

Development of Cryogenic Engine for GSLV MkIII: Technological Challenges

Science.gov (United States)

Praveen, RS; Jayan, N.; Bijukumar, KS; Jayaprakash, J.; Narayanan, V.; Ayyappan, G.

2017-02-01

Cryogenic engine capable of delivering 200 kN thrust is being developed for the first time in the country by ISRO for powering the upper stage of GSLV Mk-III, the next generation launch vehicle of ISRO capable of launching four tonne class satellites to Geo-synchronous Transfer Orbit(GTO). Development of this engine started a decade ago when various sub-systems development and testing were taken up. Starting with injector element development, the design, realization and testing of the major sub-systems viz the gas generator, turbopumps, start-up system and thrust chamber have been successfully done in a phased manner before conducting a series of developmental tests in the integrated engine mode. Apart from the major sub-systems, many critical components like the igniter, control components etc were independently developed and qualified. During the development program many challenges were faced in almost all areas of propulsion engineering. Systems engineering of the engine was another key challenge in the realization. This paper gives an outlook on various technological challenges faced in the key areas related to the engine development, insight to the solutions and measures taken to overcome the challenges.

The Thai-Australian Health Alliance: developing health management capacity and sustainability for primary health care services.

Science.gov (United States)

Briggs, D S; Tejativaddhana, P; Cruickshank, M; Fraser, J; Campbell, S

2010-11-01

There have been recent calls for a renewed worldwide focus on primary health care. The Thai-Australian Health Alliance addresses this call by developing health care management capability in primary health care professionals in rural Thailand. This paper describes the history and current activities of the Thai-Australian Health Alliance and its approaches to developing health care management capacity for primary care services through international collaborations in research, education and training over a sustained time period. The Alliance's approach is described herein as a distributed network of practices with access to shared knowledge through collaboration. Its research and education approaches involve action research, multi-methods projects, and evaluative studies in the context of workshops and field studies. WHO principles underpin this approach, with countries sharing practical experiences and outcomes, encouraging leadership and management resource networks, creating clearing houses/knowledge centres, and harmonising and aligning partners with their country's health systems. Various evaluations of the Alliance's activities have demonstrated that a capacity building approach that aligns researchers, educators and health practitioners in comparative and reflective activities can be effective in transferring knowledge and skills among a collaboration's partners. Project participants, including primary health care practitioners, health policy makers and academics embraced the need to acquire management skills to sustain primary care units. Participants believe that the approaches described herein were crucial to developing the management skills needed of health care professionals for rural and remote primary health care. The implementation of this initiative was challenged by pre-existing low opinions of the importance of the management role in health care, but with time the Alliance's activities highlighted for all the importance of health care management

Islay development flow assurance challenges

Energy Technology Data Exchange (ETDEWEB)

Helingoe, Mark; Greder, Hugues

2010-07-01

The Islay field is located in the Northern North Sea UK sector in the vicinity of the Alwyn Platforms. This gas condensate Brent structure is planned to be developed subsea with first gas in 2011. The main development challenge for this HPHT field comes from the early expected formation water production which is the source of major hydrate related flow assurance issues. As continuous inhibition is not feasible, Total has progressed a development scenario based on seabed conditioning prior to pipe laying so that water can be collected and temporarily inhibited at specific low points after a shut-down. It is also intended to heat trace the pipeline as a back-up solution to avoid hydrate formation. Heat tracing has so far never been implemented in Subsea developments. The Islay pilot could open the path to a new hydrate management philosophy for future developments. (Author)

The Challenges of New Product Development in a Developing Economy

OpenAIRE

M. O. Oduola; A. M. Yakubu

2017-01-01

New Product Development (NPD) involves creating a new product from concept to the market. The product could be entirely new or rebranding. It is a critical focus of any production firm. The increase in volume of new competitive products is an indicator of any fast growing production concern. However the challenges that could affect development of a new product in a developing economy include, but not limited to the following: Inadequate infrastructural facilities, lack of funding, low technol...

RNA-Sequencing of Primary Retinoblastoma Tumors Provides New Insights and Challenges Into Tumor Development

Directory of Open Access Journals (Sweden)

Sailaja V. Elchuri

2018-05-01

Full Text Available Retinoblastoma is rare tumor of the retina caused by the homozygous loss of the Retinoblastoma 1 tumor suppressor gene (RB1. Loss of the RB1 protein, pRB, results in de-regulated activity of the E2F transcription factors, chromatin changes and developmental defects leading to tumor development. Extensive microarray profiles of these tumors have enabled the identification of genes sensitive to pRB disruption, however, this technology has a number of limitations in the RNA profiles that they generate. The advent of RNA-sequencing has enabled the global profiling of all of the RNA within the cell including both coding and non-coding features and the detection of aberrant RNA processing events. In this perspective, we focus on discussing how RNA-sequencing of rare Retinoblastoma tumors will build on existing data and open up new area’s to improve our understanding of the biology of these tumors. In particular, we discuss how the RB-research field may be to use this data to determine how RB1 loss results in the expression of; non-coding RNAs, causes aberrant RNA processing events and how a deeper analysis of metabolic RNA changes can be utilized to model tumor specific shifts in metabolism. Each section discusses new opportunities and challenges associated with these types of analyses and aims to provide an honest assessment of how understanding these different processes may contribute to the treatment of Retinoblastoma.

The Challenges in Developing E-Content

Directory of Open Access Journals (Sweden)

Jowati Juhary

2010-11-01

Full Text Available Malaysia is considered an active key player in information communication technologies (ICTs especially in education. In fact, in the National Higher Education Strategic Plan, one of the Critical Agenda Projects (CAPs of the Minister of Higher Education is e-learning. It goes without saying that all higher learning providers in Malaysia must be prepared to provide state-of-the-art facilities for the students. One critical aspect of e-learning is the quality and quantity of the content, or what will be referred by many scholars as e-content. This paper attempts to identify the challenges of content development for e-learning practice at the National Defence University of Malaysia (NDUM. It is crucial to investigate this issue since the university just purchased its Learning Management System (LMS. It is expected that resistance will be present as the academics at the defence university is a mixture of junior and senior lecturers, as well as civilian and military lecturers; and some of these academics have been teaching without the assistance of e-learning. In so doing, the methodology of this paper will mainly be content analysis of various reports, governmental documents, as well as semi-structured interviews with lecturers at the NDUM. As this paper acts as a preliminary investigation into the issue of e-content at the university, only seven lecturers were interviewed. Initial findings suggest that there are basically five challenges of developing e-content at the NDUM. These include the lack of ICT and e-learning policy that can provide guidelines to academics; the uncertainty of ownership for e-learning initiatives; the lack of understanding of the roles of e-learning; the lack of awareness on e-learning; and the difficulties to develop military based content due to confidentiality issues. Two possible solutions for these challenges are also examined which take into consideration the urgent need to set up an e-Learning Unit and to provide

The Challenges of Developing Research Resources for Leading Vietnamese Universities

Science.gov (United States)

Nguyen, Thi Lan Huong

2013-01-01

This paper examines the challenges of developing research resources for leading Vietnamese universities. The first part of the paper presents the background to the study, including literature review on the challenges to research resources development, and describes the research questions and research methods. The next part provides empirical…

Monitoring Forest Change in Landscapes Under-Going Rapid Energy Development: Challenges and New Perspectives

Directory of Open Access Journals (Sweden)

Paul D. Pickell

2014-07-01

Full Text Available The accelerated development of energy resources around the world has substantially increased forest change related to oil and gas activities. In some cases, oil and gas activities are the primary catalyst of land-use change in forested landscapes. We discuss the challenges associated with characterizing ecological change related to energy resource development using North America as an exemplar. We synthesize the major impacts of energy development to forested ecosystems and offer new perspectives on how to detect and monitor anthropogenic disturbance during the Anthropocene. The disturbance of North American forests for energy development has resulted in persistent linear corridors, suppression of historical disturbance regimes, novel ecosystems, and the eradication of ecological memory. Characterizing anthropogenic disturbances using conventional patch-based disturbance measures will tend to underestimate the ecological impacts of energy development. Suitable indicators of anthropogenic impacts in forests should be derived from the integration of multi-scalar Earth observations. Relating these indicators to ecosystem condition will be a capstone in the progress toward monitoring forest change in landscapes undergoing rapid energy development.

Salt Sensitivity: Challenging and Controversial Phenotype of Primary Hypertension.

Science.gov (United States)

Iatrino, Rossella; Manunta, Paolo; Zagato, Laura

2016-09-01

Increases in life expectancy and cardiovascular adverse events in patients with hypertension highlight the need for new risk-reduction strategies to reduce the burden of degenerative diseases. Among the environmental factors, high salt consumption is currently considered the most important risk factor of hypertension. However, while high salt intake significantly raises blood pressure in some individuals, others do not show variation or even decrease their blood pressure. This heterogeneity is respectively classified as salt sensitivity and salt resistance. In this review, we propose salt sensitivity as a useful phenotype to unravel the mechanistic complexity of primary hypertension. The individual variability in blood pressure modification in response to salt intake changes derives from the combination of genetic and environmental determinants. This combination of random and non random determinants leads to the development of a personal index of sensitivity to salt. However, those genes involved in susceptibility to salt are still not completely identified, and the triggering mechanisms underlying the following development of hypertension still remain uncovered. One reason might be represented by the absence of a specific protocol, universally followed, for a standard definition of salt sensitivity. Another reason may be linked to the absence of common criteria for patient recruitment during clinical studies. Thus, the generation of a reliable approach for a proper recognition of this personal index of sensitivity to salt, and through it the identification of novel therapeutic targets for primary hypertension, should be one of the aspirations for the scientific community.

Challenges and opportunities in building a sustainable rural primary care workforce in alignment with the Affordable Care Act: the WWAMI program as a case study.

Science.gov (United States)

Allen, Suzanne M; Ballweg, Ruth A; Cosgrove, Ellen M; Engle, Kellie A; Robinson, Lawrence R; Rosenblatt, Roger A; Skillman, Susan M; Wenrich, Marjorie D

2013-12-01

The authors examine the potential impact of the Patient Protection and Affordable Care Act (ACA) on a large medical education program in the Northwest United States that builds the primary care workforce for its largely rural region. The 42-year-old Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) program, hosted by the University of Washington School of Medicine, is one of the nation's most successful models for rural health training. The program has expanded training and retention of primary care health professionals for the region through medical school education, graduate medical education, a physician assistant training program, and support for practicing health professionals.The ACA and resulting accountable care organizations (ACOs) present potential challenges for rural settings and health training programs like WWAMI that focus on building the health workforce for rural and underserved populations. As more Americans acquire health coverage, more health professionals will be needed, especially in primary care. Rural locations may face increased competition for these professionals. Medical schools are expanding their positions to meet the need, but limits on graduate medical education expansion may result in a bottleneck, with insufficient residency positions for graduating students. The development of ACOs may further challenge building a rural workforce by limiting training opportunities for health professionals because of competing demands and concerns about cost, efficiency, and safety associated with training. Medical education programs like WWAMI will need to increase efforts to train primary care physicians and increase their advocacy for student programs and additional graduate medical education for rural constituents.

Research and Development Projects with ICT and students as learning designers in Primary Schools: A methodological challenge

DEFF Research Database (Denmark)

Levinsen, Karin Ellen Tweddell; Sørensen, Birgitte Holm; Tosca, Susana

of how: • ICT supports students learning, • ICT release time for more teaching, and • teachers digital literacy impact on the role of ICT in the educational practice. Further the call required collaboration between universities and university colleges in order to disseminate knowledge and new practices......In this paper we present some methodological challenges that emerged during the process of shaping the research design for the comprehensive and complex research project Children as learning designers in a digital school. The project is the realization of our proposal to a research call from...... the Danish Ministry of Education named Development projects and pilot school experiments (Udviklingsprojekter med demonstrationsskoleforsøg vedr. it i folkeskolen – see Undervisningsministeriet 2013) in the spring 2013. The call was based on a governmental decision to allocate 500 million DKR to increase...

Implementation and evaluation of a pharmacist-led hypertension management service in primary care: outcomes and methodological challenges

OpenAIRE

Bajorek, Beata; Lemay, Kate S.; Magin, Parker; Roberts, Christopher; Krass, Ines; Armour, Carol L.

2016-01-01

Background: Suboptimal utilisation of pharmacotherapy, non-adherence to prescribed treatment, and a lack of monitoring all contribute to poor blood (BP) pressure control in patients with hypertension. Objective: The objective of this study was to evaluate the implementation of a pharmacist-led hypertension management service in terms of processes, outcomes, and methodological challenges. Method: A prospective, controlled study was undertaken within the Australian primary care setting. C...

Energy and sustainable urban transport development in China: Challenges and solutions

International Nuclear Information System (INIS)

Zhang, Xilang; Hu, Xiaojun

2002-01-01

This paper presents an overview of urban road transport development and challenges in energy consumption in China. It relates sustainable urban road transport development with energy consumption and environmental management. It analyzes the main challenges related to urban road transport development: energy security, low efficiency in energy utilization, and unsustainable environmental management. It also discusses necessary technological and policy initiatives to deal with these challenges: e.g., promoting the development and dissemination of cleaner vehicle technologies, substitution of LPG, CNG, LNG and bio fuels for gasoline and diesel, strengthening regulations on vehicle emissions, expediting public transport development, and the effective management of the soaring private cars. (author)

Energy and sustainable urban transport development in China: Challenges and solutions

Energy Technology Data Exchange (ETDEWEB)

Zhang, Xilang; Hu, Xiaojun

2002-07-01

This paper presents an overview of urban road transport development and challenges in energy consumption in China. It relates sustainable urban road transport development with energy consumption and environmental management. It analyzes the main challenges related to urban road transport development: energy security, low efficiency in energy utilization, and unsustainable environmental management. It also discusses necessary technological and policy initiatives to deal with these challenges: e.g., promoting the development and dissemination of cleaner vehicle technologies, substitution of LPG, CNG, LNG and bio fuels for gasoline and diesel, strengthening regulations on vehicle emissions, expediting public transport development, and the effective management of the soaring private cars. (author)

The typology and development of attitude to primary science education

Science.gov (United States)

Gray, Adelaide

The introduction and development of science within the primary curriculum has been a challenge to teachers, parents and children and a highly politicised decision. Augmenting any difficulties are the images of science within popular culture and the traditions of scientific inquiry that have maintained the Western, male elitist hierarchy of the Vienna circle throughout the last millennium. The Royal Society's committee on the public understanding of science has recognised the difficulty in recruiting students to higher-level science study and embarked on a programme of sponsorship to address this. At the same time major governmental policy changes have provided a new 'market' model of education that has encouraged parental involvement in schools and enforced a new 'transparency' of evaluation on schools through league tables and Ofsted. Set against this backdrop, this research explores the development of attitudes to science and science education in the parent's of primary school aged children. It examines the perceptions of science and science education through the narrative of the parent's and their understanding of the interaction between different areas of science. The use of key events within narrative as a method of exploring attitude and conceptual development is novel to this research and through this exploration the concept of attitude itself is examined and criticised developing a new concept of attitude as process-based rather than static or crystallised. This reconceptualisation allows a more operational understanding of attitude that overcomes the difficulties of the traditional concept, which has only a limited theoretical basis on which to examine behaviour. The research generates a typology for views of science and the more operational compliment to this, stance to science. This framework allows a greater understanding of attitude formation, how science is perceived and how this perception is actualised. It is particularly interesting given the

The challenges of sustainable development in post-colonial African ...

African Journals Online (AJOL)

The challenges of sustainable development in post-colonial African states: a review of Adamu Usman's Sieged. ... This paper discusses and contributes to debates on the critical governance challenges faced by post-colonial African states such as bribery and corruption, lack of democratic and participatory governance, ...

Development of a monitoring instrument to assess the performance of the Swiss primary care system.

Science.gov (United States)

Ebert, Sonja T; Pittet, Valérie; Cornuz, Jacques; Senn, Nicolas

2017-11-29

The Swiss health system is customer-driven with fee-for-service paiement scheme and universal coverage. It is highly performing but expensive and health information systems are scarcely implemented. The Swiss Primary Care Active Monitoring (SPAM) program aims to develop an instrument able to describe the performance and effectiveness of the Swiss PC system. Based on a Literature review we developed a conceptual framework and selected indicators according to their ability to reflect the Swiss PC system. A two round modified RAND method with 24 inter-/national experts took place to select primary/secondary indicators (validity, clarity, agreement). A limited set of priority indicators was selected (importance, priority) in a third round. A conceptual framework covering three domains (structure, process, outcome) subdivided into twelve sections (funding, access, organisation/ workflow of resources, (Para-)Medical training, management of knowledge, clinical-/interpersonal care, health status, satisfaction of PC providers/ consumers, equity) was generated. 365 indicators were pre-selected and 335 were finally retained. 56 were kept as priority indicators.- Among the remaining, 199 were identified as primary and 80 as secondary indicators. All domains and sections are represented. The development of the SPAM program allowed the construction of a consensual instrument in a traditionally unregulated health system through a modified RAND method. The selected 56 priority indicators render the SPAM instrument a comprehensive tool supporting a better understanding of the Swiss PC system's performance and effectiveness as well as in identifying potential ways to improve quality of care. Further challenges will be to update indicators regularly and to assess validity and sensitivity-to-change over time.

e-research: Changes and challenges in the use of digital tools in primary care research

DEFF Research Database (Denmark)

Bruun Larsen, Lars; Skonnord, Trygve; Gjelstad, Svein

in primary care research. Examples of this are online randomisation, electronic questionnaires, automatic email scheduling, mobile phone applications and data extraction tools. The amount of data can be increased to a low cost, and this can help to reach adequate sample sizes. However, there are still...... challenges within the field. To secure a high response rate, you need to follow up manually or use another application. There are also practical and ethical problems, and the data security for sensitive data have to be followed carefully. Session content Oral presentations about some technological...

A matter of interpretation: developing primary pupils' enquiry skills using position-linked datalogging

Science.gov (United States)

Davies, Daniel John; Collier, Christopher; Howe, Alan

2012-11-01

not been sustained. While there is evidence of pupils developing a range of scientific enquiry skills through the project, the extent to which their interpretation of data improved is unclear. All participating schools made greater use of scientific data than before the project to develop their environmental education. Conclusions: The project has demonstrated the potential of combining datalogging with GPS technology to support challenging, motivating and relevant scientific enquiry. Primary teachers require targeted technical and pedagogical support to maximise learning benefits for pupils.

Urban Big Data and Sustainable Development Goals: Challenges and Opportunities

OpenAIRE

Kharrazi, A.; Qin, H.; Zhang, Y.

2016-01-01

Cities are perhaps one of the most challenging and yet enabling arenas for sustainable development goals. The Sustainable Development Goals (SDGs) emphasize the need to monitor each goal through objective targets and indicators based on common denominators in the ability of countries to collect and maintain relevant standardized data. While this approach is aimed at harmonizing the SDGs at the national level, it presents unique challenges and opportunities for the development of innovative ur...

IWRM and developing countries: Implementation challenges in Ghana

NARCIS (Netherlands)

Agyenim, J.B.; Gupta, J.

2012-01-01

Since 1990, there has been growing theoretical consensus on the need for integrated water resource management. At the same time, there is growing empirical evidence that challenges the scientific consensus and the practical implications of implementing IWRM in the developed and the developing

Cultural Challenges in Developing E-Learning Content

Directory of Open Access Journals (Sweden)

Marianne Amir Azer

2011-03-01

Full Text Available Education is an important component of any nation’s development process. Society has been credited with creating technology, but technology is simultaneously creating society. One of the key benefits of such technology creation includes learning and curriculum development, which is otherwise referred to as e-leaning, and more appropriately referred to as global e-learning. Global e-learning raises some implications, which include communication, culture, and technology, that must be addressed before successful implementation and outcome can occur. In this paper, we discuss cultural related issues such as culture influence on e-learning and the dimensions of cultural variability. In addition, we present the main challenges to provide e-learning opportunities. Finally, a case study for facing the cultural challenges is presented; this will be followed by concluding remarks at the end of this paper.

Primary health care staff's perception of childhood tuberculosis

DEFF Research Database (Denmark)

Bjerrum, Stephanie; Rose, Michala Vaaben; Bygbjerg, Ib Christian

2012-01-01

Background: Diagnosing tuberculosis in children remains a great challenge in developing countries. Health staff working in the front line of the health service delivery system has a major responsibility for timely identification and referral of suspected cases of childhood tuberculosis. This study...... explored primary health care staff’s perception, challenges and needs pertaining to the identification of children with tuberculosis in Muheza district in Tanzania. Methods: We conducted a qualitative study that included 13 semi-structured interviews and 3 focus group discussions with a total of 29 health...... staff purposively sampled from primary health care facilities. Analysis was performed in accordance with the principles of a phenomenological analysis. Results: Primary health care staff perceived childhood tuberculosis to be uncommon in the society and tuberculosis was rarely considered as a likely...

[Primary health care and the millennium development goals].

Science.gov (United States)

Faye, A; Bob, M; Fall, A; Fall, C

2012-01-01

Member countries of the World Health Organization (WHO) met in Alma Ata (8-12 September 1978) to define and advocate the implementation of primary health care (PHC) worldwide, above all, in developing countries, which had a real need to review their strategies for meeting the health needs of their populations. They did not suspect that 20 years later the vision they displayed would remain undeniably relevant. Here we examine the similarities and points of convergence of their declaration about PHC with the Millennium Development Goals that seek today to reduce poverty across the world. An exhaustive and analytic literature review was conducted to collect those similarities. Further analysis of the definitions, objectives, principles and recommendations of the Alma Ata Declaration and the Millennium Declaration reveals multiple dependencies and fundamental points of similarity between these two representations. Almost all states have pledged to achieve the eight MDG by 2015: to eradicate extreme poverty and hunger, achieve universal primary education, promote gender equality and empower women, reduce child mortality, improve maternal health, combat HIV/AIDS, malaria and other diseases, ensure environmental sustainability, and develop a global partnership for development. The Alma Ata conference defined primary health care as essential health care, based on practical methods and techniques that are both scientifically sound and socially acceptable, universally accessible to all individuals and all families of the community, through their full participation and at a cost that the community and countries can afford at all stages of their development in the spirit of self-reliance and self-determination. It is an integral part of economic and social development. The following principles are involved in the achievement of both primary health care and the MDG: social equity, community participation, and intersectorality. Public health is an essential condition of poverty

Musicality Development Among Primary School Pupils in Music Studies

OpenAIRE

Vilde, Ilze

2013-01-01

Abstract Research goal. To explore the structure of musicality, to examine components that characterize musicality among primary school pupils and the pedagogic logic of its development during music lessons in primary school. As a result of the theoretical study, characterizing components and criteria of musicality among primary school pupils were researched and described and the description of musicality was broadened. The created model for music studies for facilitating the developme...

Engineering: issues, challenges and opportunities for development

CSIR Research Space (South Africa)

Wall, K

2010-10-01

Full Text Available to contribute to greater international understanding of the issues, challenges and opportunities facing engineering, with a particular focus on contributions of our discipline to sustainable development. The Report, one of the most cost-effective reports UNESCO...

Bursaries, writing grants and fellowships: a strategy to develop research capacity in primary health care

Directory of Open Access Journals (Sweden)

Farmer Elizabeth A

2007-04-01

Full Text Available Abstract Background General practitioners and other primary health care professionals are often the first point of contact for patients requiring health care. Identifying, understanding and linking current evidence to best practice can be challenging and requires at least a basic understanding of research principles and methodologies. However, not all primary health care professionals are trained in research or have research experience. With the aim of enhancing research skills and developing a research culture in primary health care, University Departments of General Practice and Rural Health have been supported since 2000 by the Australian Government funded 'Primary Health Care Research Evaluation and Development (PHCRED Strategy'. A small grant funding scheme to support primary health care practitioners was implemented through the PHCRED program at Flinders University in South Australia between 2002 and 2005. The scheme incorporated academic mentors and three types of funding support: bursaries, writing grants and research fellowships. This article describes outcomes of the funding scheme and contributes to the debate surrounding the effectiveness of funding schemes as a means of building research capacity. Methods Funding recipients who had completed their research were invited to participate in a semi-structured 40-minute telephone interview. Feedback was sought on acquisition of research skills, publication outcomes, development of research capacity, confidence and interest in research, and perception of research. Data were also collected on demographics, research topics, and time needed to complete planned activities. Results The funding scheme supported 24 bursaries, 11 writing grants, and three research fellows. Nearly half (47% of all grant recipients were allied health professionals, followed by general practitioners (21%. The majority (70% were novice and early career researchers. Eighty-nine percent of the grant recipients were

Learning challenges and sustainable development: A methodological perspective.

Science.gov (United States)

Seppänen, Laura

2017-01-01

Sustainable development requires learning, but the contents of learning are often complex and ambiguous. This requires new integrated approaches from research. It is argued that investigation of people's learning challenges in every-day work is beneficial for research on sustainable development. The aim of the paper is to describe a research method for examining learning challenges in promoting sustainable development. This method is illustrated with a case example from organic vegetable farming in Finland. The method, based on Activity Theory, combines historical analysis with qualitative analysis of need expressions in discourse data. The method linking local and subjective need expressions with general historical analysis is a promising way to overcome the gap between the individual and society, so much needed in research for sustainable development. Dialectically informed historical frameworks have practical value as tools in collaborative negotiations and participatory designs for sustainable development. The simultaneous use of systemic and subjective perspectives allows researchers to manage the complexity of practical work activities and to avoid too simplistic presumptions about sustainable development.

Development and evolution of the vertebrate primary mouth

Science.gov (United States)

Soukup, Vladimír; Horácek, Ivan; Cerny, Robert

2013-01-01

The vertebrate oral region represents a key interface between outer and inner environments, and its structural and functional design is among the limiting factors for survival of its owners. Both formation of the respective oral opening (primary mouth) and establishment of the food-processing apparatus (secondary mouth) require interplay between several embryonic tissues and complex embryonic rearrangements. Although many aspects of the secondary mouth formation, including development of the jaws, teeth or taste buds, are known in considerable detail, general knowledge about primary mouth formation is regrettably low. In this paper, primary mouth formation is reviewed from a comparative point of view in order to reveal its underestimated morphogenetic diversity among, and also within, particular vertebrate clades. In general, three main developmental modes were identified. The most common is characterized by primary mouth formation via a deeply invaginated ectodermal stomodeum and subsequent rupture of the bilaminar oral membrane. However, in salamander, lungfish and also in some frog species, the mouth develops alternatively via stomodeal collar formation contributed both by the ecto- and endoderm. In ray-finned fishes, on the other hand, the mouth forms via an ectoderm wedge and later horizontal detachment of the initially compressed oral epithelia with probably a mixed germ-layer derivation. A very intriguing situation can be seen in agnathan fishes: whereas lampreys develop their primary mouth in a manner similar to the most common gnathostome pattern, hagfishes seem to undergo a unique oropharyngeal morphogenesis when compared with other vertebrates. In discussing the early formative embryonic correlates of primary mouth formation likely to be responsible for evolutionary–developmental modifications of this area, we stress an essential role of four factors: first, positioning and amount of yolk tissue; closely related to, second, endoderm formation during

Knowledge management challenges in new business development

NARCIS (Netherlands)

Berends, J.J.; Vanhaverbeke, W.P.M.; Kirschbaum, R.

2007-01-01

This paper's focus is on the knowledge management challenges that come along with technology-based new business development (NBD). NBD thrives upon the exploration of knowledge, under radical uncertainty. Furthermore, existing knowledge may both enable and constrain the radical innovation process.

Challenges in energy supply and infrastructural development in ...

African Journals Online (AJOL)

On the overall, developing countries must address the eminent energy challenges and invest more towards energy security as the key to industrialization and economic development. National energy mix must also be diversified to cover alternative fuels and renewable energy sources to ensure sustainability. Keywords: ...

Challenges on wind power development in China

Energy Technology Data Exchange (ETDEWEB)

Liu, Qianjin; Shi, Jingli

2010-09-15

Wind power has experienced exponential growth in China in the past five years, which exceeds the most optimistic expectations. The increasing penetration and aggressive future plan are arousing big concerns about its impact on operation and security of existing power networks. This paper introduces present condition of wind power development in China and the challenges on both grid integration and regulations. Most of these challenges are economical rather than technical. Feed-in tariff policies and grid code are the key countermeasures. Accurate wind forecast and economical mass energy storage are needed to guarantee compliance of wind power to the grid.

SAFETY BASIS DESIGN DEVELOPMENT CHALLENGES IMECE2007-42747

Energy Technology Data Exchange (ETDEWEB)

RYAN GW

2007-09-24

'Designing in Safety' is a desired part of the development of any new potentially hazardous system, process, or facility. It is a required part of nuclear safety activities as specified in the U.S. Department of Energy (DOE) Order 420.B, Facility Safety. This order addresses the design of nuclear related facilities developed under federal regulation IOCFR830, Nuclear Safety Management. IOCFR830 requires that safety basis documentation be provided to identify how nuclear safety is being adequately addressed as a condition for system operation (e.g., the safety basis). To support the development of the safety basis, a safety analysis is performed. Although the concept of developing a design that addresses 'Safety is simple, the execution can be complex and challenging. This paper addresses those complexities and challenges for the design activity of a system to treat sludge, a corrosion product of spent nuclear fuel, at DOE's Hanford Site in Washington State. The system being developed is referred to as the Sludge Treatment Project (STP). This paper describes the portion of the safety analysis that addresses the selection of design basis events using the experience gained from the STP and the development of design requirements for safety features associated with those events. Specifically, the paper describes the safety design process and the application of the process for two types of potential design basis accidents associated with the operation of the system, (1) flashing spray leaks and (2) splash and splatter leaks. Also presented are the technical challenges that are being addressed to develop effective safety features to deal with these design basis accidents.

SAFETY BASIS DESIGN DEVELOPMENT CHALLENGES IMECE2007-42747

International Nuclear Information System (INIS)

RYAN GW

2007-01-01

'Designing in Safety' is a desired part of the development of any new potentially hazardous system, process, or facility. It is a required part of nuclear safety activities as specified in the U.S. Department of Energy (DOE) Order 420.B, Facility Safety. This order addresses the design of nuclear related facilities developed under federal regulation IOCFR830, Nuclear Safety Management. IOCFR830 requires that safety basis documentation be provided to identify how nuclear safety is being adequately addressed as a condition for system operation (e.g., the safety basis). To support the development of the safety basis, a safety analysis is performed. Although the concept of developing a design that addresses 'Safety is simple, the execution can be complex and challenging. This paper addresses those complexities and challenges for the design activity of a system to treat sludge, a corrosion product of spent nuclear fuel, at DOE's Hanford Site in Washington State. The system being developed is referred to as the Sludge Treatment Project (STP). This paper describes the portion of the safety analysis that addresses the selection of design basis events using the experience gained from the STP and the development of design requirements for safety features associated with those events. Specifically, the paper describes the safety design process and the application of the process for two types of potential design basis accidents associated with the operation of the system, (1) flashing spray leaks and (2) splash and splatter leaks. Also presented are the technical challenges that are being addressed to develop effective safety features to deal with these design basis accidents

Challenges on innovations of newly-developed safety analysis codes

International Nuclear Information System (INIS)

Yang, Yanhua; Zhang, Hao

2016-01-01

With the development of safety analysis method, the safety analysis codes meet more challenges. Three challenges are presented in this paper, which are mathematic model, code design and user interface. Combined with the self-reliance safety analysis code named COSINE, the ways of meeting these requirements are suggested, that is to develop multi-phases, multi-fields and multi-dimension models, to adopt object-oriented code design ideal and to improve the way of modeling, calculation control and data post-processing in the user interface.

Challenges on innovations of newly-developed safety analysis codes

Energy Technology Data Exchange (ETDEWEB)

Yang, Yanhua [Shanghai Jiao Tong Univ. (China). School of Nuclear Science and Engineering; Zhang, Hao [State Nuclear Power Software Development Center, Beijing (China). Beijing Future Science and Technology City

2016-05-15

With the development of safety analysis method, the safety analysis codes meet more challenges. Three challenges are presented in this paper, which are mathematic model, code design and user interface. Combined with the self-reliance safety analysis code named COSINE, the ways of meeting these requirements are suggested, that is to develop multi-phases, multi-fields and multi-dimension models, to adopt object-oriented code design ideal and to improve the way of modeling, calculation control and data post-processing in the user interface.

CHALLENGES AND STRATEGIES FOR E-LEARNING DEVELOPMENT IN THE UNIVERSITY OF PAYAM NOOR IN IRAN

Directory of Open Access Journals (Sweden)

Mahnaz MOHAMADZADEH (Correspond author,

2012-08-01

Full Text Available Higher education in Iran is confronting with several challenges; Some of them are increasing demand for education and insufficiency of current programs to meet the growing needs, emerging information age and the necessity of achieving information literacy, speed up in knowledge production and the necessity of development of a lifelong and continuous training system, necessity of considering to user orientation and extending educational justice. It is assumes that a high performance e-learning system can overcome to the mentioned problems. E-learning is main component of educational systems in 21st century. It removes time and place restrictions and creates economical benefits, and makes available lifelong learning opportunity for all. The primary purpose of this study was to identify challenges of electronic learning development in Payam Noor University of Ardabil province of Iran to present feasible solutions for establishing a suitable e-learning system. Descriptive survey design for data collection was adopted in this study. The population of this study was consisted of 600 instructors and faculty members. A sample of 160 faculty member was selected by using random sampling method. Results show that barriers such as incompatibility of contents and methods, skill unavailability, attitudinal hampering, cultural barriers, infrastructural obstacles, encouraging and credit barriers as well as barriers related to incorporating e- learning into traditional education systems were the main challenges of e-learning in the Payam Noor University. Also results revealed that factors such as educational effectiveness in e- learning, policy making, university's technical and social support of e- learning, financial support and expansion of income earning for instructors and faculty members, improving working conditions, foreign language skill and faculty members interest in professional development were the most important factors in developing e-learning in

Continuing Professional Development and Learning in Primary Science Classrooms

Science.gov (United States)

Fraser, Christine A.

2010-01-01

This article explores the effects of continuing professional development (CPD) on teachers' and pupils' experiences of learning and teaching science in primary classrooms. During 2006-2007, quantitative and qualitative data were elicited from two primary teachers in Scotland using questionnaires, semi-structured interviews and video-stimulated…

Computerizing primary schools in rural kenya

DEFF Research Database (Denmark)

Ogembo, J.G.; Ngugi, B.; Pelowski, Matthew John

2012-01-01

questions surrounding this endeavour. Specifically: 1.) what problems do rural schools actually want to solve with computerization; 2.) is computerization the most important priority for rural schools; 3.) are schools ready, in terms of infrastructure, for a computer in the classroom; or 4.) might...... and protective roofing -posing severe challenges to the outstanding conception of computerization. We consider these results and make recommendations for better adapting programs for computer introduction, and also suggest the use of new innovative devices, such as cell phones, which might already have overcome......This paper investigates the outstanding challenges facing primary schools' computerization in rural Kenya. Computerization of schools is often envisaged as a 'magic', or at least a particularly efficient, solution to many of the problems that developing countries face in improving primary school...

Challenges in developing human resources for nuclear safety in South Africa

Energy Technology Data Exchange (ETDEWEB)

Tsatsi, Louisa [National Nuclear Regulator, PO BOX 7106, 00046 Centurion (South Africa)

2008-07-01

Challenges in developing Human Resources for nuclear safety in South Africa ESKOM Holding Limited which is the South African Government owned utility, operates over 10 power stations. The total installed is about 40 GW, and nuclear contributes only 6 percent. The existing nuclear power station, Koeberg NPP, is comprised of two 900 MW(e) units at the South African west coast near Cape Town. The South African Government has a policy to increase the share of nuclear in the generation mix from 6 percent to 15 percent before the year 2020. The challenge is that there have been a 'greying' of nuclear experts and a shrinking of nuclear engineering and science departments. As a consequence of this, ESKOM has realized that a large number of young engineers and scientists would have to be recruited and then trained in South Africa and abroad. Some people, especially high performers in the industry are continually looking for new challenges and opportunities and though it is important in the nuclear industry to retain these key staff members it have proved to be a serious challenge. The nuclear industry had to consider their national training infrastructures and the South African government in partnership with ESKOM, NECSA and PBMR has started a process of funding university chairs in reactor engineering and allied subjects. These departments undertake research and provide training for the South African nuclear industry. The recruitment process has initially involved the transfer of personnel from ESKOM, NECSA as well as direct recruitment from the market. The primary recruitment process going forward will be from universities and other Further Education Training (FET) institutions with a focus on ESKOM and PBMR providing the specific nuclear training. In this regard, both ESKOM and PBMR provide bursaries, project work and other assistance to selected candidates. Upon completion of studies, the specific training is provided both in-house and with partner national

Challenges in developing human resources for nuclear safety in South Africa

International Nuclear Information System (INIS)

Tsatsi, Louisa

2008-01-01

Challenges in developing Human Resources for nuclear safety in South Africa ESKOM Holding Limited which is the South African Government owned utility, operates over 10 power stations. The total installed is about 40 GW, and nuclear contributes only 6 percent. The existing nuclear power station, Koeberg NPP, is comprised of two 900 MW(e) units at the South African west coast near Cape Town. The South African Government has a policy to increase the share of nuclear in the generation mix from 6 percent to 15 percent before the year 2020. The challenge is that there have been a 'greying' of nuclear experts and a shrinking of nuclear engineering and science departments. As a consequence of this, ESKOM has realized that a large number of young engineers and scientists would have to be recruited and then trained in South Africa and abroad. Some people, especially high performers in the industry are continually looking for new challenges and opportunities and though it is important in the nuclear industry to retain these key staff members it have proved to be a serious challenge. The nuclear industry had to consider their national training infrastructures and the South African government in partnership with ESKOM, NECSA and PBMR has started a process of funding university chairs in reactor engineering and allied subjects. These departments undertake research and provide training for the South African nuclear industry. The recruitment process has initially involved the transfer of personnel from ESKOM, NECSA as well as direct recruitment from the market. The primary recruitment process going forward will be from universities and other Further Education Training (FET) institutions with a focus on ESKOM and PBMR providing the specific nuclear training. In this regard, both ESKOM and PBMR provide bursaries, project work and other assistance to selected candidates. Upon completion of studies, the specific training is provided both in-house and with partner national and

Development of Effective Academic Affairs Administration System in Thai Primary Schools

Science.gov (United States)

Thongnoi, Niratchakorn; Srisa-ard, Boonchom; Sri-ampai, Anan

2013-01-01

This research aimed to: 1) study current situations and problems of academic affairs administration system in Primary Schools. 2) develop an effective academic affairs administration system, and 3) evaluate the implementation of the developed system in the primary school, Thailand. Research and Development (R&D) was employed which consisted of…

The renewable energy development framework - I. The challenge of renewable energy development. Territorial challenges

International Nuclear Information System (INIS)

Fournier, Mauricette; Grison, Jean-Baptiste; Rieutort, Laurent

2012-01-01

The authors comment the evolutions of renewable energy production in the world during the last thirty years and notice how the geography of this production and of the associated consumption has changed while still displaying contrasts. They also notice the diversification of actors (big companies as well as small and medium sized companies and local communities). Then, they highlight the challenges of renewable energies at the local level: these energies can be tools for local development and competitiveness, but are also matters of either cooperation or conflict (they comment factors related to social acceptance or non-acceptance of wind farm projects in France)

Challenges of Research and Human Capital Development in Nigeria

Science.gov (United States)

Chikwe, Christian K.; Ogidi, Reuben C.; Nwachukwu, K.

2015-01-01

The paper discussed the challenges of research and human capital development in Nigeria. Research and human capital development are critical to the development of any nation. Research facilitates human capital development. A high rating in human capital development indices places a country among the leading countries of the world. The paper…

Studies on herd-immunity and primary versus secondary infection of VHSV in challenge and vaccination trials with rainbow trout

DEFF Research Database (Denmark)

Lorenzen, Ellen; Kjær, Torben Egil; Lorenzen, Niels

as well as selective breeding, i.e. the more non-susceptible individuals in a population, the lower the risk of disease among susceptible individuals. Thus as part of a recent field trial with a VHS-DNA-vaccine vaccinated as well as naïve fish from a Danish fish farm were brought to the laboratory......Abstract for Scofda meeting 4-5.11.09 Studies on herd-immunity effect and primary versus secondary infection of VHSV by Ellen Lorenzen, Torben Eigil Kjær & Niels Lorenzen, National Veterinary Laboratory, Århus The phenomenon of “herd-immunity” is one of the basal principles behind vaccination...... at a size of 24g to be subjected to an experimental challenge with VHSV. The setup included 7 aquaria with 100 fish in each: 2 aquaria with 100 vaccinated fish (+VHS-challenge), 2 aquaria with 100 naïve fish (+ VHS-challenge), 2 aquaria with 50 vaccinated + 50 naïve fish (+VHS-challenge), and 1 aquarium...

Challenges in horizontal integration of eye care services into the pre-existing rural primary care structure: an operations research perspective from Nigeria

OpenAIRE

Chinyere Nkemdilim Ezisi; Boniface Ikenna Eze; Obiekwe Okoye; Chimdi Memnofu Chuka-Okosa; Jude Obinna Shiweobi

2017-01-01

Background . The provision of population-wide, accessible, affordable, acceptable and evenly distributed qualitative eye care services remains a recurrent challenge to eye care organizations worldwide. Objectives . To report the challenges encountered in setting up eye care service in a pre-existing primary health care facility in rural Nigeria and also audit the common causes of eye disorders in rural setting southeast of Nigeria. Material and methods . The study was an operations ...

Learning Analytics: drivers, developments and challenges

Directory of Open Access Journals (Sweden)

Rebecca Ferguson

2014-12-01

Full Text Available Learning analytics is a significant area of Technology-Enhanced Learning (TEL that has emerged during the last decade. This review of the field begins with an examination of the technological, educational and political factors that have driven the development of analytics in educational settings. It goes on to chart the emergence of learning analytics, including their origins in the 20th century, the development of data-driven analytics, the rise of learning-focused perspectives and the influence of national economic concerns. It next focuses on the relationships between learning analytics, educational data mining and academic analytics. Finally, it examines developing areas of learning analytics research, and identifies a series of future challenges.

NASA Composite Materials Development: Lessons Learned and Future Challenges

Science.gov (United States)

Tenney, Darrel R.; Davis, John G., Jr.; Pipes, R. Byron; Johnston, Norman

2009-01-01

Composite materials have emerged as the materials of choice for increasing the performance and reducing the weight and cost of military, general aviation, and transport aircraft and space launch vehicles. Major advancements have been made in the ability to design, fabricate, and analyze large complex aerospace structures. The recent efforts by Boeing and Airbus to incorporate composite into primary load carrying structures of large commercial transports and to certify the airworthiness of these structures is evidence of the significant advancements made in understanding and use of these materials in real world aircraft. NASA has been engaged in research on composites since the late 1960 s and has worked to address many development issues with these materials in an effort to ensure safety, improve performance, and improve affordability of air travel for the public good. This research has ranged from synthesis of advanced resin chemistries to development of mathematical analyses tools to reliably predict the response of built-up structures under combined load conditions. The lessons learned from this research are highlighted with specific examples to illustrate the problems encountered and solutions to these problems. Examples include specific technologies related to environmental effects, processing science, fabrication technologies, nondestructive inspection, damage tolerance, micromechanics, structural mechanics, and residual life prediction. The current state of the technology is reviewed and key issues requiring additional research identified. Also, grand challenges to be solved for expanded use of composites in aero structures are identified.

Understanding partnership practice in primary health as pedagogic work: what can Vygotsky's theory of learning offer?

Science.gov (United States)

Hopwood, Nick

2015-01-01

Primary health policy in Australia has followed international trends in promoting models of care based on partnership between professionals and health service users. This reform agenda has significant practice implications, and has been widely adopted in areas of primary health that involve supporting families with children. Existing research shows that achieving partnership in practice is associated with three specific challenges: uncertainty regarding the role of professional expertise, tension between immediate needs and longer-term capacity development in families, and the need for challenge while maintaining relationships based on trust. Recently, pedagogic or learning-focussed elements of partnership practice have been identified, but there have been no systematic attempts to link theories of learning with the practices and challenges of primary health-care professionals working with families in a pedagogic role. This paper explores key concepts of Vygotsky's theory of learning (including mediation, the zone of proximal development, internalisation, and double stimulation), showing how pedagogic concepts can provide a bridge between the policy rhetoric of partnership and primary health practice. The use of this theory to address the three key challenges is explicitly discussed.

Re-thinking Innovation in Organizations in the Industry 4.0 Scenario: New Challenges in a Primary Prevention Perspective.

Science.gov (United States)

Palazzeschi, Letizia; Bucci, Ornella; Di Fabio, Annamaria

2018-01-01

In organizations, innovation is considered a relevant aspect of success and long-term survival. Organizations recognize that innovation contributes to creating competitive advantages in a more competitive, challenging and changing labor market. The present contribution addresses innovation in organizations in the scenario of Industry 4.0, including technological innovation and psychological innovation. Innovation is a core concept in this framework to face the challenge of globalized and fluid labor market in the 21st century. Reviewing the definition of innovation, the article focuses on innovative work behaviors and the relative measures. This perspective article also suggests new directions in a primary prevention perspective for future research and intervention relative to innovation and innovative work behaviors in the organizational context.

Challenging the development dialogue on Africa | IDRC ...

International Development Research Centre (IDRC) Digital Library (Canada)

2016-06-08

Jun 8, 2016 ... Africa Yesterday, Today and Tomorrow: Exploring the Multi-dimensional Discourses on 'Development' challenges longstanding views and practices in ... The two-day conference, organized by the African Students Association at the University of Alberta, brought together scholars from a wide variety of fields ...

Developing primary care in Hong Kong: evidence into practice and the development of reference frameworks.

Science.gov (United States)

Griffiths, Sian M; Lee, Jeff P M

2012-10-01

Enhancing primary care is one of the proposals put forward in the Healthcare Reform Consultation Document "Your Health, Your Life" issued in March 2008. In 2009, the Working Group on Primary Care, chaired by the Secretary for Food and Health, recommended the development of age-group and disease-specific primary care conceptual models and reference frameworks. Drawing on international experience and best evidence, the Task Force on Conceptual Model and Preventive Protocols of the Working Group on Primary Care has developed two reference frameworks for the management of two common chronic diseases in Hong Kong, namely diabetes and hypertension, in primary care settings. Adopting a population approach for the prevention and control of diabetes and hypertension across the life course, the reference frameworks aim to provide evidence-based and appropriate recommendations for the provision of continuing and comprehensive care for patients with chronic diseases in the community.

Shaping the future: a primary care research and development strategy for Scotland.

Science.gov (United States)

Hannaford, P; Hunt, J; Sullivan, F; Wyke, S

1999-09-01

Primary care is at the centre of the National Health Service (NHS) in Scotland; however, its R & D capacity is insufficiently developed. R&D is a potentially powerful way of improving the health and well-being of the population, and of securing high quality care for those who need it. In order to achieve this, any Scottish strategy for primary care R&D should aim to develop both a knowledge-based service and a research culture in primary care. In this way, decisions will be made based upon best available evidence, whatever the context. Building on existing practice and resources within primary care research, this strategy for achieving a thriving research culture in Scottish primary care has three key components: A Scottish School of Primary Care which will stimulate and co-ordinate a cohesive programme of research and training. A comprehensive system of funding for training and career development which will ensure access to a range of research training which will ensure that Scotland secures effective leadership for its primary care R&D. Designated research and development practices (DRDPs) which will build on the work of existing research practices, in the context of Local Health Care Co-operatives (LHCCs) and Primary Care Trusts (PCTs), to create a co-operative environment in which a range of primary care professionals can work together to improve their personal and teams' research skills, and to support research development in their areas. A modest investment will create substantial increases in both the quality and quantity of research being undertaken in primary care. This investment should be targeted at both existing primary care professionals working in service settings in primary care, LHCCs and PCTs, and at centres of excellence (including University departments). A dual approach will foster collaboration and will allow existing centres of excellence both to undertake more primary care research and to support the development of service based primary care

Primary vertex reconstruction with the ATLAS detector

International Nuclear Information System (INIS)

Meloni, F.

2016-01-01

Efficient and precise reconstruction of the primary vertex in a LHC collision is essential for determining the full kinematic properties of a hard-scatter event and of soft interactions as a measure of the amount of pile-up. The reconstruction of primary vertices in the busy, high pile-up environment of Run-2 of the LHC is a challenging task. The algorithms developed by the ATLAS experiments to reconstruct multiple vertices with small spatial separation are presented.

Development of Protective Immunity in New Zealand White Rabbits Challenged with Bacillus anthracis Spores and Treated with Antibiotics and Obiltoxaximab, a Monoclonal Antibody against Protective Antigen.

Science.gov (United States)

Henning, Lisa N; Carpenter, Sarah; Stark, Gregory V; Serbina, Natalya V

2018-02-01

The recommended management of inhalational anthrax, a high-priority bioterrorist threat, includes antibiotics and antitoxins. Obiltoxaximab, a chimeric monoclonal antibody against anthrax protective antigen (PA), is licensed under the U.S. Food and Drug Administration's (FDA's) Animal Rule for the treatment of inhalational anthrax. Because of spore latency, disease reemergence after treatment cessation is a concern, and there is a need to understand the development of endogenous protective immune responses following antitoxin-containing anthrax treatment regimens. Here, acquired protective immunity was examined in New Zealand White (NZW) rabbits challenged with a targeted lethal dose of Bacillus anthracis spores and treated with antibiotics, obiltoxaximab, or a combination of both. Survivors of the primary challenge were rechallenged 9 months later and monitored for survival. Survival rates after primary and rechallenge for controls and animals treated with obiltoxaximab, levofloxacin, or a combination of both were 0, 65, 100, and 95%, and 0, 100, 95, and 89%, respectively. All surviving immune animals had circulating antibodies to PA and serum toxin-neutralizing titers prior to rechallenge. Following rechallenge, systemic bacteremia and toxemia were not detected in most animals, and the levels of circulating anti-PA IgG titers increased starting at 5 days postrechallenge. We conclude that treatment with obiltoxaximab, alone or combined with antibiotics, significantly improves the survival of rabbits that received a lethal inhalation B. anthracis spore challenge dose and does not interfere with the development of immunity. Survivors of primary challenge are protected against reexposure, have rare incidents of systemic bacteremia and toxemia, and have evidence of an anamnestic response. Copyright © 2018 Henning et al.

Lifestyle counseling in primary care: opportunities and challenges for changing practice.

Science.gov (United States)

Sargeant, Joan; Valli, Michel; Ferrier, Suzanne; MacLeod, Heather

2008-01-01

Many patients today have health concerns related to lifestyle factors. This has created a situation where physicians are regularly confronted with the challenge of how to conduct lifestyle counseling with patients. Specific strategies can enable physicians to more effectively navigate this complex area of communication with patients, improving patient response in adopting healthy behaviours and increasing physician satisfaction with this task. To evaluate the impact of a lifestyle counseling workshop incorporating the motivational enhancement and transtheoretical models upon primary care clinicians' counseling practice patterns, especially communication and counseling skills, and attitudes toward lifestyle counseling. This study used a mixed method research design. Forty-three clinicians completed a post-workshop evaluation and identified intended changes to practice following the workshop. Twelve participated in interviews several months later to explore the kinds of changes made and influences upon them. Forty-one (95.3%) questionnaire respondents reported an intention to change their practice. Main changes reported were: asking more questions, listening more, assessing patients' readiness to change, tailoring counseling to patients' readiness to change. They seemed to have acquired and retained new knowledge and most were able to apply the new skills in their practices. Many reported feeling more comfortable and/or confident when interacting with patients in need of lifestyle change. But, time constraints, comfort with current skills, lack of self-efficacy, and fears of missing opportunities to influence patients, moderated participants' ability to adopt and maintain new approaches. While primary care clinicians can successfully learn specific lifestyle counseling skills and incorporate them into their practice following a two-hour evidence-based workshop, individual, educational and system factors can interfere.

Cost-Effective Additive Manufacturing in Space: HELIOS Technology Challenge Guide

Science.gov (United States)

DeVieneni, Alayna; Velez, Carlos Andres; Benjamin, David; Hollenbeck, Jay

2012-01-01

Welcome to the HELIOS Technology Challenge Guide. This document is intended to serve as a general road map for participants of the HELIOS Technology Challenge [HTC] Program and the associated inaugural challenge: HTC-01: Cost-Effective Additive Manufacturing in Space. Please note that this guide is not a rule book and is not meant to hinder the development of innovative ideas. Its primary goal is to highlight the objectives of the HTC-01 Challenge and to describe possible solution routes and pitfalls that such technology may encounter in space. Please also note that participants wishing to demonstrate any hardware developed under this program during any future HELIOS Technology Challenge showcase event(s) may be subject to event regulations to be published separately at a later date.

Primary cardiac lymphoma: diagnostic tools and treatment challenges.

LENUS (Irish Health Repository)

Bambury, R

2011-03-01

Primary cardiac lymphoma (PCL) is a rare malignancy and the optimal treatment strategy remains uncertain. It appears to respond much better to systemic chemotherapy than to surgery and it should be considered in the differential diagnosis of all cardiac tumours before definitive management is undertaken. We report a case of this rare disorder treated successfully with a combination of rituximab and cyclophosphamide, adriamycin, vincristine and prednisolone. The patient developed recurrent unstable ventricular tachycardia (VT) post-chemotherapy secondary to extensive scarring at the tumour site. The tumour as well as the post-treatment scarring is well illustrated by cardiac magnetic resonance imaging highlighting its usefulness in this setting. An implantable cardioverter defibrillator (ICD) was placed. This is only the second case in the literature of PCL to have an ICD placed for recurrent VT. A brief literature review is included.

Electronic health records and support for primary care teamwork

Science.gov (United States)

Draper, Kevin; Gourevitch, Rebecca; Cross, Dori A.; Scholle, Sarah Hudson

2015-01-01

Objective Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges. Methods Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size. Results EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time. Discussion Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges. Conclusions EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time. PMID:25627278

Electronic health records and support for primary care teamwork.

Science.gov (United States)

O'Malley, Ann S; Draper, Kevin; Gourevitch, Rebecca; Cross, Dori A; Scholle, Sarah Hudson

2015-03-01

Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges. Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size. EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time. Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges. EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Challenges for IT-supported shared care

DEFF Research Database (Denmark)

Granlien, Maren Fich; Simonsen, Jesper

2007-01-01

: (1) Poor integration with the general practitioners' existing IT systems; (2) low compatibility with general practitioners' work ethic; (3) and discrepancy between the number of diabetes patients and the related need for shared care. We conclude that development of IT-supported shared care must...... the same challenges that led to the same problem: The secondary care sector quickly adopted the system while the primary sector was far more sceptical towards using it. In both cases, we observe a discrepancy of needs satisfied, especially with regard to the primary care sector and its general...

Multicultural development in human services agencies: challenges and solutions.

Science.gov (United States)

Hyde, Cheryl A

2004-01-01

Comprehensive multicultural organizational development (MCOD) is increasingly necessary in human services agencies. This article presents results from an exploratory study that identified challenges and solutions to MCOD, against the backdrop of daily realities of agency life. The author conducted interviews with 20 consultants and 20 practitioners experienced in MCOD. Qualitative analysis revealed four challenges--socioeconomic environment, organizational dynamics, conceptualization of the change effort, and consultant competence; and four solutions--collaborative environmental relations, leadership development, assessment and planning, and consultant selection. Results suggest the complexities of MCOD and ways that human services agencies can sustain such efforts.

Avoidable challenges of a nuclear medicine facility in a developing nation

International Nuclear Information System (INIS)

Adedapo, Kayode Solomon; Onimode, Yetunde Ajoke; Ejeh, John Enyi; Adepoju, Adewale Oluwaseun

2013-01-01

The role of nuclear medicine in disease management in a developing nation is as impactful as it is in other regions of the world. However, in the developing world, the practice of nuclear medicine is faced with a myriad of challenges, which can be easily avoided. In this review, we examine the many avoidable challenges to the practice of nuclear medicine in a developing nation. The review is largely based on personal experiences of the authors who are the pioneers and current practitioners of nuclear medicine in a typical developing nation. If the challenges examined in this review are avoided, the practice of nuclear medicine in such a nation will be more effective and practitioners will be more efficient in service delivery. Hence, the huge benefits of nuclear medicine will be made available to patients in such a developing nation

Examining the Role of Primary Care Physicians and Challenges Faced When Their Patients Transition to Home Hospice Care.

Science.gov (United States)

Shalev, Ariel; Phongtankuel, Veerawat; Lampa, Katherine; Reid, M C; Eiss, Brian M; Bhatia, Sonica; Adelman, Ronald D

2018-04-01

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.

Primary amoebic meningoencephalitis caused by Naegleria fowleri: an old enemy presenting new challenges.

Directory of Open Access Journals (Sweden)

Ruqaiyyah Siddiqui

2014-08-01

Full Text Available First discovered in 1899, Naegleria fowleri is a protist pathogen, known to infect the central nervous system and produce primary amoebic meningoencephalitis. The most distressing aspect is that the fatality rate has remained more than 95%, despite our advances in antimicrobial chemotherapy and supportive care. Although rare worldwide, most cases have been reported in the United States, Australia, and Europe (France. A large number of cases in developing countries go unnoticed. In particular, religious, recreational, and cultural practices such as ritual ablution and/or purifications, Ayurveda, and the use of neti pots for nasal irrigation can contribute to this devastating infection. With increasing water scarcity and public reliance on water storage, here we debate the need for increased awareness of primary amoebic meningoencephalitis and the associated risk factors, particularly in developing countries.

Developing Children's Language Learner Strategies at Primary School

Science.gov (United States)

Kirsch, Claudine

2012-01-01

This article discusses the strategy repertoires and strategy development of six English children who learned foreign languages at primary school. My study differs from mainstream research, in that it focuses on young children and on the development of their strategies, draws on sociocultural theory and uses ethnographic methods. My findings show…

Industrial hazardous waste management in Turkey: Current state of the field and primary challenges

International Nuclear Information System (INIS)

Salihoglu, Gueray

2010-01-01

A holistic evaluation of a country's hazardous waste management (HWM) practices is useful in identifying the necessary actions to focus on. Based on an analysis of industrial hazardous waste (HW) generation in Turkey, this paper attempts to critically evaluate and report current Turkish HWM practices and discuss the primary challenges to be addressed. The generation of industrial HW for Turkey reported in 2004 was 1.195 million tons, which accounted for 7% of the total industrial solid waste (ISW) generated by the manufacturing industry, and for nearly 4.9% of the total solid waste generated in the country. The HW generated by the top five manufacturing product categories - basic metals, chemicals and chemical products, food and beverages, coke and refined petroleum, motor vehicles and trailers - accounted for 89.0% of total industrial HW. 21% of the HW generated in 2004 was recycled or reused, and 6% was sold or donated, whereas 73% was sent to ultimate disposal. 67% of the HW sent to ultimate disposal was disposed of at municipal landfills. The total capacity of the existing regional HW facilities is 212,500 tons/year, which accounts for about 24% of the HW to be disposed. Turkey has identified the HW problem in the country and enacted legislation, designated a lead agency, and promulgated rules and regulations. Several new initiatives are planned for improving HW management nationally; however, some HWM problems will be persistent due to previous and existing industrial development plans. These development policies led to the concentration of industry in regions marked by precious agricultural fields and high population density. This occurred because the government previously exhibited a default prioritization towards industrial development, leading to insufficient implementation of regulations on HW generators. Some of the problems may also be rooted in other countries that allow illegal transboundary HW movements despite international regulations.

Rotary endodontics in primary teeth – A review

OpenAIRE

Sageena George; S. Anandaraj; Jyoti S. Issac; Sheen A. John; Anoop Harris

2016-01-01

Endodontic treatment in primary teeth can be challenging and time consuming, especially during canal preparation, which is considered one of the most important steps in root canal therapy. The conventional instrumentation technique for primary teeth remains the “gold-standard” over hand instrumentation, which makes procedures much more time consuming and adversely affects both clinicians and patients. Recently nickel–titanium (Ni–Ti) rotary files have been developed for use in pediatric endod...

The use of the Climate-science Computational End Station (CCES) development and grand challenge team for the next IPCC assessment: an operational plan

International Nuclear Information System (INIS)

Washington, W M; Buja, L; Gent, P; Drake, J; Erickson, D; Anderson, D; Bader, D; Dickinson, R; Ghan, S; Jones, P; Jacob, R

2008-01-01

The grand challenge of climate change science is to predict future climates based on scenarios of anthropogenic emissions and other changes resulting from options in energy and development policies. Addressing this challenge requires a Climate Science Computational End Station consisting of a sustained climate model research, development, and application program combined with world-class DOE leadership computing resources to enable advanced computational simulation of the Earth system. This project provides the primary computer allocations for the DOE SciDAC and Climate Change Prediction Program. It builds on the successful interagency collaboration of the National Science and the U.S. Department of Energy in developing and applying the Community Climate System Model (CCSM) for climate change science. It also includes collaboration with the National Aeronautics and Space Administration in carbon data assimilation and university partners with expertise in high-end computational climate research

Genetics in primary health care and the National Policy on Comprehensive Care for People with Rare Diseases in Brazil: opportunities and challenges for professional education.

Science.gov (United States)

Melo, Débora Gusmão; de Paula, Pamela Karen; de Araujo Rodrigues, Stephania; da Silva de Avó, Lucimar Retto; Germano, Carla Maria Ramos; Demarzo, Marcelo Marcos Piva

2015-07-01

As discoveries regarding the genetic contribution to disease have grown rapidly, health care professionals are expected to incorporate genetic and genomic perspectives into health education and practice. Genetic competencies common to all health professionals have been identified by the US National Coalition for Health Professional Education in Genetics (NCHPEG), which defined the knowledge, skills, and attitudes required to achieve these competencies. The aim of this study is to analyze genetic competencies of primary health care professionals in Brazil. It is a descriptive survey study, whereby doctors, nurses, and dentists were invited to participate by answering a questionnaire including 11 issues based on competencies established by the NCHPEG. Data were presented as percentages. Differences between groups of participants were assessed by the Fisher exact test, with the level of significance set at p < 0.05. Results showed that concerning knowledge, about 80 % of the participants recognized basic genetics terminology, but practitioners had difficulty in identifying patterns of inheritance. Regarding clinical skills, practitioners were able to recognize facial dysmorphias and identify situations where referral of patients to specialists was necessary. Nevertheless, there were challenges in the process of valuing and gathering information about family history. Regarding attitudes, 68.9 % of the participants thought about the comprehensiveness of care but faced challenges in counselling parents. The results of this study may contribute to developing an ongoing education program for primary health care professionals, leading to a strategy to overcome the challenges of including genetics in the Brazilian Unified Health System.

Intercultural challenges in offshore software development outsourcing relationship: an empirical study

International Nuclear Information System (INIS)

Khan, S.U.; Azeem, M.I.

2016-01-01

The importance of intercultural challenges is recognized by both the practitioners and researchers in offshore software development outsourcing (OSDO) relationships. These challenges affect almost all the activities involved in offshore software development outsourcing relationships especially communication, mutual understanding, interpretation and decision making processes etc. which in turn leads to project failure. In our previous published study we identified, through systematic literature review (SLR), various intercultural challenges faced by vendors in OSDO relationship. The aim of this study was to validate these findings through industry practitioners and to identify its intensity as well as to identify any other intercultural challenges, faced by vendor organizations in OSDO relationships. We performed questionnaire surveys with 41 experts from different software companies. A seven point likert scale was used to determine the significance of each intercultural challenge. Our findings indicate that all the intercultural challenges are critical for OSDO vendors. We further analyzed these challenges based on different variables, such as company size, company type, expert's job/position etc. We have identified that there is no significant difference in the intercultural challenges based on company type and expert's experience level. We identified that language and language proficiency is the most commonly agreed and difference in social behavior is the most commonly disagreed intercultural challenge in the category of both sizes of company. Similarly language and language proficiency is the most commonly agreed challenge based on experts job positions. (author)

Human Resources Development Challenges for Nuclear Newcomers

International Nuclear Information System (INIS)

Perrette, Xavier

2014-01-01

Conclusion and take away messages: • HRD solution is dependent upon country’s economical, societal, industrial situation and development strategy. • HRD to be integrated in the global HCB approach (education and training, KM, knowledge networks). • Maximum local benefit with national development. • International collaboration and partnership with competent and experienced partners is recommended (lever effect). • Anticipation is key. → HRD for a nuclear program is challenging but achievable. Countries already did it and are ready to build long term partnerships

eHEALTH SERVICES AND TECHNOLOGY: CHALLENGES FOR CO-DEVELOPMENT

Directory of Open Access Journals (Sweden)

Hannele Hyppönen

2007-01-01

Full Text Available The promises of ICT have been poorly redeemed in health care; many projects have failed. This article conceptualizes the co-construction of services and technologies in order to help future practitioners in the field to understand and find solutions to the challenges in ICT-enhanced service change. The conceptualization is created by structuring the findings of a case study with the help of theoretical concepts. The conceptualization then is implemented in another case to study its potential for finding challenges and suggesting solutions. Both cases demonstrate challenges for codevelopment that contributed to poor project outcomes. Participants in eHealth projects need a better understanding of development as the parallel shaping of multiple objects. They need better skills in managing the change process and a better understanding of methods for collaboration throughout the development. The projects would benefit from networking with actors who have adequate understanding of the process as a whole and of methods of codevelopment.

Opportunities and challenges of interdisciplinary research career development: implementation of a women's health research training program.

Science.gov (United States)

Domino, Steven E; Smith, Yolanda R; Johnson, Timothy R B

2007-03-01

A key component of the National Institutes of Health (NIH) Roadmap for Medical Research is the development of interdisciplinary research teams. How best to teach and foster interdisciplinary research skills has not been determined. An effort at promoting interdisciplinary research was initiated by the Office of Research on Women's Health (ORWH) at NIH in 1999. The following year, 12 academic centers were funded to support 56 scholar positions for 2-5 years under Building Interdisciplinary Research Careers in Women's Health (BIRCWH). A second cohort of 12 centers, called BIRCWH II, was funded in 2002. In this paper, we present the experience of the University of Michigan BIRCWH program, including a practical approach to dealing with the challenges and opportunities of interdisciplinary research training. Scholars are mentored not only by their primary research advisor but also by a three-person mentor team as well as by their peers. All scholars and a core of supportive faculty meet regularly to discuss interdisciplinary research career development and approaches to apply knowledge in new ways. Of the original cohort of 10 scholars at the University of Michigan, 7 have achieved independent research funding. Challenges include arranging times to meet, developing a common language and knowledge base, dealing proactively with expectations and misunderstandings, focusing on a conceptual model, and providing timely feedback.

Design development of graphite primary structures enables SSTO success

Science.gov (United States)

Biagiotti, V. A.; Yahiro, J. S.; Suh, Daniel E.; Hodges, Eric R.; Prior, Donald J.

1997-01-01

This paper describes the development of a graphite composite wing and a graphite composite intertank primary structure for application toward Single-Stage to Orbit space vehicles such as those under development in NASA's X-33/Reusable Launch Vehicle (RLV) Program. The trade study and designs are based on a Rockwell vertical take-off and horizontal landing (VTHL) wing-body RLV vehicle. Northrop Grumman's approach using a building block development technique is described. Composite Graphite/Bismaleimide (Gr/BMI) material characterization test results are presented. Unique intertank and wing composite subcomponent test article designs are described and test results to date are presented. Wing and intertank Full Scale Section Test Article (FSTA) objectives and designs are outlined. Trade studies, supporting building block testing, and FSTA demonstrations combine to develop graphite primary structure composite technology that enables developing X-33/RLV design programs to meet critical SSTO structural weight and operations performance criteria.

Opportunities and challenges in developing gas markets in South America

Energy Technology Data Exchange (ETDEWEB)

Duarte, Cristiano Boaventura [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil)

2008-07-01

The article has the objective of identifying and analyzing the key market levers and drivers, emerging issues and challenges in developing the gas markets in South America. In section 1, the paper provides an overview of the most relevant indicators in the natural gas markets of the region. Data such as natural gas proven reserves; production; consumption; trade movements (by pipeline and LNG) and main aspects of regulatory framework are shown. In section 2, some of the key challenges and opportunities in developing gas markets in the region are identified, including those relating to market integration, political aspects and the main players' investments. In section 3, possible strategies from governments and enterprises to overcome those challenges, and seize the potential opportunities of the region are examined. In section 4, the conclusions point to the potential of developing the gas markets as a means to diversify the energy sources in the region, fostering a successful process of economic growth and political integration in the area. (author)

Challenges to Quality Primary and Secondary Education in Uganda ...

African Journals Online (AJOL)

The survey and discussion focus on the challenges to quality education in Uganda. It is over136 years since formal education was introduced in Uganda by the Christian Missionaries in 1877 and 1879. These were Anglican and Roman Catholic Missionaries respectively. Given the plethora of implicit and explicit challenges ...

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

Science.gov (United States)

Shawar, Yusra Ribhi; Shiffman, Jeremy

2017-01-07

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

Women's Health – A Continuing Challenge in Developing Countries

African Journals Online (AJOL)

Patrick Erah

Pharmacotherapy Group,. Faculty of Pharmacy, University of Benin,. Benin City, Nigeria. All rights reserved. Available online at http://www.tjpr.org. Editorial. Women's Health – A Continuing Challenge in. Developing Countries. For justifiable reasons, the health of women in developing countries is presently an important.

Historicizing Teaching in Awgni as a Mother Tongue Language at Primary Schools of Awi Nationality Administrative Zone: Challenges and Implementation

Science.gov (United States)

Engida, Alemayehu Erkihun

2015-01-01

This study examined the challenges facing the teaching as well as the implementation of Awgni as a mother tongue language in primary schools of Awi administrative zone. The need to teach through mother tongue in Ethiopia was widely discussed following the change of the politics in 1991. To this end, the government issued new education and training…

Teaching biopsychosocial competence and the principles of primary ...

African Journals Online (AJOL)

The importance of behavioural and social determinants in health was recognised long ago, yet we still grapple with the challenges of developing appropriate teaching pedagogies to bring these principles into routine clinical practice. A teaching pedagogy blending the biopsychosocial approach and the principles of primary ...

Budgetary Challenges of Higher Education: Evidence from Bangladesh

Science.gov (United States)

Sarkar, Shakhawat Hossain; Hossain, Syed Zabid

2016-01-01

This study strives to ascertain the financial and nonfinancial challenges of higher education budget for human resources development (HRD) based on both primary and secondary sources of data. Inadequate budgetary support from the government and inappropriate implementation of the same due to nonexistence of good governance and inefficient…

Challenges and prospects for power development in Africa

International Nuclear Information System (INIS)

Davidson, O.R.

1994-01-01

Formulating innovative power development strategies to provide adequate, affordable and reliable services to meet Africa's growing population and developing demands is a major challenge. The development of its huge energy resource base will be limited by its inability to access investment funds and by general concerns for the environment. Institutional and policy reform, exploitation of continued progress on demand-side options, and conservation and diversification of energy resources provide opportunities for meeting future demand. (author). 13 refs, 5 figs, 3 tabs

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria: Successes and Challenges.

Science.gov (United States)

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System-AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.

Mnemonic abilities of primary school children with delayed mental development.

Directory of Open Access Journals (Sweden)

Murafa S.V.

2015-07-01

Full Text Available This paper presents the results of research regarding the mnemonic abilities of primary school children with developmental delays. Empirical studies of impaired mental development offer an opportunity to elucidate the psychological mechanisms underlying the process of normal development and enable us to consider at a micro level the formation of mental processes in ontogeny, which would, under normal conditions, be nondescript and not always amenable to psychological analysis. The research addresses an experimental investigation of productivity and qualitative characteristics of mnemonic abilities among primary school students with developmental delays. V.D. Shadrikov’s Theory of Abilities, developed in a systemic approach framework, is the theoretical basis of the research. The method of deploying a memorization activity, as elaborated by V.D. Shadrikov and L.V. Cheremoshkina, was the investigation tool used. The sample included students in grades 1 to 4 between ages 7 to 12 and included a total of 100 children (66 boys and 34 girls. The control group of primary school students with typical development included 105 children (50 boys and 55 girls. The research consisted of several stages: a pilot study, experimental research (the test task was to memorize card #1; the basic task was to memorize cards #2 and #3; to reproduce cards #2 and #3; and to poll the students, mathematical data processing, and a description of the levels of mnemonic ability development among primary students with developmental delays. The following procedures were employed during statistical analysis: Spearman r3, Mann-Whitney U-test, Jonckheere-Terpstra test, and Kruskal-Wallis test. The structure of mnemonic abilities in primary schoolchildren with developmental delays was determined to vary according to the underdevelopment of their operational mechanisms. For example, memory functions are based on the use of inborn mechanisms, and a portion of children differ in the

Developing the Botswana Primary Care Guideline: an integrated, symptom-based primary care guideline for the adult patient in a resource-limited setting

Directory of Open Access Journals (Sweden)

Tsima BM

2016-08-01

Full Text Available Billy M Tsima,1 Vincent Setlhare,1 Oathokwa Nkomazana2 1Department of Family Medicine and Public Health, 2Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Botswana Background: Botswana’s health care system is based on a primary care model. Various national guidelines exist for specific diseases. However, most of the guidelines address management at a tertiary level and often appear nonapplicable for the limited resources in primary care facilities. An integrated symptom-based guideline was developed so as to translate the Botswana national guidelines to those applicable in primary care. The Botswana Primary Care Guideline (BPCG integrates the care of communicable diseases, including HIV/AIDS and noncommunicable diseases, by frontline primary health care workers.Methods: The Department of Family Medicine, Faculty of Medicine, University of Botswana, together with guideline developers from the Knowledge Translation Unit (University of Cape Town collaborated with the Ministry of Health to develop the guideline. Stakeholder groups were set up to review specific content of the guideline to ensure compliance with Botswana government policy and the essential drug list.Results: Participants included clinicians, academics, patient advocacy groups, and policymakers from different disciplines, both private and public. Drug-related issues were identified as necessary for implementing recommendations of the guideline. There was consensus by working groups for updating the essential drug list for primary care and expansion of prescribing rights of trained nurse prescribers in primary care within their scope of practice. An integrated guideline incorporating common symptoms of diseases seen in the Botswana primary care setting was developed.Conclusion: The development of the BPCG took a broad consultative approach with buy in from relevant stakeholders. It is anticipated that implementation of the BPCG will translate into better

The Challenges of Service Provision and Economic Development in South Africa

Directory of Open Access Journals (Sweden)

Cecile Gerwel Proches

2012-11-01

Full Text Available South Africa faces difficulties related to the provision of services, which stem from common challenges related to globalisation, urbanisation, and the divide between the rich and poor. The country also has to take account of other factors which impact negatively on economic development. Various stakeholders in the public and private sector, Non-Governmental Organisations (NGOs and even communities engage in Local Economic Development (LED initiatives. Such efforts include job creation and economic stimulation, the creation and support of enterprise establishment and development, infrastructure investment, and attempts to increase the competitiveness in a local area, through the use of the available physical and intellectual resources. The aim of this theoretical paper is to focus on the role of LED in addressing the local and global challenges that impact on service provision and economic development in South Africa. The specific challenges will be outlined, and LED in South Africa will be discussed in some detail, along with recommendations to address areas of concern.

Meeting the flow assurance challenges of deep water developments - from CAPEX development to field start up

Energy Technology Data Exchange (ETDEWEB)

Jordan, M.M.; Feasey, N.D. [National Aluminium Company Ltd. (Nalco), Cheshire (United Kingdom); Afonso, M.; Silva, D. [NALCO Brasil Ltda., Sao Paulo, SP (Brazil)

2008-07-01

As oil accumulations in easily accessible locations around the world become less available developments in deeper water become a more common target for field development. Deep water projects, particularly sub sea development, present a host of challenges in terms of flow assurance and integrity. In this paper the focus will be on the chemical control of flow assurance challenges in hydrate control, scale control and wax/asphaltene control within deep water (>750 meter) developments. The opportunities for kinetic hydrate control vs. conventional thermodynamic hydrate control will be outlined with examples of where these technologies have been applied and the limitations that still exist. The development of scale control chemical formulations specifically for sub sea application and the challenges of monitoring such control programs will be highlighted with developments in real time and near real time monitoring. Organic deposit control (wax/asphaltene) will focus on the development of new chemicals that have higher activity but lower viscosity than currently used chemicals hence allowing deployment at colder temperatures and over longer distances. The factors that need to be taken into account when selecting chemicals for deep water application will be highlighted. Fluid viscosity, impact of hydrostatic head on injectivity, product stability at low temperature and interaction with other production chemicals will be reviewed as they pertain to effective flow assurance. This paper brings learning from other deep water basins with examples from the Gulf of Mexico, West Africa and Brazil, which will be used to highlight these challenges and some of the solutions currently available along with the technology gaps that exist. (author)

Performance of the ATLAS primary vertex reconstruction algorithms

CERN Document Server

Zhang, Matt

2017-01-01

The reconstruction of primary vertices in the busy, high pile up environment of the LHC is a challenging task. The challenges and novel methods developed by the ATLAS experiment to reconstruct vertices in such environments will be presented. Such advances in vertex seeding include methods taken from medical imagining, which allow for reconstruction of very nearby vertices will be highlighted. The performance of the current vertexing algorithms using early Run-2 data will be presented and compared to results from simulation.

Perceived challenges in business development of smallholder dairy ...

African Journals Online (AJOL)

Dairy farmers face various challenges in developing their businesses. The current literature identifies several constraints towards a more efficient dairy sector that relate mostly to on-farm management practices. The available studies analyze constraints mostly from the objective viewpoint of the researcher, whereas very ...

Barriers and challenges of educational development in China: an ...

African Journals Online (AJOL)

Educational inequality and inequity has been the cry of all stakeholders in the educational development in every country. China is of no exception. The barriers of education development in China are gradually being uprooted by solid and sound policies. That notwithstanding, there are still few challenges that demands a ...

Dune management challenges on developed coasts

Science.gov (United States)

Elko, Nicole A.; Brodie, Kate; Stockdon, Hilary F.; Nordstrom, Karl F.; Houser, Chris; McKenna, Kim; Moore, Laura; Rosati, Julie D.; Ruggiero, Peter; Thuman, Roberta; Walker, Ian J.

2015-01-01

From October 26-28, 2015, nearly 100 members of the coastal management and research communities met in Kitty Hawk, NC, USA to bridge the apparent gap between the coastal dune research of scientists and engineers and the needs of coastal management practitioners. The workshop aimed to identify the challenges involved in building and managing dunes on developed coasts, assess the extent to which scientific knowledge can be applied to the management community, and identify approaches to provide means to bridge the gap between needs and potential solutions.

CHALLENGE FUNDS AND INCLUSIVE BUSINESSES – KEY TO SOCIO-ECONOMIC DEVELOPMENT?

Directory of Open Access Journals (Sweden)

Boleslaw Stawicki

2016-09-01

Full Text Available This paper will introduce the concept of the challenge fund mechanism, and its role, from both a private sector development (PSD perspective as well as from the sustainable social impact angle. The paper is informed by practical experience and reflections from the point of view of a manager who manages one of the world’s largest challenge funds with a capitalisation of USD 250m and 200+ investments across 23 different markets. A challenge fund, which by nature, is a risk taking and risk-sharing PSD mechanism is used to support innovative, forprofit business ventures, which, by the virtue of being innovative, and therefore, more risky than other business ventures have restricted access to capital. A challenge fund, in a developing or frontier market context, will invest in innovative for-profit companies that exhibit strong intentionality on social impact, i.e. they will implement the inclusive business model concept. Essentially, inclusive businesses engage low income communities in a formal way either as suppliers of raw material, such as cocoa seeds, which the company then processes, or they engage low income communities as customers who buy and consume products and services which cater to them specifically. In this way, an inclusive business makes a profit and at the same time increases the income of low income communities. In this arrangement social impact remains sustainable because the business sees that it can make a profit by collaborating with low income communities. A challenge fund, by financing innovative and risky SMEs doesn’t only support PSD and social impact, it also creates a tested and proven deal flow of companies for more commercial investors such as private equity funds or development finance institutions such as the International Finance Corporation. Therefore, the challenge fund mechanism serves a critical function in sustainable business and social development.

The challenges of rapid urbanization on sustainable development of ...

African Journals Online (AJOL)

The challenges of rapid urbanization on sustainable development of Nyanya, Federal Capital ... PROMOTING ACCESS TO AFRICAN RESEARCH ... unaffordable health care facilities, poor environmental health and traffic congestion on the ...

CULTURAL GLOBALISATION AND CHALLENGES TO TRADITIONAL COMMUNICATION THEORIES

Directory of Open Access Journals (Sweden)

Lauren Movius

2010-01-01

Full Text Available This article reviews existing traditional media theories, and analyses the challenges that the current developments of globalisation present to them. The article provides a short history of the concept of globalisation, and reviews the primary theoretical approaches to globalisation that are critical to communication scholars. The article also examines how globalisation challenges the ways in which media and communication have traditionally been theorised. Specifically, the cultural imperialism theory is discussed, as well as the main challenges to the theory. Audience reception studies, which focus on how audiences negotiate meaning differently in specific cultural contexts, are highlighted as the key critique of cultural imperialism

Challenges and impacts of agricultural biotechnology on developing ...

African Journals Online (AJOL)

demands and raise incomes while protecting the environment for future generations. Agricultural biotechnology has the potential to play a large role toward this achievement. Sadly, this opportunity remains a mirage for most developing societies because of numerous challenges that prevent them from benefiting from the ...

Language development: Progress and challenges in a multilingual ...

African Journals Online (AJOL)

Some such challenges discussed include issues like language selection for development, absence of clear language policy and the important issue of attitudes of respective language communities towards language research programmes. The article also looks at how the project and the institute have managed to make ...

Integrated primary health care in Australia

Directory of Open Access Journals (Sweden)

Gawaine Powell Davies

2009-10-01

Full Text Available Introduction: To fulfil its role of coordinating health care, primary health care needs to be well integrated, internally and with other health and related services. In Australia, primary health care services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Description of policy: Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary health care centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary health care under one level of government with a national primary health care policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary health care. Discussion: Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary health care.

Integrated primary health care in Australia.

Science.gov (United States)

Davies, Gawaine Powell; Perkins, David; McDonald, Julie; Williams, Anna

2009-10-14

To fulfil its role of coordinating health care, primary health care needs to be well integrated, internally and with other health and related services. In Australia, primary health care services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary health care centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary health care under one level of government with a national primary health care policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary health care. Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary health care.

Exploring the effects of developing collaboration in a primary science teacher community

DEFF Research Database (Denmark)

Sillasen, Martin Krabbe

2010-01-01

This paper presents findings from a qualitative study to explore factors that may facilitate sustainable changes of collaboration in a primary science teacher community in one school. The context for this study is a development project aimed at improving science teaching by changing teacher......’s collective work in schools and developing network between schools. The objective is to improve the collaboration within primary science teacher communities on sharing best practice and developing new ways of teaching. This study represents an in-depth approach to explore possibilities and constraints for how...... a development project can facilitate sustainable change in primary science teachers’ collaboration. The purpose of the research project introduced here is to examine closer, why many development projects fail to produce sustainable results. The framework of McLaughlin and Talbert (2006) on building teacher...

Career Planning: Developing the Nation's Primary Resource.

Science.gov (United States)

Jarvis, Phillip S.

Career planning is the most critical ingredient in developing a nation's primary resource, its workers. A 1988 Gallup Poll showed that 62 percent of U.S. workers had no career goal when they began their first job, and more than 50 percent felt they were in the wrong job. The same results probably could be applied to Canada. Career planning skills…

Development of Learning to Learn Skills in Primary School

Science.gov (United States)

Vainikainen, Mari-Pauliina; Wüstenberg, Sascha; Kupiainen, Sirkku; Hotulainen, Risto; Hautamäki, Jarkko

2015-01-01

In Finland, schools' effectiveness in fostering the development of transversal skills is evaluated through large-scale learning to learn (LTL) assessments. This article presents how LTL skills--general cognitive competences and learning-related motivational beliefs--develop during primary school and how they predict pupils' CPS skills at the end…

Rotary endodontics in primary teeth - A review.

Science.gov (United States)

George, Sageena; Anandaraj, S; Issac, Jyoti S; John, Sheen A; Harris, Anoop

2016-01-01

Endodontic treatment in primary teeth can be challenging and time consuming, especially during canal preparation, which is considered one of the most important steps in root canal therapy. The conventional instrumentation technique for primary teeth remains the "gold-standard" over hand instrumentation, which makes procedures much more time consuming and adversely affects both clinicians and patients. Recently nickel-titanium (Ni-Ti) rotary files have been developed for use in pediatric endodontics. Using rotary instruments for primary tooth pulpectomies is cost effective and results in fills that are consistently uniform and predictable. This article reviews the use of nickel-titanium rotary files as root canal instrumentation in primary teeth. The pulpectomy technique is described here according to different authors and the advantages and disadvantages of using rotary files are discussed.

Developing, delivering and evaluating primary mental health care: the co-production of a new complex intervention.

Science.gov (United States)

Reeve, Joanne; Cooper, Lucy; Harrington, Sean; Rosbottom, Peter; Watkins, Jane

2016-09-06

Health services face the challenges created by complex problems, and so need complex intervention solutions. However they also experience ongoing difficulties in translating findings from research in this area in to quality improvement changes on the ground. BounceBack was a service development innovation project which sought to examine this issue through the implementation and evaluation in a primary care setting of a novel complex intervention. The project was a collaboration between a local mental health charity, an academic unit, and GP practices. The aim was to translate the charity's model of care into practice-based evidence describing delivery and impact. Normalisation Process Theory (NPT) was used to support the implementation of the new model of primary mental health care into six GP practices. An integrated process evaluation evaluated the process and impact of care. Implementation quickly stalled as we identified problems with the described model of care when applied in a changing and variable primary care context. The team therefore switched to using the NPT framework to support the systematic identification and modification of the components of the complex intervention: including the core components that made it distinct (the consultation approach) and the variable components (organisational issues) that made it work in practice. The extra work significantly reduced the time available for outcome evaluation. However findings demonstrated moderately successful implementation of the model and a suggestion of hypothesised changes in outcomes. The BounceBack project demonstrates the development of a complex intervention from practice. It highlights the use of Normalisation Process Theory to support development, and not just implementation, of a complex intervention; and describes the use of the research process in the generation of practice-based evidence. Implications for future translational complex intervention research supporting practice change

Public Tourism Infrastructure: Challenges in the Development and Maintenance Activities

Directory of Open Access Journals (Sweden)

Abdullah Shardy

2014-01-01

Full Text Available In Malaysia, the tourism sector is a major contributor to the nation’s development and is spearheaded by the government’s efforts in investing heavily towards providing sufficient and well-functioning public tourism infrastructure. This infrastructure should be ideally developed with a clear and systematic maintenance plan in hand. The challenge herein is not merely providing the necessary infrastructure to sustain tourism activities but rather a pro-active approach towards establishing and subsequently maintaining this infrastructure at its optimal level. The aim of this paper therefore is to identify critical aspects that need to be in place to further enhance the Malaysian tourism industry. The paper discusses the issues and challenges that need to be addressed as a precursor towards an effectively developed and maintained tourism infrastructure system. Development issues that have been identified revolve around the dimensions of quality, quantity and ability of the public agencies involved, particularly issues of inadequate infrastructure, quality of infrastructure and the capability of the agencies in undertaking efficient maintenance activities. These issues were found to lead towards challenges of working with resource constraints, lack of an effective maintenance culture and system as well as the need for clear and effective policies and strategies.

0.20-m (8-in.) primary burner development report

International Nuclear Information System (INIS)

Stula, R.T.; Young, D.T.; Rode, J.S.

1977-12-01

High-Temperature Gas-Cooled Reactors (HTGRs) utilize graphite-base fuels. Fluidized-bed burners are being employed successfully in the experimental reprocessing of these fuels. The primary fluidized-bed burner is a unit operation in the reprocessing flowsheet in which the graphite moderator is removed. A detailed description of the development status of the 0.20-m (8-in.) diameter primary fluidized-bed burner as of July 1, 1977 is presented. Experimental work to date performed in 0.10; 0.20; and 0.40-m (4, 8, and 16 in.) diameter primary burners has demonstrated the feasibility of the primary burning process and, at the same time, has defined more clearly the areas in which additional experimental work is required. The design and recent operating history of the 0.20-m-diameter burner are discussed, with emphasis placed upon the evolution of the current design and operating philosophy

Challenges faced by primary care physicians when prescribing for patients with chronic diseases in a teaching hospital in Malaysia: a qualitative study.

Science.gov (United States)

Sellappans, Renukha; Lai, Pauline Siew Mei; Ng, Chirk Jenn

2015-08-27

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

Challenges of sustainable rural tourism development in KwaZulu ...

African Journals Online (AJOL)

Challenges of sustainable rural tourism development in KwaZulu-Natal. ... for promoting tourism as a sustainable economic driver in their municipalities. ... the nature of tourism, evaluating community's sensitivity and associated impacts should ...

A Challenging Case of Primary Breast Hodgkin's Lymphoma.

Science.gov (United States)

Zarnescu, Narcis Octavian; Iliesiu, Andreea; Procop, Alexandru; Tampa, Mircea; Matei, Clara; Sajin, Maria; Costache, Mariana; Dumitru, Adrian; Lazaroiu, Anca Mihaela

2015-03-01

Primary breast lymphoma (PBL) is a rare entity accounting for less than 1% of all breast malignancies. Diagnostic criteria for primary Hodgkin's lymphoma of the breast are: the presence of sufficient tissue for diagnosis, close interaction between mammary tissue and lymphomatous infiltrate and no evidence or prior diagnosis of widespread lymphoma. Our case illustrates an unusual presentation of Hodgkin's lymphoma of the breast: clinically as inflammatory breast cancer and core biopsy as granulomatous mastitis, the final diagnosis requiring surgical biopsy. Current information regarding this entity is scant, mainly build upon its rarity. In this paper we assess the clinical presentation, the step-by-step diagnosis, the treatment and the importance of immunohistochemistry in this uncommon condition.

Developing consumer involvement in rural HIV primary care programmes.

Science.gov (United States)

Mamary, Edward M; Toevs, Kim; Burnworth, Karla B; Becker, Lin

2004-06-01

As part of a broader medical and psychosocial needs assessment in a rural region of northern California, USA, five focus groups were conducted to explore innovative approaches to creating a system of consumer involvement in the delivery of HIV primary care services in the region. A total of five focus groups (n = 30) were conducted with clients from three of five counties in the region with the highest number of HIV patients receiving primary care. Participants were recruited by their HIV case managers. They were adults living with HIV, who were receiving health care, and who resided in a rural mountain region of northern California. Group discussions explored ideas for new strategies and examined traditional methods of consumer involvement, considering ways they could be adapted for a rural environment. Recommendations for consumer involvement included a multi-method approach consisting of traditional written surveys, a formal advisory group, and monthly consumer led social support/informal input groups. Specific challenges discussed included winter weather conditions, transportation barriers, physical limitations, confidentiality concerns, and needs for social support and education. A multiple-method approach would ensure more comprehensive consumer involvement in the programme planning process. It is also evident that methods for incorporating consumer involvement must be adapted to the specific context and circumstances of a given programme.

Development status of nuclear power in China and fundamental research progress on PWR primary water chemistry in China

International Nuclear Information System (INIS)

Wu, Xinqiang; Liu, Xiahe; Han, En-Hou; Ke, Wei; Xu, Yuming

2015-01-01

China's non-fossil fuels are expected to reach 20% in primary energy ratio by 2030. It is urgent for China to speed up the development of nuclear power to increase energy supply, reduce gas emissions and optimize resource allocation. Chinese government slowed down the approval of new nuclear power plant (NPP) projects after Fukushima accident in 2011. At the end of 2012, the State Council approved the nuclear safety program and adjusted long-term nuclear power development plan (2011-2020), the new NPP's projects have been restarted. In June 2015, there are 23 operating units in mainland in China with total installed capacity of about 21.386 GWe; another 26 units are under construction with total installed capacity of 28.5 GWe. The main type of reactors in operation and under construction in China is pressurized water reactor (PWR), including the first AP1000 NPPs in the world (units 1 in Sanmen) and China self-developed Hualong one NPPs (units 5 and 6 in Fuqing). Currently, China's nuclear power development is facing historic opportunities and also a series of challenges. One of the most important is the safety and economy of nuclear power. The optimization of primary water chemistry is one of the most effective ways to minimize radiation field, mitigate material degradation and maintain fuel performance in PWR NPPs, which is also a preferred path to achieve both safety and economy for operating NPPs. In recent years, an increased attention has been paid to fundamental research and engineering application of PWR primary water chemistry in China. The present talk mainly consists of four parts: (1) development status of China's nuclear power industry; (2) safety of nuclear power and operating water chemistry; (3) fundamental research progress on Zn-injected water chemistry in China; (4) summary and future. (author)

Tissue Engineering at the Blood-Contacting Surface: A Review of Challenges and Strategies in Vascular Graft Development.

Science.gov (United States)

Radke, Daniel; Jia, Wenkai; Sharma, Dhavan; Fena, Kemin; Wang, Guifang; Goldman, Jeremy; Zhao, Feng

2018-05-07

Tissue engineered vascular grafts (TEVGs) are beginning to achieve clinical success and hold promise as a source of grafting material when donor grafts are unsuitable or unavailable. Significant technological advances have generated small-diameter TEVGs that are mechanically stable and promote functional remodeling by regenerating host cells. However, developing a biocompatible blood-contacting surface remains a major challenge. The TEVG luminal surface must avoid negative inflammatory responses and thrombogenesis immediately upon implantation and promote endothelialization. The surface has therefore become a primary focus for research and development efforts. The current state of TEVGs is herein reviewed with an emphasis on the blood-contacting surface. General vascular physiology and developmental challenges and strategies are briefly described, followed by an overview of the materials currently employed in TEVGs. The use of biodegradable materials and stem cells requires careful control of graft composition, degradation behavior, and cell recruitment ability to ensure that a physiologically relevant vessel structure is ultimately achieved. The establishment of a stable monolayer of endothelial cells and the quiescence of smooth muscle cells are critical to the maintenance of patency. Several strategies to modify blood-contacting surfaces to resist thrombosis and control cellular recruitment are reviewed, including coatings of biomimetic peptides and heparin. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Teachers' perceptions on primary science teaching

Science.gov (United States)

Kijkuakul, Sirinapa

2018-01-01

This qualitative research aimed to review what primary teachers think about how to teach science in rural school contexts. Three primary schools in Thailand were purposively chosen for this study. Eleven primary science teachers of these schools were the research participants. Questionnaires, interviews, and observations were implemented to reveal the primary school teachers' educational backgrounds, science teaching context, and need for self-driven professional development. Content and discourse analysis indicated that the non-science educational background and the science teaching context implied a need for self-driven professional development. The non-science educational background teachers were generally unfamiliar with the current national science curriculum, and that they would not be comfortable when the researcher observed their science teaching practice. They also believed that experimentation was the only one strategy for teaching science, and that the priority for their teaching support was teaching media rather than their understanding of scientific concepts or teaching strategies. As implication of this research, subsequent developments on science teacher profession in rural context, therefore, need to promote teachers' understandings of nature of science and technological and pedagogical content knowledge. In addition, they should be challenged to practice on critically participatory action research for academic growth and professional learning community.

Development and validation of challenge materials for double-blind, placebo-controlled food challenges in children

NARCIS (Netherlands)

Vlieg-Boerstra, BJ; Bijleveld, CMA; van der Heide, S; Beusekamp, BJ; Wolt-Plompen, SAA; Kukler, J; Brinkman, J; Duiverman, EJ; Dubois, AEJ

Background: The use of double-blind, placebo-controlled food challenges (DBPCFCs) is considered the gold standard for the diagnosis of food allergy. Despite this, materials and methods used in DBPCFCs have not been standardized. Objective: The purpose of this study was to develop and validate

Across the divide: "Primary care departments working together to redesign care to achieve the Triple Aim".

Science.gov (United States)

Koslov, Steven; Trowbridge, Elizabeth; Kamnetz, Sandra; Kraft, Sally; Grossman, Jeffrey; Pandhi, Nancy

2016-09-01

Primary care is considered the foundation of an effective health care system. However, primary care departments at academic health centers have numerous challenges to overcome when trying to achieve the Triple Aim. As part of an organizational initiative to redesign primary care at a large academic health center, departments of internal medicine, general pediatrics and adolescent medicine, and family medicine worked together to comprehensively redesign primary care. This article describes the process of aligning these three primary care departments: defining panel size, developing a common primary care job description, redesigning the primary care compensation plan, redesigning the care model, and developing standardized staffing. Prior to the initiative, the rate of patient satisfaction was 85%, anticoagulation measurement 65%, pneumococcal vaccination 85%, breast cancer screening 79%, and colorectal cancer screening 69%. These rates all improved to 87%, 75%, 88%, 80%, and 80% respectively. Themes around key challenges to departmental integration are identified: (1) implementing effective communication strategies; (2) addressing specialty differences in primary care delivery; (3) working within resource limitations; and (4) developing long-term sustainability. Primary care in this large academic health center was transformed through developing a united primary care leadership team that bridged individual departments to create and adopt a common vision and solutions to shared problems. Our collaboration has achieved improvements across patient satisfaction, clinical safety metrics, and publicly-reported preventive care outcomes. The description of this experience may be useful for other academic health centers or other non-integrated delivery systems undertaking primary care practice transformation. Copyright © 2015 Elsevier Inc. All rights reserved.

Challenges to the Indicators on Science, Technology and Innovation Development

OpenAIRE

Chobanova, Rossitsa

2006-01-01

The paper attempts to define the challenges to the indicators on science, technology and innovation development which result from the contemporary dynamics of the global knowledge based economy progress and the pursued challenges of identification of the specific national priority dimensions for public funding research and innovation projects on the case of Bulgaria. It is argued that recent the most widespread methodologies of positioning science, technology and innovation indicators do not ...

Implementing EHR in a developing country: potential challenges and benefits

OpenAIRE

Tanko, Abdulai

2009-01-01

Developing countries are slow adopters of new technologies, particularly with regards to the health services of these countries. This study explores the data collection and management challenges in a Ghanaian hospital using an interpretative case study approach and proposes implementing an Electronic Health Record (EHR) system as a solution to these challenges. The Technology Acceptance Model (TAM), Actor Network Theory (ANT) and Computer Supported Cooperative Work (CSCW) are used in discussi...

iPad Learning Ecosystem: Developing Challenge-Based Learning Using Design Thinking

Science.gov (United States)

Marin, Catalina; Hargis, Jace; Cavanaugh, Cathy

2013-01-01

In order to maximize college English language students' learning, product development, 21st Century skills and engagement with real world meaningful challenges, a course was designed to integrate Challenge Based Learning (CBL) and iPad mobile learning technology. This article describes the course design, which was grounded in design thinking, and…

Detailing profiles of Lawsonia intracellularis specific lymphocytes in the immune response to a challenge inoculation after oral vaccination or primary inoculation with virulent bacteria

DEFF Research Database (Denmark)

Riber, Ulla; Hvass, Henriette Cordes; Heegaard, Peter M. H.

2012-01-01

Vaccination against the intracellular porcine enteric pathogen Lawsonia intracellularis remains a challenge as the commercially available vaccine does not provide full protection. In an experimental challenge study, the Enterisol® Ileitis attenuated live vaccine against Lawsonia intracellularis did...... not induce measurable primary humoral or cell-mediated immune responses, nor was it able to reduce faecal shedding of bacteria from eight vaccinated pigs compared to seven age-matched naïve challenge-control pigs. Vaccinated pigs did, however, respond to vaccination with an acute phase protein response...

Use of primary corticosteroid injection in the management of plantar fasciopathy: is it time to challenge existing practice?

Science.gov (United States)

Kirkland, Paul; Beeson, Paul

2013-01-01

Plantar fasciopathy (PF) is characterized by degeneration of the fascia at the calcaneal enthesis. It is a common cause of foot pain, accounting for 90% of clinical presentations of heel pathology. In 2009-2010, 9.3 million working days were lost in England due to musculoskeletal disorders, with 2.4 million of those attributable to lower-limb disorders, averaging 16.3 lost working days per case. Numerous studies have attempted to establish the short- and long-term clinical efficacy of corticosteroid injections in the management of PF. Earlier studies have not informed clinical practice. As the research base has developed, evidence has emerged supporting clinical efficacy. With diverse opinions surrounding the etiology and efficacy debate, there does not seem to be a consensus of opinion on a common treatment pathway. For example, in England, the National Institute for Clinical Health and Excellence does not publish strategic guidance for clinical practice. Herein, we review and evaluate core literature that examines the clinical efficacy of corticosteroid injection as a treatment for PF. Outcome measures were wide ranging but largely yielded results supportive of the short- and long-term benefits of this modality. The analysis also looked to establish, where possible, "proof of concept." This article provides evidence supporting the clinical efficacy of corticosteroid injections, in particular those guided by imaging technology. The evidence challenges existing orthodoxy, which marginalizes this treatment as a secondary option. This challenge is supported by recently revised guidelines published by the American College of Foot and Ankle Surgeons advocating corticosteroid injection as a primary treatment option.

Development challenges of resource-rich countries: the case of oil ...

African Journals Online (AJOL)

This paper discusses some of the challenges that confront oil-rich developing countries in their development quest. It stresses that one of the surest ways governments in oil-rich developing countries have at their disposal to avoid the so-called curse of oil is through the insulation of fiscal policy from the volatility associated ...

Cooperation and communication challenges in small-scale eHealth development projects.

Science.gov (United States)

Petersen, Lone Stub; Bertelsen, Pernille; Bjørnes, Charlotte

2013-12-01

In eHealth development there is an increasing focus on user participation inspired by the information systems field of practice and research. There are, however, many other challenges in developing information systems that fit healthcare practices. One of these is the challenge of cooperation and communication in development projects that are initiated and managed by clinicians e.g. cooperating with IT professionals in 'bottom up' health informatics projects that have been initiated and are managed by healthcare professional project managers. The analysis and results are drawn from a qualitative case study on a systems development project that was managed by a local, non-technical, healthcare professional and the complex blend and interactions with the IT professionals in the phases of ideas, design, development, implementation, maintenance and distribution. We analyze the challenges of cooperation and communication using perspectives from information systems research and the concepts of 'language-games' and 'shared design spaces', and thereby exploring the boundaries between the different communication, practice and culture of the IT professionals and the healthcare professionals. There is a need to (a) develop a better understanding of the development process from the point of view of the 'user' and (b) tools for making technical knowledge explicit in the development process. Cooperative and communicative methods are needed that support and develop the shared design spaces between IT professionals and the clinical context in order to strengthen small-scale health information systems projects. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Urban Big Data and Sustainable Development Goals: Challenges and Opportunities

Directory of Open Access Journals (Sweden)

Ali Kharrazi

2016-12-01

Full Text Available Cities are perhaps one of the most challenging and yet enabling arenas for sustainable development goals. The Sustainable Development Goals (SDGs emphasize the need to monitor each goal through objective targets and indicators based on common denominators in the ability of countries to collect and maintain relevant standardized data. While this approach is aimed at harmonizing the SDGs at the national level, it presents unique challenges and opportunities for the development of innovative urban-level metrics through big data innovations. In this article, we make the case for advancing more innovative targets and indicators relevant to the SDGs through the emergence of urban big data. We believe that urban policy-makers are faced with unique opportunities to develop, experiment, and advance big data practices relevant to sustainable development. This can be achieved by situating the application of big data innovations through developing mayoral institutions for the governance of urban big data, advancing the culture and common skill sets for applying urban big data, and investing in specialized research and education programs.

Usability challenges in an Ethiopian software development organization

DEFF Research Database (Denmark)

Teka, Degif; Dittrich, Yvonne; Kifle, Mesfin

2016-01-01

Usability and user centered design (UCD) are central to software development. In developing countries, the gap between IT development and the local use situation is larger than in western countries. However, usability is neither well addressed in software practice nor at the policy making level...... in Ethiopia. Software practitioners focus on functional requirements, meeting deadlines and budget. The software development industry in Ethiopia is in its early stage. The article aims at understanding usability practices in an Ethiopian software development company. Developers, system analysts, product...... configuration, their experience, cultural knowledge and common sense regarding the users' situation guided the design. Prototypes and fast delivery of working versions helped in getting user feedback even if early user focus proved to be a challenge as communication between developers and users suffered from...

Assessing Zika virus replication and the development of Zika-specific antibodies after a mid-gestation viral challenge in guinea pigs.

Science.gov (United States)

Bierle, Craig J; Fernández-Alarcón, Claudia; Hernandez-Alvarado, Nelmary; Zabeli, Jason C; Janus, Bradley C; Putri, Dira S; Schleiss, Mark R

2017-01-01

Primary Zika virus (ZIKV) infections that occur during pregnancy can cause spontaneous abortion and profoundly disrupt fetal development. While the full range of developmental abnormalities associated with congenital Zika syndrome is not yet known, severe cases of the syndrome can present with microcephaly, extensive neurologic and ocular damage, and pronounced joint malformations. Animal models that accurately recapitulate congenital Zika syndrome are urgently needed for vaccine development and for the study of ZIKV pathogenesis. As guinea pigs have successfully been used to model transplacental infections by cytomegalovirus, syphilis, and Listeria monocytogenes, we sought to test whether ZIKV could productively infect guinea pigs and whether viral transmission with attendant fetal pathology would occur after a mid-gestation viral challenge. We found that guinea pig cells supported ZIKV replication in vitro. Experimental infection of non-pregnant animals did not result in overt disease but low-level, detectable viremia was observed. When pregnant guinea pigs were challenged with ZIKV at between 18 and 21 days gestational age, ZIKV was not detected in maternal or pup blood, plasma, or tissues and no significant differences in maternal weight gain or pup size were observed following challenge. Nonetheless, a robust antibody response against ZIKV was detected in both the pups and dams. These results suggest that, while guinea pigs can model aspects of the immune response to ZIKV infection during pregnancy, naturally circulating ZIKV strains are not pathogenic during the pregnancy of immunocompetent guinea pigs and do not interfere with normal pup development.

The primary care amplification model: taking the best of primary care forward

Directory of Open Access Journals (Sweden)

Nicholson Caroline

2008-12-01

Full Text Available Abstract Background Primary care internationally is approaching a new paradigm. The change agenda implicit in this threatens to de-stabilise and challenge established general practice and primary care. Discussion The Primary Care Amplification Model offers a means to harness the change agenda by 'amplifying' the strengths of established general practices around a 'beacon' practice. Conclusion Such 'beacon' practices can provide a mustering point for an expanded scope of practice for primary care, integrated primary/secondary service delivery, interprofessional learning, relevant local clinical research, and a focus on local service innovation, enhancing rather than fragmenting the collective capacity of existing primary care.

Development and Exemplification of a Model for Teacher Assessment in Primary Science

Science.gov (United States)

Davies, D. J.; Earle, S.; McMahon, K.; Howe, A.; Collier, C.

2017-01-01

The Teacher Assessment in Primary Science project is funded by the Primary Science Teaching Trust and based at Bath Spa University. The study aims to develop a whole-school model of valid, reliable and manageable teacher assessment to inform practice and make a positive impact on primary-aged children's learning in science. The model is based on a…

Culture and the Challenges of Development in Africa: Towards A ...

African Journals Online (AJOL)

Development is a multi-dimensional process involving changes in structures, altitudes and institutions as well as the acceleration of economic growth, reduction of inequality and eradication of absolute poverty. However, the paper argues that the cultural dimension is a long-neglected aspect of development; the challenge, ...

New developments in seismic analysis of primary and secondary systems

International Nuclear Information System (INIS)

Gupta, A.K.

1984-01-01

Primary and secondary systems often must be analyzed using decoupled models. This paper presents recent advances made at NCSU in the seismic analysis of these systems. Algorithms are presented by which coupled mode shapes and frequencies can be evaluated without performing a new eigenvalue solution, given the mode shapes and frequencies of the decoupled models. Simple and accurate equations are presented to predict changes in frequencies and responses. With the coupled mode shapes and frequencies, one can obtain any primary or secondary response directly from the input spectrum. Alternatively, one can develop instructure spectra at various locations in the primary system accounting for the primary-secondary system interaction. Correlation between the support motions is also generated. Equations are presented for evaluating complex mode shapes and frequencies of coupled systems when due to unequal damping values of primary and secondary systems, the coupled system becomes nonproportionally damped. Recent progress, in case of tuned systems is also reported

Challenges and potential solutions for big data implementations in developing countries.

Science.gov (United States)

Luna, D; Mayan, J C; García, M J; Almerares, A A; Househ, M

2014-08-15

The volume of data, the velocity with which they are generated, and their variety and lack of structure hinder their use. This creates the need to change the way information is captured, stored, processed, and analyzed, leading to the paradigm shift called Big Data. To describe the challenges and possible solutions for developing countries when implementing Big Data projects in the health sector. A non-systematic review of the literature was performed in PubMed and Google Scholar. The following keywords were used: "big data", "developing countries", "data mining", "health information systems", and "computing methodologies". A thematic review of selected articles was performed. There are challenges when implementing any Big Data program including exponential growth of data, special infrastructure needs, need for a trained workforce, need to agree on interoperability standards, privacy and security issues, and the need to include people, processes, and policies to ensure their adoption. Developing countries have particular characteristics that hinder further development of these projects. The advent of Big Data promises great opportunities for the healthcare field. In this article, we attempt to describe the challenges developing countries would face and enumerate the options to be used to achieve successful implementations of Big Data programs.

Strategies for Primary Care Stakeholders to Improve Electronic Health Records (EHRs).

Science.gov (United States)

Olayiwola, J Nwando; Rubin, Ashley; Slomoff, Theo; Woldeyesus, Tem; Willard-Grace, Rachel

2016-01-01

The use of electronic health records (EHRs) and the vendors that develop them have increased exponentially in recent years. While there continues to emerge literature on the challenges EHRs have created related to primary care provider satisfaction and workflow, there is sparse literature on the perspective of the EHR vendors themselves. We examined the role of EHR vendors in optimizing primary care practice through a qualitative study of vendor leadership and developers representing 8 companies. We found that EHR vendors apply a range of strategies to elicit feedback from their clinical users and to engage selected users in their development and design process, but priorities are heavily influenced by the macroenvironment and government regulations. To improve the "marriage" between primary care and the EHR vendor community, we propose 6 strategies that may be most impactful for primary care stakeholders seeking to influence EHR development processes. © Copyright 2016 by the American Board of Family Medicine.

Development of Eimeria nieschulzi (Coccidia, Apicomplexa Gamonts and Oocysts in Primary Fetal Rat Cells

Directory of Open Access Journals (Sweden)

Hong Chen

2013-01-01

Full Text Available The in vitro production of gametocytes and oocysts of the apicomplexan parasite genus Eimeria is still a challenge in coccidiosis research. Until today, an in vitro development of gametocytes or oocysts had only been shown in some Eimeria species. For several mammalian Eimeria species, partial developments could be achieved in different cell types, but a development up to gametocytes or oocysts is still lacking. This study compares several permanent cell lines with primary fetal cells of the black rat (Rattus norvegicus concerning the qualitative in vitro development of the rat parasite Eimeria nieschulzi. With the help of transgenic parasites, the developmental progress was documented. The selected Eimeria nieschulzi strain constitutively expresses the yellow fluorescent protein and a macrogamont specific upregulated red tandem dimer tomato. In the majority of all investigated host cells the development stopped at the second merozoite stage. In a mixed culture of cells derived from inner fetal organs the development of schizont generations I-IV, macrogamonts, and oocysts were observed in crypt-like organoid structures. Microgamonts and microgametes could not be observed and oocysts did not sporulate under air supply. By immunohistology, we could confirm that wild-type E. nieschulzi stages can be found in the crypts of the small intestine. The results of this study may be helpful for characterization of native host cells and for development of an in vitro cultivation system for Eimeria species.

Management of Primary Care: a challenge for international cooperation in health.

Science.gov (United States)

Fonseca, Luiz Eduardo; Figueiredo, Maria Cristina Botelho de; Porto, Celina Santos Boga Marques

2017-07-01

The need to resolve immediate problems in basic healthcare systems and the decisions that must be made in the daily management of healthcare centers must reach beyond awareness of common sense, and be reinforced by the evidence sought in scientific knowledge that will provide a new look at the facts and phenomena that happen on a daily basis. This article examines an experience of triangular cooperation in health between Angola, Brazil and Japan, which took place in Luanda, Angola between 2011 and 2014. The "Project to Strengthen the Healthcare Through the Development of Human Resources at the Josina Hospital and in other Healthcare Services, and to Revitalize Primary Healthcare in Angola (ProForsa)", with the involvement of Fiocruz as the party executing the primary healthcare component. This is an innovative role in technical cooperation as a tool of political action. A training program with multiple possibilities enabled technical-political partnerships in an approach for "structuring cooperation in health". The article analyzes how interventions in international cooperation in health management may create scientific evidence that, together with the local political context, can transform organizational elements such as healthcare centers, their clinical management and physical infrastructure.

The challenges associated with developing science-based landscape scale management plans.

Science.gov (United States)

Robert C. Szaro; Douglas A. Jr. Boyce; Thomas. Puchlerz

2005-01-01

Planning activities over large landscapes poses a complex of challenges when trying to balance the implementation of a conservation strategy while still allowing for a variety of consumptive and nonconsumptive uses. We examine a case in southeast Alaska to illustrate the breadth of these challenges and an approach to developing a science-based resource plan. Not only...

Primary care workforce development in Europe.

NARCIS (Netherlands)

Groenewegen, P.; Heinemann, S.; Gress, S.; Schäfer, W.

2014-01-01

Background: There is a large variation in the organization of primary care in Europe. In some health care systems, primary care is the gatekeeper to more specialized care, whilst in others patients have the choice between a wide range of providers. Primary care has increasingly become teamwork.

Accuracy of SIAscopy for pigmented skin lesions encountered in primary care: development and validation of a new diagnostic algorithm.

Science.gov (United States)

Emery, Jon D; Hunter, Judith; Hall, Per N; Watson, Anthony J; Moncrieff, Marc; Walter, Fiona M

2010-09-25

Diagnosing pigmented skin lesions in general practice is challenging. SIAscopy has been shown to increase diagnostic accuracy for melanoma in referred populations. We aimed to develop and validate a scoring system for SIAscopic diagnosis of pigmented lesions in primary care. This study was conducted in two consecutive settings in the UK and Australia, and occurred in three stages: 1) Development of the primary care scoring algorithm (PCSA) on a sub-set of lesions from the UK sample; 2) Validation of the PCSA on a different sub-set of lesions from the same UK sample; 3) Validation of the PCSA on a new set of lesions from an Australian primary care population. Patients presenting with a pigmented lesion were recruited from 6 general practices in the UK and 2 primary care skin cancer clinics in Australia. The following data were obtained for each lesion: clinical history; SIAscan; digital photograph; and digital dermoscopy. SIAscans were interpreted by an expert and validated against histopathology where possible, or expert clinical review of all available data for each lesion. A total of 858 patients with 1,211 lesions were recruited. Most lesions were benign naevi (64.8%) or seborrhoeic keratoses (22.1%); 1.2% were melanoma. The original SIAscopic diagnostic algorithm did not perform well because of the higher prevalence of seborrhoeic keratoses and haemangiomas seen in primary care. A primary care scoring algorithm (PCSA) was developed to account for this. In the UK sample the PCSA had the following characteristics for the diagnosis of 'suspicious': sensitivity 0.50 (0.18-0.81); specificity 0.84 (0.78-0.88); PPV 0.09 (0.03-0.22); NPV 0.98 (0.95-0.99). In the Australian sample the PCSA had the following characteristics for the diagnosis of 'suspicious': sensitivity 0.44 (0.32-0.58); specificity 0.95 (0.93-0.97); PPV 0.52 (0.38-0.66); NPV 0.95 (0.92-0.96). In an analysis of lesions for which histological diagnosis was available (n = 111), the PCSA had a significantly

Rotary endodontics in primary teeth – A review

Science.gov (United States)

George, Sageena; Anandaraj, S.; Issac, Jyoti S.; John, Sheen A.; Harris, Anoop

2015-01-01

Endodontic treatment in primary teeth can be challenging and time consuming, especially during canal preparation, which is considered one of the most important steps in root canal therapy. The conventional instrumentation technique for primary teeth remains the “gold-standard” over hand instrumentation, which makes procedures much more time consuming and adversely affects both clinicians and patients. Recently nickel–titanium (Ni–Ti) rotary files have been developed for use in pediatric endodontics. Using rotary instruments for primary tooth pulpectomies is cost effective and results in fills that are consistently uniform and predictable. This article reviews the use of nickel–titanium rotary files as root canal instrumentation in primary teeth. The pulpectomy technique is described here according to different authors and the advantages and disadvantages of using rotary files are discussed. PMID:26792964

Rotary endodontics in primary teeth – A review

Directory of Open Access Journals (Sweden)

Sageena George

2016-01-01

Full Text Available Endodontic treatment in primary teeth can be challenging and time consuming, especially during canal preparation, which is considered one of the most important steps in root canal therapy. The conventional instrumentation technique for primary teeth remains the “gold-standard” over hand instrumentation, which makes procedures much more time consuming and adversely affects both clinicians and patients. Recently nickel–titanium (Ni–Ti rotary files have been developed for use in pediatric endodontics. Using rotary instruments for primary tooth pulpectomies is cost effective and results in fills that are consistently uniform and predictable. This article reviews the use of nickel–titanium rotary files as root canal instrumentation in primary teeth. The pulpectomy technique is described here according to different authors and the advantages and disadvantages of using rotary files are discussed.

Developing a study orientation questionnaire in Mathematics for primary school students

OpenAIRE

Van Der Walt, Martha

2009-01-01

The Study Orientation Questionnaire in Mathematics (Primary) is being developed as a diagnostic measure for South African teachers and counsellors to help primary school students improve their orientation towards the study of mathematics. In this study, participants were primary school students in the North-West Province of South Africa. During the standardisation in 2007, 1,013 students (538 boys: M age = 12.61; SD = 1.53; 555 girls: M age = 11.98; SD = 1.35; 10 missing values) were assessed...

Challenges and status of multi-unit PSA development in Canada

International Nuclear Information System (INIS)

Yalaoui, Smain

2015-01-01

Firstly, this paper discusses the issues and challenges related to the development of a Multi-Unit PSA (MU-PSA) and the general recommendations and conclusions from the MU-PSA Workshop organized by the CNSC in Ottawa, November 2014. This includes a discussion regarding the issue related to the methodological challenges in performing MU-PSA, the site-based risk metrics to be adopted, and the issue of risk aggregation across all hazards and all units. The paper also addresses the challenges for establishing site-based safety goals as the current safety goals were established on a per-unit basis. CNSC Staff efforts, both at the national and international level, on developing whole-site safety goals and guidance on MU-PSA and risk aggregation methodologies will also be discussed. Finally, the paper will provide a summary of the industry effort and road map for completing the pilot Whole-site PSA project for the Pickering Nuclear Generating Station, as requested by the Commission following to the public hearing for licence renewal in February 20 and May 29-31, 2013. (author)

Audit of antenatal services in primary healthcare centres in Jos ...

African Journals Online (AJOL)

Introduction: Maternal mortality remains a big challenge in developing countries including Nigeria where the figures are amongst the highest in the world. The Nigerian government's response in providing primary healthcare centres (PHCs) in all local government areas is commendable but access to quality antenatal care is ...

Underestimating the Toxicological Challenges Associated with the Use of Herbal Medicinal Products in Developing Countries

Directory of Open Access Journals (Sweden)

Vidushi S. Neergheen-Bhujun

2013-01-01

Full Text Available Various reports suggest a high contemporaneous prevalence of herb-drug use in both developed and developing countries. The World Health Organisation indicates that 80% of the Asian and African populations rely on traditional medicine as the primary method for their health care needs. Since time immemorial and despite the beneficial and traditional roles of herbs in different communities, the toxicity and herb-drug interactions that emanate from this practice have led to severe adverse effects and fatalities. As a result of the perception that herbal medicinal products have low risk, consumers usually disregard any association between their use and any adverse reactions hence leading to underreporting of adverse reactions. This is particularly common in developing countries and has led to a paucity of scientific data regarding the toxicity and interactions of locally used traditional herbal medicine. Other factors like general lack of compositional and toxicological information of herbs and poor quality of adverse reaction case reports present hurdles which are highly underestimated by the population in the developing world. This review paper addresses these toxicological challenges and calls for natural health product regulations as well as for protocols and guidance documents on safety and toxicity testing of herbal medicinal products.

Underestimating the toxicological challenges associated with the use of herbal medicinal products in developing countries.

Science.gov (United States)

Neergheen-Bhujun, Vidushi S

2013-01-01

Various reports suggest a high contemporaneous prevalence of herb-drug use in both developed and developing countries. The World Health Organisation indicates that 80% of the Asian and African populations rely on traditional medicine as the primary method for their health care needs. Since time immemorial and despite the beneficial and traditional roles of herbs in different communities, the toxicity and herb-drug interactions that emanate from this practice have led to severe adverse effects and fatalities. As a result of the perception that herbal medicinal products have low risk, consumers usually disregard any association between their use and any adverse reactions hence leading to underreporting of adverse reactions. This is particularly common in developing countries and has led to a paucity of scientific data regarding the toxicity and interactions of locally used traditional herbal medicine. Other factors like general lack of compositional and toxicological information of herbs and poor quality of adverse reaction case reports present hurdles which are highly underestimated by the population in the developing world. This review paper addresses these toxicological challenges and calls for natural health product regulations as well as for protocols and guidance documents on safety and toxicity testing of herbal medicinal products.

WANO. Development, programs, challenges

International Nuclear Information System (INIS)

Haferburg, Manfred

2011-01-01

In the wake of the accident at the Soviet RBMK reactor unit 4 in Chernobyl the nuclear industry founded the World Association of Nuclear Operators (WANO). To this day, the purpose of the organization has been to enhance worldwide cooperation of nuclear industry and, in this way, strengthen the safety and availability of nuclear power plants. Following some first steps after 1986, the charter of the organization was signed at the WANO constituent assembly in Moscow on May 15 and 16, 1989. The member companies thus committed themselves to support WANO's mission. WANO was established for these purposes: ''The mission of WANO is to maximize the safety and reliability of nuclear power plants worldwide by working together to assess, benchmark and improve performance through mutual support, exchange of information, and emulation of best practices.'' The WANO programs developed speedily thereafter. The focus was on peer reviews. In 2000, the first interim objective had been reached: Fifty percent of all member nuclear power plants had undergone peer reviews. In addition, plant-related peer reviews were extended throughout all operator organizations, and corporate peer reviews were developed. The other WANO programs as well, i.e. exchanges of experience, technical support, and performance indicators, exerted more and more influence on industry. Peer reviews covered entire operator organizations, and corporate peer reviews were developed. The worldwide paradigm shift in evaluating the use of nuclear power, and the associated construction programs for new nuclear power plants already in their implementation phase, assigned a new quality to the work of WANO. The organization is preparing a long-term strategy in the face of the challenges to be expected. The ultimate objective of these efforts is to support member organizations from the first preparations of a nuclear power plant project to the end of commercial operation. (orig.)

Reconstituting development of pancreatic intraepithelial neoplasia from primary human pancreas duct cells

OpenAIRE

Lee, Jonghyeob; Snyder, Emily R.; Liu, Yinghua; Gu, Xueying; Wang, Jing; Flowers, Brittany M.; Kim, Yoo Jung; Park, Sangbin; Szot, Gregory L.; Hruban, Ralph H.; Longacre, Teri A.; Kim, Seung K.

2017-01-01

Development of systems that reconstitute hallmark features of human pancreatic intraepithelial neoplasia (PanINs), the precursor to pancreatic ductal adenocarcinoma, could generate new strategies for early diagnosis and intervention. However, human cell-based PanIN models with defined mutations are unavailable. Here, we report that genetic modification of primary human pancreatic cells leads to development of lesions resembling native human PanINs. Primary human pancreas duct cells harbouring...

Developing primary health care and public health competencies in ...

African Journals Online (AJOL)

Stephen E Knight

community-based programme within the undergraduate medical curriculum, which aims to develop primary ... educational imperatives, namely improving medical students' ... Selectives is an innovative longitudinal, ... assessments of students in the Selectives module is the collective .... health and well-being of individuals,.

Challenges in the development of therapeutics for narcolepsy.

Science.gov (United States)

Black, Sarah Wurts; Yamanaka, Akihiro; Kilduff, Thomas S

2017-05-01

Narcolepsy is a neurological disorder that afflicts 1 in 2000 individuals and is characterized by excessive daytime sleepiness and cataplexy-a sudden loss of muscle tone triggered by positive emotions. Features of narcolepsy include dysregulation of arousal state boundaries as well as autonomic and metabolic disturbances. Disruption of neurotransmission through the hypocretin/orexin (Hcrt) system, usually by degeneration of the HCRT-producing neurons in the posterior hypothalamus, results in narcolepsy. The cause of Hcrt neurodegeneration is unknown but thought to be related to autoimmune processes. Current treatments for narcolepsy are symptomatic, including wake-promoting therapeutics that increase presynaptic dopamine release and anticataplectic agents that activate monoaminergic neurotransmission. Sodium oxybate is the only medication approved by the US Food and Drug Administration that alleviates both sleep/wake disturbances and cataplexy. Development of therapeutics for narcolepsy has been challenged by historical misunderstanding of the disease, its many disparate symptoms and, until recently, its unknown etiology. Animal models have been essential to elucidating the neuropathology underlying narcolepsy. These models have also aided understanding the neurobiology of the Hcrt system, mechanisms of cataplexy, and the pharmacology of narcolepsy medications. Transgenic rodent models will be critical in the development of novel therapeutics for the treatment of narcolepsy, particularly efforts directed to overcome challenges in the development of hypocretin replacement therapy. Copyright © 2015 Elsevier Ltd. All rights reserved.

Knowledge of primary health care and career choice at primary health care settings among final year medical students - challenges to human resources for health in Vietnam.

Science.gov (United States)

Giang, Kim Bao; Minh, Hoang Van; Hien, Nguyen Van; Ngoc, Nguyen Minh; Hinh, Nguyen Duc

2015-01-01

There is a shortage of medical doctors in primary health care (PHC) settings in Vietnam. Evidence about the knowledge medical students have about PHC and their career decision-making is important for making policy in human resources for health. The objective of this study was to analyse knowledge and attitudes about PHC among medical students in their final year and their choice to work in PHC after graduation. A cross-sectional study was conducted among 400 final year general medical students from Hanoi Medical University. Self-administered interviews were conducted. Key variables were knowledge, awareness of the importance of PHC and PHC career choices. Descriptive and analytic statistics were performed. Students had essential knowledge of the concept and elements of PHC and were well aware of its importance. However, only one-third to one half of them valued PHC with regard to their professional development or management opportunities. Less than 1% of students would work at commune or district health facilities after graduation. This study evidences challenges related to increasing the number of medical doctors working in PHC settings. Immediate and effective interventions are needed to make PHC settings more attractive and to encourage medical graduates to start and continue a career in PHC.

Primary health care management challenges for childhood atopic ...

African Journals Online (AJOL)

Kaarina Frieda Meintjes

primary health care (PHC) management of their children's atopic eczema in a Gauteng district. A qualitative, explorative, descriptive, contextual embedded single case study design ... direct observation until saturation occurred; analysed according to Tesch's ..... needed, it was provided by the researcher as part of the pro-.

Completion of a Full Course of Primary Schooling among All Children Everywhere by 2015: A Case of Sub-Saharan Africa

Science.gov (United States)

Wamala, Robert

2013-01-01

Achieving the United Nations Millennium Development Goals (MDGs) remains a major challenge, particularly in developing countries. Specifically, achieving the target of completing a full course of primary schooling among all children, which is goal two, is a major challenge for Sub-Saharan Africa. Though literature consensually suggests that the…

Post engineered nanomaterials lifespan: nanowastes classification, legislative development/implementation challenges, and proactive approaches

CSIR Research Space (South Africa)

Musee, N

2012-05-01

Full Text Available -1 NANOLCA Symposium, "Safety issues and regulatory challenges of nanomaterials", San Sebastian, Spain, 3-4 May 2012 Post engineered nanomaterials lifespan: nanowastes classification, legislative development/implementation challenges, and proactive...

Ethical challenges in developing drugs for psychiatric disorders.

Science.gov (United States)

Carrier, Felix; Banayan, David; Boley, Randy; Karnik, Niranjan

2017-05-01

As the classification of mental disorders advances towards a disease model as promoted by the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC), there is hope that a more thorough neurobiological understanding of mental illness may allow clinicians and researchers to determine treatment efficacy with less diagnostic variability. This paradigm shift has presented a variety of ethical issues to be considered in the development of psychiatric drugs. These challenges are not limited to informed consent practices, industry funding, and placebo use. The consideration for alternative research models and quality of research design also present ethical challenges in the development of psychiatric drugs. The imperatives to create valid and sound research that justify the human time, cost, risk and use of limited resources must also be considered. Clinical innovation, and consideration for special populations are also important aspects to take into account. Based on the breadth of these ethical concerns, it is particularly important that scientific questions regarding the development of psychiatric drugs be answered collaboratively by a variety of stakeholders. As the field expands, new ethical considerations will be raised with increased focus on genetic markers, personalized medicine, patient-centered outcomes research, and tension over funding. We suggest that innovation in trial design is necessary to better reflect practices in clinical settings and that there must be an emphasized focus on expanding the transparency of consent processes, regard for suicidality, and care in working with special populations to support the goal of developing sound psychiatric drug therapies. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Assessing Zika virus replication and the development of Zika-specific antibodies after a mid-gestation viral challenge in guinea pigs.

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Craig J Bierle

Full Text Available Primary Zika virus (ZIKV infections that occur during pregnancy can cause spontaneous abortion and profoundly disrupt fetal development. While the full range of developmental abnormalities associated with congenital Zika syndrome is not yet known, severe cases of the syndrome can present with microcephaly, extensive neurologic and ocular damage, and pronounced joint malformations. Animal models that accurately recapitulate congenital Zika syndrome are urgently needed for vaccine development and for the study of ZIKV pathogenesis. As guinea pigs have successfully been used to model transplacental infections by cytomegalovirus, syphilis, and Listeria monocytogenes, we sought to test whether ZIKV could productively infect guinea pigs and whether viral transmission with attendant fetal pathology would occur after a mid-gestation viral challenge. We found that guinea pig cells supported ZIKV replication in vitro. Experimental infection of non-pregnant animals did not result in overt disease but low-level, detectable viremia was observed. When pregnant guinea pigs were challenged with ZIKV at between 18 and 21 days gestational age, ZIKV was not detected in maternal or pup blood, plasma, or tissues and no significant differences in maternal weight gain or pup size were observed following challenge. Nonetheless, a robust antibody response against ZIKV was detected in both the pups and dams. These results suggest that, while guinea pigs can model aspects of the immune response to ZIKV infection during pregnancy, naturally circulating ZIKV strains are not pathogenic during the pregnancy of immunocompetent guinea pigs and do not interfere with normal pup development.

Solid waste management challenges for cities in developing countries

NARCIS (Netherlands)

Abarca Guerrero, L.; Maas, G.J.; Hogland, W

2013-01-01

Solid waste management is a challenge for the cities’ authorities in developing countries mainly due to the increasing generation of waste, the burden posed on the municipal budget as a result of the high costs associated to its management, the lack of understanding over a diversity of factors that

Towards Sustainable ASEAN Port Development: Challenges and Opportunities for Vietnamese Ports

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Saeyeon Roh

2016-06-01

Full Text Available Sustainability agendas are challenging port authorities around the world to find ways of operating and managing their ports efficiently and effectively in terms of economic, social, as well as environmental development. In this respect, governments in ASEAN countries have been implementing various green activities seeking to reduce the environmental impact of shipping and related activities. In this connection, most studies in the existing literature mainly focus on the environmental aspects of sustainable development and have not clearly explained what sustainable port development exactly entails. Furthermore, most of these studies emphasized on the impact of port development and overlooked what factors influence sustainable port development. To address these gaps, this research aim to explore the main factors shaping sustainable port development. This was conducted through a comprehensive review of related literature as well as confirmatory in-depth interviews with port authorities. As a result, findings from this research would help identify key elements of sustainable port development from port authorities’ perspective. The challenges, opportunities and managerial implications for Vietnamese ports are also discussed accordingly.

Challenges in the Implementation of Green Home Development in Malaysia: Perspective of Developers

Science.gov (United States)

Nordin, Rumaizah Mohd; Halim, Ahmad Hafizi Abd; Yunus, Julitta

2017-12-01

The construction industry is the main contributor to Malaysian economic growth. One of the main sectors to be highlighted by the Government is housing sector. The population in Malaysia is increasing year by year, thus the demand for houses also rises significantly. However, the fulfilment of basic needs for people normally gives the adverse impacts to the environment. Green home concept is introduced with a purpose to create an acceptable standard of living as well as to preserve nature from destruction, whilst to promote efficiency of energy, water and other natural resources. The study aims to identify current level of awareness and understanding regarding the Green Home concept, together with identifying the challenges that contribute to lack of initiatives in implementation of green home development. This study utilizes the qualitative methodology utilising interviews with housing developers operating in Klang Valley. 20 respondents were interviewed with a semi-structured interview. This study found that level of awareness and understanding on green home concept among construction players and public is low to moderate level. However, it shows improvement in terms of its implementation with all respondents agreed that cost factor is greatest challenge to its implementation. Other challenges identified from the study are low awareness and understanding among construction players and public, low demand for green home, and lack of Government enforcement and initiatives. The study is eventually intended to enhance and improve the sustainable practice in Malaysian’s construction industry.

Primary intestinal lymphangiectasia in adults - diagnostic and therapeutic challenge

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Jocić Tatiana

2018-01-01

Full Text Available Introduction. Primary intestinal lymphangiectasia is a rare disorder, characterized by abnormal dilation of intestinal lymphatic vessels and extensive enteric loss of lymph rich in plasma proteins, lymphocytes and chylomicrons. The main characteristics of the disease are hypoalbuminemia, hypogammaglobulinemia, lymphocytopenia, and more rarely, the deficit of liposoluble vitamins and anemia. Except for primary, there are secondary lymphangiectasia, associated with celiac disease, malignant, infective and inflammatory diseases of the small intestine, fibrosis, liver and cardiovascular diseases. Case report. A male, 33 years of age, presented for his medical examination suffering from diarrhea and edema. The diagnosis was established upon the histological examination of a small intestine biopsy during double balloon enteroscopy, which revealed changes only in one segment of the intestine examined. Such a finding was later confirmed by the video endoscopy capsule. Conclusion. The diagnosis of intestinal lymphangiectasia is usually established before the age of 3, but it can also be diagnosed in adults. The diagnosis is based on the histological analysis of the intestinal mucosa biopsy, obtained by endoscopic procedures. The diagnosis of primary intestinal lymphangiectasia is also made upon the exclusion of secondary causes.

Waste to energy opportunities and challenges for developing and transition economies

CERN Document Server

2012-01-01

Solid waste management is currently a major issue worldwide with numerous areas reaching critical levels. Many developing countries and countries in transition still miss basic waste management  infrastructure and awareness. It is here that many of the solid waste management problems and challenges are currently being faced. As such, waste-to-energy (WTE) consists of a proven and continuously developing spectrum and range of technologies in a number of (mostly) developed countries. However, it’s integration in developing countries and systems in transition is often faced with scepticism and a complex set of barriers which are quite unique and differ greatly from those where WTE has been validated and applied over the years. Waste-to-Energy: Opportunities and Challenges for Developing and Transition Economies will address this issue both theoretically and using concrete examples, including: ·         contributions from numerous scholars and practitioners in the field, ·         useful less...

Challenges associated with knowledge sharing in international product development teams

DEFF Research Database (Denmark)

Sonne, Anne-Mette; Harmsen, Hanne

on product development teams, knowledge sharing, and international product development management to form a conceptual framework of factors that influence knowledge sharing in international teams. Four in-depth case studies are used to explore and expand the understanding of the challenges associated...... with international product development teams. Results indicate that international product development might not be as international as would be expected and that even if many of the characteristics and problems associated with international product development in the literature are found, there are also a number...

Exosomes Enter Vaccine Development: Strategies Meeting Global Challenges of Emerging Infections.

Science.gov (United States)

Jungbauer, Alois

2018-04-01

New approaches for vaccination must be developed in order to meet the grand challenges for emerging infectious diseases. Exosomes now enter vaccine development and these are strategies are meeting these global challenges, as demonstrated by Anticoli et al., in this issue of Biotechnology Journal. Using exosome vaccines has been now been demonstrated in vivo for several viruses such as Ebola Virus VP24, VP40, and NP, Influenza Virus NP, Crimean-Congo Hemorrhagic Fever NP, West Nile Virus NS3, and Hepatitis C Virus NS3. Now this technology must be tested in clinics. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Development and exemplification of a model for Teacher Assessment in Primary Science

Science.gov (United States)

Davies, D. J.; Earle, S.; McMahon, K.; Howe, A.; Collier, C.

2017-09-01

The Teacher Assessment in Primary Science project is funded by the Primary Science Teaching Trust and based at Bath Spa University. The study aims to develop a whole-school model of valid, reliable and manageable teacher assessment to inform practice and make a positive impact on primary-aged children's learning in science. The model is based on a data-flow 'pyramid' (analogous to the flow of energy through an ecosystem), whereby the rich formative assessment evidence gathered in the classroom is summarised for monitoring, reporting and evaluation purposes [Nuffield Foundation. (2012). Developing policy, principles and practice in primary school science assessment. London: Nuffield Foundation]. Using a design-based research (DBR) methodology, the authors worked in collaboration with teachers from project schools and other expert groups to refine, elaborate, validate and operationalise the data-flow 'pyramid' model, resulting in the development of a whole-school self-evaluation tool. In this paper, we argue that a DBR approach to theory-building and school improvement drawing upon teacher expertise has led to the identification, adaptation and successful scaling up of a promising approach to school self-evaluation in relation to assessment in science.

Hypertension in Developing Countries: A Major Challenge for the Future.

Science.gov (United States)

Mohsen Ibrahim, M

2018-05-01

Outline recent epidemiologic data regarding hypertension in developing countries, distinguish differences from developed countries, and identify challenges in management and future perspectives. Increased sugar intake, air and noise pollution, and low birth weight are emerging hypertension risk factors. The major challenges in management are difficulties in accurate diagnosis of hypertension and adequate blood pressure control. In contrast to developed countries, hypertension prevalence rates are on the rise in developing countries with no improvement in awareness or control rates. The increasing burden of hypertension is largely attributable to behavioral factors, urbanization, unhealthy diet, obesity, social stress, and inactivity. Health authorities, medical societies, and drug industry can collaborate to improve hypertension control through education programs, public awareness campaigns, legislation to limit salt intake, encourage generic drugs, development and dissemination of national guidelines, and involving nurses and pharmacists in hypertension management. More epidemiologic data are needed in the future to identify reasons behind increased prevalence and poor blood pressure control and examine trends in prevalence, awareness, treatment, and control. National programs for better hypertension control based on local culture, economic characteristics, and available resources in the population are needed. The role of new tools for hypertension management should be tested in developing world.

Challenges to the development of complex virtual reality surgical simulations.

Science.gov (United States)

Seymour, N E; Røtnes, J S

2006-11-01

Virtual reality simulation in surgical training has become more widely used and intensely investigated in an effort to develop safer, more efficient, measurable training processes. The development of virtual reality simulation of surgical procedures has begun, but well-described technical obstacles must be overcome to permit varied training in a clinically realistic computer-generated environment. These challenges include development of realistic surgical interfaces and physical objects within the computer-generated environment, modeling of realistic interactions between objects, rendering of the surgical field, and development of signal processing for complex events associated with surgery. Of these, the realistic modeling of tissue objects that are fully responsive to surgical manipulations is the most challenging. Threats to early success include relatively limited resources for development and procurement, as well as smaller potential for return on investment than in other simulation industries that face similar problems. Despite these difficulties, steady progress continues to be made in these areas. If executed properly, virtual reality offers inherent advantages over other training systems in creating a realistic surgical environment and facilitating measurement of surgeon performance. Once developed, complex new virtual reality training devices must be validated for their usefulness in formative training and assessment of skill to be established.

Human Capital Development in Education: Challenges and Policy Options

Science.gov (United States)

Best, Jane R.

2010-01-01

Increasing student achievement and narrowing the achievement gap are challenges that states and districts continue to confront as they strive to develop talent that will contribute to our nation's economy. Some strategies to produce authentic improvement in learning are not entirely a mystery. A preponderance of research in recent years provides…

Nursing challenges for universal health coverage: a systematic review

Directory of Open Access Journals (Sweden)

Mariana Cabral Schveitzer

2016-01-01

Full Text Available Objectives to identify nursing challenges for universal health coverage, based on the findings of a systematic review focused on the health workforce' understanding of the role of humanization practices in Primary Health Care. Method systematic review and meta-synthesis, from the following information sources: PubMed, CINAHL, Scielo, Web of Science, PsycInfo, SCOPUS, DEDALUS and Proquest, using the keyword Primary Health Care associated, separately, with the following keywords: humanization of assistance, holistic care/health, patient centred care, user embracement, personal autonomy, holism, attitude of health personnel. Results thirty studies between 1999-2011. Primary Health Care work processes are complex and present difficulties for conducting integrative care, especially for nursing, but humanizing practices have showed an important role towards the development of positive work environments, quality of care and people-centered care by promoting access and universal health coverage. Conclusions nursing challenges for universal health coverage are related to education and training, to better working conditions and clear definition of nursing role in primary health care. It is necessary to overcome difficulties such as fragmented concepts of health and care and invest in multidisciplinary teamwork, community empowerment, professional-patient bond, user embracement, soft technologies, to promote quality of life, holistic care and universal health coverage.

Interprofessional practice in primary care: development of a tailored process model

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Stans SEA

2013-04-01

Full Text Available Steffy EA Stans, JG Anita Stevens, Anna JHM Beurskens Research Center of Autonomy and Participation for Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands Purpose: This study investigated the improvement of interprofessional practice in primary care by performing the first three steps of the implementation model described by Grol et al. This article describes the targets for improvement in a setting for children with complex care needs (step 1, the identification of barriers and facilitators influencing interprofessional practice (step 2, and the development of a tailored interprofessional process model (step 3. Methods: In step 2, thirteen qualitative semistructured interviews were held with several stakeholders, including parents of children, an occupational therapist, a speech and language therapist, a physical therapist, the manager of the team, two general practitioners, a psychologist, and a primary school teacher. The data were analyzed using directed content analysis and using the domains of the Chronic Care Model as a framework. In step 3, a project group was formed to develop helpful strategies, including the development of an interprofessional process through process mapping. Results: In step 2, it was found that the most important barriers to implementing interprofessional practice related to the lack of structure in the care process. A process model for interprofessional primary care was developed for the target group. Conclusion: The lack of a shared view of what is involved in the process of interprofessional practice was the most important barrier to its successful implementation. It is suggested that the tailored process developed, supported with the appropriate tools, may provide both professional staff and their clients, in this setting but also in other areas of primary care, with insight to the care process and a clear representation of "who should do what, when, and how." Keywords

The Use of Kanban to Alleviate Collaboration and Communication Challenges of Global Software Development

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Maureen Tanner

2017-05-01

Full Text Available Aim/Purpose: This paper aims to describe how various Kanban elements can help alleviate two prominent types of challenges, communication and collaboration in Global Software Development (GSD. Background: Iterative and Lean development methodologies like Kanban have gained significance in the software development industry, both in the co-located and globally distributed contexts. However, little is known on how such methodologies can help mitigate various challenges in that occur in a globally distributed software development context. Methodology: The study was conducted using a single-case study based on a general inductive approach to analysis and theory development. Through the literature review, collaboration and communication challenges that GSD teams face were identified. Data collected through semi-structured interviews was then inductively analyzed to describe how the case-study teams employed various Kanban elements to mitigate communication and collaboration challenges they face during GSD. Findings: The study found that some Kanban elements, when properly employed, can help alleviate collaboration and communication challenges that occur within GSD teams. These relate to Inclusion Criteria, Reverse Items, Kanban Board, Policies, Avatars, and Backlog. Contribution: The paper contributes to knowledge by proposing two simple concept maps that detail the specific types of communication and collaboration challenges which can be alleviated by the aforementioned Kanban elements in GSD. Recommendations for Practitioners: This paper is relevant to GSD teams who are seeking ways to enhance their team collaboration and communication as these are the most important elements that contribute to GSD project success. It is recommended that relevant Kanban elements be used to that effect, depending on the challenges that they aim to alleviate. Future Research: Future research can investigate the same research questions (or similar ones using a

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

Science.gov (United States)

Shah, T

2005-01-01

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

GLOBAL CHALLENGES FOR SUSTAINABLE AGRICULTURE AND RURAL DEVELOPMENT IN SLOVAKIA

Directory of Open Access Journals (Sweden)

Magdalana Bartosova

2013-09-01

Full Text Available The paper is focused on the evaluation of economic, social and environmental challenges of sustainable agriculture. The selected indicators of the economic challenges of sustainable agriculture imply that agriculture in Slovakia is not in long term be able to ensure competitiveness in the European market, gross agricultural output is characterized by a faster decline in animal production than in crop production and the value of import of agri-food commodities is higher than the value of export. According to selected indicators of social challenges of sustainable agriculture the number of persons working in agriculture has decreasing tendency in last years. The evaluation of selected indicators of environmental challenges of sustainable agriculture implies that area of organic agriculture is the most widely applied sub-measure within the measure agri-environmental payments. For ensuring the balance of the three mentioned dimensions of sustainable agriculture is necessary to increase of local production and consumption of local products, to ensure the protection of nature and landscape, to ensure rural development and to increase the employment opportunities in countryside.

Administration of primary school in Nigeria: challenges ahead ...

African Journals Online (AJOL)

This paper discusses the administration of primary school in Nigeria. It traces the trend from previous years until the recent situation and highlights government's position and what it should be. It also suggests ways of improving on the present situation so that the future of the young ones will not be jeopardized. Nigerian ...

Human Resource Development in Mauritius: Context, Challenges and Opportunities

Science.gov (United States)

Garavan, Thomas N.; Neeliah, Harris; Auckloo, Raj; Ragaven, Raj

2016-01-01

Purpose: The purpose of this paper is to explore human resource development (HRD) in Mauritius and the challenges and opportunities faced by organisations in different sectors in adopting HRD practices. Findings: This special issue presents four papers that explore dimensions of HRD in public sector, small- and medium-sized enterprises (SMEs) and…

Limited resources of genome sequencing in developing countries: Challenges and solutions

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Mohamed Helmy

2016-06-01

Full Text Available The differences between countries in national income, growth, human development and many other factors are used to classify countries into developed and developing countries. There are several classification systems that use different sets of measures and criteria. The most common classifications are the United Nations (UN and the World Bank (WB systems. The UN classification system uses the UN Human Development Index (HDI, an indicator that uses statistic of life expectancy, education, and income per capita for countries' classification. While the WB system uses gross national income (GNI per capita that is calculated using the World Bank Atlas method. According to the UN and WB classification systems, there are 151 and 134 developing countries, respectively, with 89% overlap between the two systems. Developing countries have limited human development, and limited expenditure in education and research, among several other limitations. The biggest challenge facing genomic researchers and clinicians is limited resources. As a result, genomic tools, specifically genome sequencing technologies, which are rapidly becoming indispensable, are not widely available. In this report, we explore the current status of sequencing technologies in developing countries, describe the associated challenges and emphasize potential solutions.

Piagetian Cognitive Development and Primary Process Thinking in Children

Science.gov (United States)

Wulach, James S.

1977-01-01

Thirty-seven middle-class white children, ages 5-8, were tested on eight Piagetian tasks and the Rorschach test, and divided into preoperational, transitional, and concrete operational groups. Measures of primary process vs. secondary process thinking were found to be related to the Piagetian stages of development. (GDC)

Current challenges in autonomous vehicle development

Science.gov (United States)

Connelly, J.; Hong, W. S.; Mahoney, R. B., Jr.; Sparrow, D. A.

2006-05-01

The field of autonomous vehicles is a rapidly growing one, with significant interest from both government and industry sectors. Autonomous vehicles represent the intersection of artificial intelligence (AI) and robotics, combining decision-making with real-time control. Autonomous vehicles are desired for use in search and rescue, urban reconnaissance, mine detonation, supply convoys, and more. The general adage is to use robots for anything dull, dirty, dangerous or dumb. While a great deal of research has been done on autonomous systems, there are only a handful of fielded examples incorporating machine autonomy beyond the level of teleoperation, especially in outdoor/complex environments. In an attempt to assess and understand the current state of the art in autonomous vehicle development, a few areas where unsolved problems remain became clear. This paper outlines those areas and provides suggestions for the focus of science and technology research. The first step in evaluating the current state of autonomous vehicle development was to develop a definition of autonomy. A number of autonomy level classification systems were reviewed. The resulting working definitions and classification schemes used by the authors are summarized in the opening sections of the paper. The remainder of the report discusses current approaches and challenges in decision-making and real-time control for autonomous vehicles. Suggested research focus areas for near-, mid-, and long-term development are also presented.

CHALLENGES OF EMPOWERING PEOPLE WITH DISABILITIES IN NIGERIA FOR NATIONAL DEVELOPMENT

Directory of Open Access Journals (Sweden)

Johan ELEWEKE

2016-09-01

Full Text Available Introduction: This paper reviews issues affecting the empowerment of people with disabilities in Nigeria so they can be productive and contribute to the development of the nation. The questions of concern are: What is known about the extent people with disabilities are empowered to contribute to national development in Nigeria? What challenges do people with disabilities in Nigeria encounter in their attempt to contribute to national development? What are the implications of these challenges regarding strategies that could enhance the empowerment of people with disabilities to facilitate their contribution to national development? Method: This paper addresses these questions by reviewing available research on issues pertaining to (1 legislative mandates on provision of services to individuals with disabilities in the country, (2 funding for services by the government, (3 accessing education and related services, which can ensure that people with disabilities are able to develop their potential and be able to contribute to national development as workers, administrators or employers of labour. Findings: Available evidence indicates that people with disabilities in Nigeria encounter challenges in accessing essential services that could enhance their contribution to national development due to factors such as the absence of legislation protecting their rights to receive these services, inadequate funding of services, absence of effective inclusion programmes, and lack of facilities, personnel, and resources. Suggestions and conclusion: The author recommended some strategies that could produce better outcomes and enhance the opportunities for people with disabilities to be empowered so that they can contribute their quota to national development. These strategies include: enacting and implementing а national disability legislation, utilisation of community-based strategies in the provision of services, and increased advocacy activities by

African primary care research: Choosing a topic and developing a proposal

Directory of Open Access Journals (Sweden)

Bob Mash

2014-02-01

Full Text Available This is the first in a series of articles on primary care research in the African context. The aim of the series is to help build capacity for primary care research amongst the emerging departments of family medicine and primary care on the continent. Many of the departments are developing Masters of Medicine programmes in Family Medicine and their students will all be required to complete research studies as part of their degree. This series is being written with this audience in particular in mind – both the students who must conceptualise and implement a research project as well as their supervisors who must assist them.This article gives an overview of the African primary care context, followed by a typology of primary care research. The article then goes on to assist the reader with choosing a topic and defining their research question. Finally the article addresses the structure and contents of a  research proposal and the ethical issues that should be considered.

Developing a Study Orientation Questionnaire in Mathematics for primary school students.

Science.gov (United States)

Maree, Jacobus G; Van der Walt, Martha S; Ellis, Suria M

2009-04-01

The Study Orientation Questionnaire in Mathematics (Primary) is being developed as a diagnostic measure for South African teachers and counsellors to help primary school students improve their orientation towards the study of mathematics. In this study, participants were primary school students in the North-West Province of South Africa. During the standardisation in 2007, 1,013 students (538 boys: M age = 12.61; SD = 1.53; 555 girls: M age = 11.98; SD = 1.35; 10 missing values) were assessed. Factor analysis yielded three factors. Analysis also showed satisfactory reliability coefficients and item-factor correlations. Step-wise linear regression indicated that three factors (Mathematics anxiety, Study attitude in mathematics, and Study habits in mathematics) contributed significantly (R2 = .194) to predicting achievement in mathematics as measured by the Basic Mathematics Questionnaire (Primary).

Challenges Involved in the Development and Delivery of Abuse-deterrent Formulations of Opioid Analgesics.

Science.gov (United States)

Cohen, Joshua P; Mendoza, Mario; Roland, Carl

2018-02-01

This commentary examines the development, regulatory, and reimbursement challenges facing abuse-deterrent formulation (ADF) products. In January 2017, the Tufts Center for the Study of Drug Development convened a roundtable to explore clinical development, regulatory, and reimbursement challenges with respect to ADFs of opioid analgesics. Roundtable participants, who included a range of pharmaceutical industry and other experts, discussed multiple challenges. First, several key clinical development challenges were identified and discussed. These challenges pertain to prodrug development and development of deterrents against oral abuse. Second, experts suggested that more clarity is needed from regulatory authorities regarding standards for proving ADF labeling claims and for being rewarded with 3-year data exclusivity. Similarly, given the substantial burdens associated with the development of postapproval evidence generation, experts raised the need for a consistent regulatory policy related to postapproval evidence generation for all ADFs (branded and generic). Third, despite the public health benefits of certain ADF products, current coverage and access policies impede patient access. Payer justification for restrictive policies appears to be based more on budget impact considerations than cost-effectiveness. Fourth, there remains a need to further expand the evidence base regarding clinical and cost-effectiveness as well as abuse deterrence in a real-world setting for all ADF products. Clinical development challenges need to be overcome with respect to novel ADF technologies, such as prodrugs and deterrents against oral abuse. More clarity is needed from regulatory authorities on labeling claims and data exclusivity eligibility with respect to ADFs. Ensuring prescriber training and awareness of various options for treating pain, including ADF products, is an important step, as is educating payers about the public health benefits of ADFs in appropriate

A step towards development of aid for visually challenged

Indian Academy of Sciences (India)

The work done towards developing a visual aid to help visually challenged people is described in this paper. An ultrasonic device is used for measuring the distance to a nearby object and SIFT algorithm based approach is used for object recognition from the captured image. Features of the recognized object as well as the ...

Sustainable development: challenges and opportunities for the natural sciences (Invited)

Science.gov (United States)

Mutter, J. C.; Fishman, R.; Anttila-Hughes, J. K.; Hsiang, S. M.

2009-12-01

The challenges of sustainable development -- equitably improving global human welfare while ensuring that the environment is preserved for future generations - demand research at the nexus of the social and natural sciences. Massive and inevitable changes in climate, ecosystem functions, and human interaction with the environment will perturb societies throughout the world in different ways over the coming century. The changes faced by poor societies and their ability to cope differs markedly from those that face the richest. Yet in all regions the dynamic interaction of social and natural drivers will govern the prospects for human welfare and its improvement. Developing an understanding of these phenomena will require field research together with analytical and modeling capabilities that couple physical and social phenomena, allowing feedback between the two to manifest and permit forecasting over long time scales. Heterogeneous income and population growth further complicate this need through their consequences for food security, migration, resource allocation, and conflict. In this contribution, we identify some key concepts of sustainable development, open research questions and outline how scientific research might engage this emerging discipline. Using recent examples of interaction, we discuss the opportunities and challenges facing the further development of this dialogue.

Development of an allergy management support system in primary care

Directory of Open Access Journals (Sweden)

Flokstra - de Blok BMJ

2017-03-01

Full Text Available Bertine MJ Flokstra - de Blok,1,2 Thys van der Molen,1,2 Wianda A Christoffers,3 Janwillem WH Kocks,1,2 Richard L Oei,4 Joanne NG Oude Elberink,2,4 Emmy M Roerdink,5 Marie Louise Schuttelaar,3 Jantina L van der Velde,1,2 Thecla M Brakel,1,6 Anthony EJ Dubois2,5 1Department of General Practice, 2GRIAC Research Institute, 3Department of Dermatology, 4Department of Allergology, 5Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen, 6Teaching Unit, Department of Social Psychology, University of Groningen, Groningen, The Netherlands Background: Management of allergic patients in the population is becoming more difficult because of increases in both complexity and prevalence. Although general practitioners (GPs are expected to play an important role in the care of allergic patients, they often feel ill-equipped for this task. Therefore, the aim of this study was to develop an allergy management support system (AMSS for primary care. Methods: Through literature review, interviewing and testing in secondary and primary care patients, an allergy history questionnaire was constructed by allergists, dermatologists, GPs and researchers based on primary care and specialists’ allergy guidelines and their clinical knowledge. Patterns of AMSS questionnaire responses and specific immunoglobulin E (sIgE-test outcomes were used to identify diagnostic categories and develop corresponding management recommendations. Validity of the AMSS was investigated by comparing specialist (gold standard and AMSS diagnostic categories. Results: The two-page patient-completed AMSS questionnaire consists of 12 (mainly multiple choice questions on symptoms, triggers, severity and medication. Based on the AMSS questionnaires and sIgE-test outcome of 118 patients, approximately 150 diagnostic categories of allergic rhinitis, asthma, atopic dermatitis, anaphylaxis, food allergy, hymenoptera allergy and other

Interprofessional education for whom? --challenges and lessons learned from its implementation in developed countries and their application to developing countries: a systematic review.

Directory of Open Access Journals (Sweden)

Bruno F Sunguya

Full Text Available BACKGROUND: Evidence is available on the potential efficacy of interprofessional education (IPE to foster interprofessional cooperation, improve professional satisfaction, and improve patient care. While the intention of the World Health Organization (WHO is to implement IPE in all countries, evidence comes from developed countries about its efficiency, challenges, and barriers to planning and implementing IPE. We therefore conducted this review to examine challenges of implementing IPE to suggest possible pathways to overcome the anticipated challenges in developing countries. METHODS: We searched for literatures on IPE in PubMed/MEDLINE, CINAHL, PsycINFO, and ERIC databases. We examined challenges or barriers and initiatives to overcome them so as to suggest methods to solve the anticipated challenges in developing countries. We could not conduct a meta-analysis because of the qualitative nature of the research question and the data; instead we conducted a meta-narrative of evidence. RESULTS: A total of 40 out of 2,146 articles were eligible for analyses in the current review. Only two articles were available from developing countries. Despite the known benefits of IPE, a total of ten challenges or barriers were common based on the retrieved evidence. They included curriculum, leadership, resources, stereotypes and attitudes, variety of students, IPE concept, teaching, enthusiasm, professional jargons, and accreditation. Out of ten, three had already been reported in developing countries: IPE curriculum, resource limitations, and stereotypes. CONCLUSION: This study found ten important challenges on implementing IPE. They are curriculum, leadership, resources, stereotypes, students' diversity, IPE concept, teaching, enthusiasm, professional jargons, and accreditation. Although only three of them are already experienced in developing countries, the remaining seven are potentially important for developing countries, too. By knowing these

Interprofessional education for whom? --challenges and lessons learned from its implementation in developed countries and their application to developing countries: a systematic review.

Science.gov (United States)

Sunguya, Bruno F; Hinthong, Woranich; Jimba, Masamine; Yasuoka, Junko

2014-01-01

Evidence is available on the potential efficacy of interprofessional education (IPE) to foster interprofessional cooperation, improve professional satisfaction, and improve patient care. While the intention of the World Health Organization (WHO) is to implement IPE in all countries, evidence comes from developed countries about its efficiency, challenges, and barriers to planning and implementing IPE. We therefore conducted this review to examine challenges of implementing IPE to suggest possible pathways to overcome the anticipated challenges in developing countries. We searched for literatures on IPE in PubMed/MEDLINE, CINAHL, PsycINFO, and ERIC databases. We examined challenges or barriers and initiatives to overcome them so as to suggest methods to solve the anticipated challenges in developing countries. We could not conduct a meta-analysis because of the qualitative nature of the research question and the data; instead we conducted a meta-narrative of evidence. A total of 40 out of 2,146 articles were eligible for analyses in the current review. Only two articles were available from developing countries. Despite the known benefits of IPE, a total of ten challenges or barriers were common based on the retrieved evidence. They included curriculum, leadership, resources, stereotypes and attitudes, variety of students, IPE concept, teaching, enthusiasm, professional jargons, and accreditation. Out of ten, three had already been reported in developing countries: IPE curriculum, resource limitations, and stereotypes. This study found ten important challenges on implementing IPE. They are curriculum, leadership, resources, stereotypes, students' diversity, IPE concept, teaching, enthusiasm, professional jargons, and accreditation. Although only three of them are already experienced in developing countries, the remaining seven are potentially important for developing countries, too. By knowing these challenges and barriers in advance, those who implement IPE programs

Making Physics Matter in Primary Schools

Science.gov (United States)

Flaherty, Jackie; Cox, Wendy; Poole, Amanda; Watson, Jenny; Greygoose, Kirstin

2016-04-01

"Efforts to broaden students' aspirations, particularly in relation to STEM, need to begin in primary school." Kings College London "Aspires" Research Project 2013 From my outreach activity I have learnt that primary teachers could feel under pressure when faced with delivering the science curriculum. The teachers could be lacking confidence in their subject knowledge, lacking the equipment needed to deliver practical science or lacking enthusiasm for the subject. In addition, English and Mathematics were the subjects that were externally tested and reported to the authorities and so some teachers felt that time for science was being marginalised to ensure the best results in the externally assessed subjects. In my work with The Ogden Trust Primary Science team I have been involved in developing a range of strategies to address some of the issues outlined above. • CPD (Teacher Training) Programme We have provided free training to improve teachers knowledge and understanding of key physics concepts to GCSE standard and a practical workshop consisting of ten investigations, extension and challenge tasks. The teachers each receive a book of lesson plans and a resource box containing a class set of the equipment required. The four year programme covers Forces Light and Sound Electricity Earth & Space • "Phiz Labs" Funding from The Ogden Trust has allowed us to set up science laboratories within primary schools. The pupils have lab coats, goggles and access to a range of equipment that allows them to participate in more practical science activity and open-ended investigative work. My Phiz Lab is in the secondary school where I teach physics and practical workshops for primary pupils and teachers are held there on a regular basis. • Enrichment In order to enthuse and challenge the primary pupils a variety of enrichment activities take place. These include "Physics of Go-Karts" and "Particle Physics for Primary" workshops, competitions and regional Science Fairs

Poor understanding? Challenges to Global Development Education

Directory of Open Access Journals (Sweden)

John Buchanan

2018-03-01

Full Text Available As members of a global community, we cohabit a metaphorically shrinking physical environment, and are increasingly connected one to another, and to the world, by ties of culture, economics, politics, communication and the like. Education is an essential component in addressing inequalities and injustices concerning global rights and responsibilities. The increasing multicultural nature of societies locally, enhanced access to distal information, and the work of charitable organisations worldwide are some of the factors that have contributed to the interest in, and need for, understanding global development education. The project on which this paper reports sought answers to the question: to what extent and in what ways can a semester-long subject enhance and extend teacher education students’ understandings of and responses to global inequalities and global development aid? In the course of the project, a continuum model emerged, as follows: Indifference or ignorance ➝ pity and charity ➝ partnership and development among equals. In particular, this paper reports on some of the challenges and obstacles that need to be addressed in order to enhance pre-service teachers’ understandings of global development education. The study, conducted in Australia, has implications for global development education in other developed nations.

Knowledge management challenges in new business development : Case study observations

NARCIS (Netherlands)

Berends, Hans; Vanhaverbeke, Wim; Kirschbaum, Robert

2007-01-01

This paper's focus is on the knowledge management challenges that come along with technology-based new business development (NBD). NBD thrives upon the exploration of knowledge, under radical uncertainty. Furthermore, existing knowledge may both enable and constrain the radical innovation process.

Vocational Literacy in Mozambique: Historical Development, Current Challenges and Contradictions

Directory of Open Access Journals (Sweden)

Oleg Popov

2016-03-01

Full Text Available The study analyses the historical development of vocational literacy in basic education and Non-Formal Vocational Education (NFVE in Mozambique, as well as current challenges and contradictions. The theoretical lens of Cultural-Historical Activity Theory (CHAT is employed in the study. Methodologically the study was executed through an analysis of oral, printed and e-resources produced by the main stakeholders and also the reflective experiences of the authors in their extensive educational work in the country. The findings reveal poorly developed vocational literacy education in schools and non-formal settings in spite of recurrent political declarations about its importance. There is a strong dependence by formal and particularly NFVE sectors on the technical and financial support provided by international organisations. Vocational literacy courses are characterized by a lack of adequate equipment and poor practice. As a consequence, theoretical or elementary forms of vocational knowledge are dominant in the courses, resulting in the dissatisfaction of both learners and educators. Vocational literacy development proved to be a complex field that faces many challenges and ischaracterised by diverse internal contradictions.

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

Science.gov (United States)

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

1985-01-01

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

Strategies and challenges for safe injection practice in developing countries.

Science.gov (United States)

Gyawali, Sudesh; Rathore, Devendra Singh; Shankar, P Ravi; Kumar, Kc Vikash

2013-01-01

Injection is one of the important health care procedures used globally to administer drugs. Its unsafe use can transmit various blood borne pathogens. This article aims to review the history and status of injection practices, its importance, interventions and the challenges for safe injection practice in developing countries. The history of injections started with the discovery of syringe in the early nineteenth century. Safe injection practice in developed countries was initiated in the early twentieth century but has not received adequate attention in developing countries. The establishment of "Safe Injection Global Network (SIGN)" was an milestone towards safe injection practice globally. In developing countries, people perceive injection as a powerful healing tool and do not hesitate to pay more for injections. Unsafe disposal and reuse of contaminated syringe is common. Ensuring safe injection practice is one of the greatest challenges for healthcare system in developing countries. To address the problem, interventions with active involvement of a number of stakeholders is essential. A combination of educational, managerial and regulatory strategies is found to be effective and economically viable. Rational and safe use of injections can save many lives but unsafe practice threatens life. Safe injection practice is crucial in developing countries. Evidence based interventions, with honest commitment and participation from the service provider, recipient and community with aid of policy makers are required to ensure safe injection practice.

Challenges to creating primary care teams in a public health centre ...

African Journals Online (AJOL)

CNP) is essential to the provision of quality primary care in the South African context. The Worcester Community Health Centre (CHC) is situated in a large town and offers primary care to the rural Breede Valley Sub-District of the Western ...

Energy and sustainable development : challenges, risks and leeway

International Nuclear Information System (INIS)

Dessus, B.

2000-01-01

Sustainable development is a major challenge facing humanity in this new millennium. Demographers have predicted that it will take approximately 100 years for our planet to reach demographic maturity, implying there is only that amount of time to find solutions to sustainable development. Problems related to energy needs and environment are influenced by factors such as: (1) population increase, (2) required access to development and urbanization, and (3) continuation by the Northern countries to consume goods and services. We are also challenged by four major risk factors concerning energy: (1) risk of depletion of fossil resources such as coal, petroleum, natural gas, (2) global warming caused by greenhouse gases, (3) risk from the utilization of nuclear energy, and (4) risk of intense utilization of potential agricultural lands for energy production. In the past 50 years, we have relied too much on the production of energy, and this approach has not yielded a satisfactory solution. Two types of scenarios were proposed for 2050. The first type is based on development through an abundance of energy, where the risks are unavoidable. The only differences between each scenario in this category is the increase or decrease of one risk factor to the detriment of the others. The second type of scenario is based on development through the control of energy requirements. Six scenarios proposed by the International Institute of Applied Systems Analysis and National Scientific Research Centre were compared. In each scenario, the world was subdivided into 11 geographical regions and based on world populations of 8 billion in 2020, and 10 billion in 2050, as well as very similar economic growth predictions. Results indicated that the main differentiating factor was volume of energy rather than type of energy resource. Greenhouse gases increase, as do the amounts of nuclear wastes. It became clear that energy conservation measures have the potential to help us achieve

Evaluating impacts of development and conservation projects using sustainability indicators: Opportunities and challenges

Energy Technology Data Exchange (ETDEWEB)

Agol, Dorice, E-mail: d.agol@uea.a.c.uk [University of East Anglia, School of International Development, Norwich NR4 7TJ (United Kingdom); Latawiec, Agnieszka E., E-mail: a.latawiec@iis-rio.org [International Institute for Sustainability, Estrada Dona Castorina 124, 22460-320 Rio de Janeiro (Brazil); Opole University of Technology, Department of Production Engineering and Logistics, Luboszycka 5, 45-036 Opole (Poland); University of East Anglia, School of Environmental Sciences, Norwich NR4 7TJ (United Kingdom); Strassburg, Bernardo B.N., E-mail: b.strassburg@iis-rio.org [International Institute for Sustainability, Estrada Dona Castorina 124, 22460-320 Rio de Janeiro (Brazil); Department of Geography and the Environment, Pontificia Universidade Catolica, 22453-900 Rio de Janeiro (Brazil)

2014-09-15

There has been an increased interest in using sustainability indicators for evaluating the impacts of development and conservation projects. Past and recent experiences have shown that sustainability indicators can be powerful tools for measuring the outcomes of various interventions, when used appropriately and adequately. Currently, there is a range of methods for applying sustainability indicators for project impact evaluation at the environment–development interface. At the same time, a number of challenges persist which have implication for impact evaluation processes especially in developing countries. We highlight some key and recurrent challenges, using three cases from Kenya, Indonesia and Brazil. In this study, we have conducted a comparative analysis across multiple projects from the three countries, which aimed to conserve biodiversity and improve livelihoods. The assessments of these projects were designed to evaluate their positive, negative, short-term, long term, direct and indirect impacts. We have identified a set of commonly used sustainability indicators to evaluate the projects and have discussed opportunities and challenges associated with their application. Our analysis shows that impact evaluation processes present good opportunities for applying sustainability indicators. On the other hand, we find that project proponents (e.g. managers, evaluators, donors/funders) face challenges with establishing full impacts of interventions and that these are rooted in monitoring and evaluation processes, lack of evidence-based impacts, difficulties of measuring certain outcomes and concerns over scale of a range of impacts. We outline key lessons learnt from the multiple cases and propose ways to overcome common problems. Results from our analysis demonstrate practical experiences of applying sustainability indicators in developing countries context where there are different prevailing socio-economic, cultural and environmental conditions. The

Evaluating impacts of development and conservation projects using sustainability indicators: Opportunities and challenges

International Nuclear Information System (INIS)

Agol, Dorice; Latawiec, Agnieszka E.; Strassburg, Bernardo B.N.

2014-01-01

There has been an increased interest in using sustainability indicators for evaluating the impacts of development and conservation projects. Past and recent experiences have shown that sustainability indicators can be powerful tools for measuring the outcomes of various interventions, when used appropriately and adequately. Currently, there is a range of methods for applying sustainability indicators for project impact evaluation at the environment–development interface. At the same time, a number of challenges persist which have implication for impact evaluation processes especially in developing countries. We highlight some key and recurrent challenges, using three cases from Kenya, Indonesia and Brazil. In this study, we have conducted a comparative analysis across multiple projects from the three countries, which aimed to conserve biodiversity and improve livelihoods. The assessments of these projects were designed to evaluate their positive, negative, short-term, long term, direct and indirect impacts. We have identified a set of commonly used sustainability indicators to evaluate the projects and have discussed opportunities and challenges associated with their application. Our analysis shows that impact evaluation processes present good opportunities for applying sustainability indicators. On the other hand, we find that project proponents (e.g. managers, evaluators, donors/funders) face challenges with establishing full impacts of interventions and that these are rooted in monitoring and evaluation processes, lack of evidence-based impacts, difficulties of measuring certain outcomes and concerns over scale of a range of impacts. We outline key lessons learnt from the multiple cases and propose ways to overcome common problems. Results from our analysis demonstrate practical experiences of applying sustainability indicators in developing countries context where there are different prevailing socio-economic, cultural and environmental conditions. The

Challenges facing primary school educators of English Second (or ...

African Journals Online (AJOL)

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 ...

Public health challenges in sun protection.

Science.gov (United States)

Eide, Melody J; Weinstock, Martin A

2006-01-01

Sunscreens are a popular choice for protection from ultraviolet radiation, and hence, important components in the public health campaign to reduce the burden of skin cancer. Public health messages in skin cancer prevention have been used effectively in educational campaigns. The benefits of sunscreen extend beyond skin cancer prevention into other aspects of health and disease prevention: sunscreen decreases the risk for sunburn during physical activity outdoors and seems not to increase the risk for osteoporosis. Public health efforts have laid a solid foundation on which to face the continuing challenge of promoting and developing effective public health campaigns and health policies that encourage sunscreen use, sun protection, and the primary prevention of skin cancer. In this article, the controversies, concerns, and challenges of sunscreen use as it relates to public health are discussed.

Growth Inhibition of Re-Challenge B16 Melanoma Transplant by Conjugates of Melanogenesis Substrate and Magnetite Nanoparticles as the Basis for Developing Melanoma-Targeted Chemo-Thermo-Immunotherapy

Directory of Open Access Journals (Sweden)

Tomoaki Takada

2009-01-01

Full Text Available Melanogenesis substrate, N-propionyl-cysteaminylphenol (NPrCAP, is selectively incorporated into melanoma cells and inhibits their growth by producing cytotoxic free radicals. Magnetite nanoparticles also disintegrate cancer cells and generate heat shock protein (HSP upon exposure to an alternating magnetic field (AMF. This study tested if a chemo-thermo-immunotherapy (CTI therapy strategy can be developed for better management of melanoma by conjugating NPrCAP on the surface of magnetite nanoparticles (NPrCAP/M. We examined the feasibility of this approach in B16 mouse melanoma and evaluated the impact of exposure temperature, frequency, and interval on the inhibition of re-challenged melanoma growth. The therapeutic protocol against the primary transplanted tumor with or without AMF exposure once a day every other day for a total of three treatments not only inhibited the growth of the primary transplant but also prevented the growth of the secondary, re-challenge transplant. The heat-generated therapeutic effect was more significant at a temperature of 43∘C than either 41∘C or 46∘C. NPrCAP/M with AMF exposure, instead of control magnetite alone or without AMF exposure, resulted in the most significant growth inhibition of the re-challenge tumor and increased the life span of the mice. HSP70 production was greatest at 43∘C compared to that with 41∘C or 46∘C. CD+T cells were infiltrated at the site of the re-challenge melanoma transplant.

Exploring themes and challenges in developing sustainable supply chains – A complexity theory perspective

DEFF Research Database (Denmark)

Abbasi, Maisam

identify, classify, and tackle the challenges that can hinder the execution of such strategies. To develop innovative strategies, the patterns of current trends and themes need to be learned and the missing ones need to be identified. The purpose of this research was to explore themes and challenges......To develop sustainable supply chains in a way that their negative environmental and social effects are minimized, shortand long-term targets should be set. The transformation of supply chains towards these targets calls for the development of innovative strategies and the need to continuously...... in developing sustainable supply chain activities from theoretical and empirical perspectives. Six research studies (RS) were designed and carried out. Two explored the patterns of the themes and challenges in making supply chains environmentally and socially sustainable in general (RS1, RS2). One explored...

Emotion Regulation Characteristics Development in Iranian Primary School Pupils

Directory of Open Access Journals (Sweden)

Asghar Dadkhah

2014-12-01

Full Text Available Objectives: Emotion regulations refer to the ability of experiencing emotions as a basic human capacity and the experience of the basic emotions happiness, anger, sadness and fear are considered as reular characteristics among nations. In school-age children, problems in socioemotional development typically shows themselves as challenging, socially disruptive paterns of behavior. The purpose of the present study was to understand Emotion Regulation characteristics in Iranian primary school pupils and whether Iranian children enable to identify common emotions. Methods: Participants included 900 children, 9 to 10 years, from elementary schools from 21 provinces in Iran. In pilot work we presented 200 children with four hypothetical vignettes of the kind typically used in display rule research. In the main study children’s knowledge regarding hiding their emotions was assessed through a structured interview. The participants were presented with the interview questions after the vignettes. The answers were coded by two people and the interrater reliability was high. The children were assessed on the basis of four common emotions:Happiness, Anger,Fear,and, Sadness. Results: The analysis of the data indicated that: 1 all children were enabled to identify and differentiate all four emotions from each other, most of students hide their happiness, anger, fear and sadness, they hide their emotions in specific situation such as school and home, hide happiness and anger against peers and hide fear and sadness in front of adults. Discussion: The study indicates that Iranian children not only differ from other culture peers in the amount of display rule use in daily life, but also in the situations they report using it and their motives for doing so they suppress their overall emotions more frequently, especially in presence of family and for pro-social and self-protective reasons. These findings provides the basic knowledge about Iranian children

Diabetes mellitus: Exploring the challenges in the drug development process

Directory of Open Access Journals (Sweden)

Julius A Vaz

2012-01-01

Full Text Available Diabetes mellitus has reached epidemic proportions and continues to be a major burden on society globally. The International Diabetes Federation (IDF estimated the global burden of diabetes to be 366 million in 2011 and predicted that by 2030 this will have risen to 552 million. In spite of newer and effective treatment options, newer delivery and diagnostic devices, stricter glycaemic targets, better treatment guidelines and increased awareness of the disease, baseline glycosylated hemoglobin remains relatively high in subjects diagnosed and treated with type 2 diabetes. The search continues for an ideal anti diabetic drug that will not only normalize blood glucose but also provide beta cell rest and possibly restoration of beta cell function. The development of anti diabetic drugs is riddled with fundamental challenges. The concept of beta cell rest and restoration is yet to be completely understood and proven on a long term. The ideal therapeutic approach to treating type 2 diabetes is not yet determined. Our understanding of drug safety in early clinical development is primarily limited to "Type A" reactions. Until marketing authorization most drugs are approved based on the principle of confirming non-inferiority with an existing gold standard or determining superiority to a placebo. The need to obtain robust pharmaco-economic data prior to marketing authorization in order to determine appropriate pricing of a new drug remains a major challenge. The present review outlines some of the challenges in drug development of anti-diabetic drugs citing examples of pulmonary insulin, insulin analogues, thiazolidinediones and the GLP1 analogues.

Diabetes mellitus: Exploring the challenges in the drug development process.

Science.gov (United States)

Vaz, Julius A; Patnaik, Ashis

2012-07-01

Diabetes mellitus has reached epidemic proportions and continues to be a major burden on society globally. The International Diabetes Federation (IDF) estimated the global burden of diabetes to be 366 million in 2011 and predicted that by 2030 this will have risen to 552 million. In spite of newer and effective treatment options, newer delivery and diagnostic devices, stricter glycaemic targets, better treatment guidelines and increased awareness of the disease, baseline glycosylated hemoglobin remains relatively high in subjects diagnosed and treated with type 2 diabetes. The search continues for an ideal anti diabetic drug that will not only normalize blood glucose but also provide beta cell rest and possibly restoration of beta cell function. The development of anti diabetic drugs is riddled with fundamental challenges. The concept of beta cell rest and restoration is yet to be completely understood and proven on a long term. The ideal therapeutic approach to treating type 2 diabetes is not yet determined. Our understanding of drug safety in early clinical development is primarily limited to "Type A" reactions. Until marketing authorization most drugs are approved based on the principle of confirming non-inferiority with an existing gold standard or determining superiority to a placebo. The need to obtain robust pharmaco-economic data prior to marketing authorization in order to determine appropriate pricing of a new drug remains a major challenge. The present review outlines some of the challenges in drug development of anti-diabetic drugs citing examples of pulmonary insulin, insulin analogues, thiazolidinediones and the GLP1 analogues.

Using Clinical Questions Asked by Primary Care Providers Through eConsults to Inform Continuing Professional Development.

Science.gov (United States)

Archibald, Douglas; Liddy, Clare; Lochnan, Heather A; Hendry, Paul J; Keely, Erin J

2018-01-01

Continuing professional development (CPD) offerings should address the educational needs of health care providers. Innovative programs, such as electronic consultations (eConsults), provide unique educational opportunities for practice-based needs assessment. The purpose of this study is to assess whether CPD offerings match the needs of physicians by coding and comparing session content to clinical questions asked through eConsults. This study analyzes questions asked by primary care providers between July 2011 and January 2015 using a service that allows specialists to provide consultation over a secure web-based server. The content of these questions was compared with the CPD courses offered in the area in which these primary care providers are practicing over a similar period (2012-2014). The clinical questions were categorized by the content area. The percentage of questions asked about each content area was calculated for each of the 12 specialties consulted. CPD course offerings were categorized using the same list of content areas. Percentage of minutes dedicated to each content area was calculated for each specialty. The percentage of questions asked and the percentage of CPD course minutes for each content area were compared. There were numerous congruencies and discrepancies between the proportion of questions asked about a given content area and the CPD minutes dedicated to it. Traditional needs assessment may underestimate the need to address topics that are frequently the subject of eConsults. Planners should recognize eConsult questions as a valuable source of practice-associated challenges that can identify professional development needs of physicians.

The challenge of sustainable mobility in urban planning and development

DEFF Research Database (Denmark)

Xue, Jin; Næss, Petter; Yao, Yinmei

2011-01-01

The theme of this article is how the challenge of sustainable mobility has been dealt with in urban planning and urban development in the metropolitan areas of Copenhagen (Denmark) and Hangzhou (China). The two metropolises have followed different trajectories in their land use and transport...

Primary Care Practices’ Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement

Science.gov (United States)

Cohen, Deborah J.; Dorr, David A.; Knierim, Kyle; DuBard, C. Annette; Hemler, Jennifer R.; Hall, Jennifer D.; Marino, Miguel; Solberg, Leif I.; McConnell, K. John; Nichols, Len M.; Nease, Donald E.; Edwards, Samuel T.; Wu, Winfred Y.; Pham-Singer, Hang; Kho, Abel N.; Phillips, Robert L.; Rasmussen, Luke V.; Duffy, F. Daniel; Balasubramanian, Bijal A.

2018-01-01

Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports—but the reports did not necessarily support quality improvement initiatives. Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures. PMID:29608365

Primary Care Practices' Abilities And Challenges In Using Electronic Health Record Data For Quality Improvement.

Science.gov (United States)

Cohen, Deborah J; Dorr, David A; Knierim, Kyle; DuBard, C Annette; Hemler, Jennifer R; Hall, Jennifer D; Marino, Miguel; Solberg, Leif I; McConnell, K John; Nichols, Len M; Nease, Donald E; Edwards, Samuel T; Wu, Winfred Y; Pham-Singer, Hang; Kho, Abel N; Phillips, Robert L; Rasmussen, Luke V; Duffy, F Daniel; Balasubramanian, Bijal A

2018-04-01

Federal value-based payment programs require primary care practices to conduct quality improvement activities, informed by the electronic reports on clinical quality measures that their electronic health records (EHRs) generate. To determine whether EHRs produce reports adequate to the task, we examined survey responses from 1,492 practices across twelve states, supplemented with qualitative data. Meaningful-use participation, which requires the use of a federally certified EHR, was associated with the ability to generate reports-but the reports did not necessarily support quality improvement initiatives. Practices reported numerous challenges in generating adequate reports, such as difficulty manipulating and aligning measurement time frames with quality improvement needs, lack of functionality for generating reports on electronic clinical quality measures at different levels, discordance between clinical guidelines and measures available in reports, questionable data quality, and vendors that were unreceptive to changing EHR configuration beyond federal requirements. The current state of EHR measurement functionality may be insufficient to support federal initiatives that tie payment to clinical quality measures.

Breast Cancer Survivors Report Similar Concerns Related to Return to Work in Developed and Developing Nations.

Science.gov (United States)

Luo, Shi-Xiang; Liu, Jun-E; Cheng, Andy S K; Xiao, Shu-Qin; Su, Ya-Li; Feuerstein, Michael

2018-02-14

Aim To determine whether breast cancer survivors (BCS) at work following the diagnosis and/or treatment of breast cancer, in a rapidly developing country such as China experience similar to return to work challenges as reported in nations with established return to work (RTW) policy and procedures for employees with cancer. Methods Semi-structured interviews were conducted with 16 BCS who returned to work following diagnosis and/or primary cancer treatment. An Interpretative Phenomenological Analysis was used to investigate responses. Results Three recurring themes emerged: (1) challenges at work related to residual effects of diagnosis and/or primary treatment; (2) positive and negative responses from employers and/or supervisors; and (3) positive and negative responses from co-workers/colleagues. Although several participants experienced a high level of workplace support, there was a subgroup that did report challenges related to symptom burden, cognitive limitations, and both positive and negative responses by employers and co-workers were reported. Conclusions Findings indicate similar challenges in BCS who RTW during and/or following cancer treatment in both rapidly developing and developed nations. Results suggest that regardless of the existence of workplace policies and practices related to RTW for workers with a history of cancer, a subgroup of BCS experience similar challenges when returning to work. These findings highlight the international nature of RTW challenges and suggest the need for more global efforts to develop and evaluate workplace interventions to assist with these similarities.

Use of new scientific developments in regulatory risk assessments: challenges and opportunities.

Science.gov (United States)

Tarazona, Jose V

2013-07-01

Since the 1990s, science based ecological risk assessments constitute an essential tool for supporting decision making in the regulatory context. Using the European REACH Regulation as example, this article presents the challenges and opportunities for new scientific developments within the area of chemical control and environmental protection. These challenges can be sorted out in 3 main related topics (sets). In the short term, the challenges are directly associated with the regulatory requirements, required for facilitating a scientifically sound implementation of the different obligations for industry and authorities. It is important to mention that although the actual tools are different due to the regulatory requirements, the basic needs are still the same as those addressed in the early 1990s: understanding the ecological relevance of the predicted effects, including the uncertainty, and facilitating the link with the socio-economic assessment. The second set of challenges covers the opportunities for getting an added value from the regulatory efforts. The information compiled through REACH registration and notification processes is analyzed as source for new integrative developments for assessing the combined chemical risk at the regional level. Finally, the article discusses the challenge of inverting the process and developing risk assessment methods focusing on the receptor, the individual or ecosystem, instead of on the stressor or source. These approaches were limited in the past due to the lack of information, but the identification and dissemination of standard information, including uses, manufacturing sites, physical-chemical, environmental, ecotoxicological, and toxicological properties as well as operational conditions and risk management measures for thousands of chemicals, combined by the knowledge gathered through large scale monitoring programs and spatial information systems is generating new opportunities. The challenge is liking

Development of a primary diffusion source of organic vapors for gas analyzer calibration

Science.gov (United States)

Lecuna, M.; Demichelis, A.; Sassi, G.; Sassi, M. P.

2018-03-01

The generation of reference mixtures of volatile organic compounds (VOCs) at trace levels (10 ppt-10 ppb) is a challenge for both environmental and clinical measurements. The calibration of gas analyzers for trace VOC measurements requires a stable and accurate source of the compound of interest. The dynamic preparation of gas mixtures by diffusion is a suitable method for fulfilling these requirements. The estimation of the uncertainty of the molar fraction of the VOC in the mixture is a key step in the metrological characterization of a dynamic generator. The performance of a dynamic generator was monitored over a wide range of operating conditions. The generation system was simulated by a model developed with computational fluid dynamics and validated against experimental data. The vapor pressure of the VOC was found to be one of the main contributors to the uncertainty of the diffusion rate and its influence at 10-70 kPa was analyzed and discussed. The air buoyancy effect and perturbations due to the weighing duration were studied. The gas carrier flow rate and the amount of liquid in the vial were found to play a role in limiting the diffusion rate. The results of sensitivity analyses were reported through an uncertainty budget for the diffusion rate. The roles of each influence quantity were discussed. A set of criteria to minimize the uncertainty contribution to the primary diffusion source (25 µg min-1) were estimated: carrier gas flow rate higher than 37.7 sml min-1, a maximum VOC liquid mass decrease in the vial of 4.8 g, a minimum residual mass of 1 g and vial weighing times of 1-3 min. With this procedure a limit uncertainty of 0.5% in the diffusion rate can be obtained for VOC mixtures at trace levels (10 ppt-10 ppb), making the developed diffusion vials a primary diffusion source with potential to become a new reference material for trace VOC analysis.

Mental health care in Nepal: current situation and challenges for development of a district mental health care plan.

Science.gov (United States)

Luitel, Nagendra P; Jordans, Mark Jd; Adhikari, Anup; Upadhaya, Nawaraj; Hanlon, Charlotte; Lund, Crick; Komproe, Ivan H

2015-01-01

Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There is an urgent need to address this enormous treatment gap. Changing the focus of specialist mental health workers (psychiatrists and psychologists) from only service delivery to also designing and managing mental health services; building clinical capacity of the primary health care (PHC) workers, and providing supervision and quality assurance of mental health services may help in scaling up mental health services in LMICs. Little is known however, about the mental health policy and services context for these strategies in fragile-state settings, such as Nepal. A standard situation analysis tool was developed by the PRogramme for Improving Mental health carE (PRIME) consortium to systematically analyze and describe the current gaps in mental health care in Nepal, in order to inform the development of a district level mental health care plan (MHCP). It comprised six sections; general information (e.g. population, socio-economic conditions); mental health policies and plans; mental health treatment coverage; district health services; and community services. Data was obtained from secondary sources, including scientific publications, reports, project documents and hospital records. Mental health policy exists in Nepal, having been adopted in 1997, but implementation of the policy framework has yet to begin. In common with other LMICs, the budget allocated for mental health is minimal. Mental health services are concentrated in the big cities, with 0.22 psychiatrists and 0.06 psychologists per 100,000 population. The key challenges experienced in developing a district level MHCP included, overburdened health workers, lack of psychotropic medicines in the PHC, lack of mental health supervision in the existing system, and lack of a coordinating body in the Ministry

Cancer of unknown primary origin: a case report

Directory of Open Access Journals (Sweden)

Elisa De Carlo

2013-03-01

Full Text Available Carcinoma of unknown primary origin (CUP accounts for 2-10% of all malignancies. The apparent absence of the primary tumour, the development of early, uncommon systemic metastases and the resistance to therapy and poor prognosis are hallmarks of this heterogeneous clinical entity and are a challenge for physicians. The diagnostic workup of patients with CUP includes a large amount of histopathological examination, as well as the use of imaging techniques that often fail to identify the primary tumour. Therefore, the optimal workup and treatment for these patients remains to be determined. Molecular diagnostic tools, such as DNA microarray analysis, could help in the search for "lost" CUP origin and guide the further treatment approach. We report the case of a 66-year-old man, with mediastinal lymph nodes metastasis of carcinoma and neurological syndrome with diplopia and balance disorders, in which many exams have been performed without finding the primary tumour.

On the formation of energy policies towards 2020: Challenges in the Swedish industrial and building sectors

International Nuclear Information System (INIS)

Thollander, Patrik; Rohdin, Patrik; Moshfegh, Bahram

2012-01-01

The impact of global climate change due to increased emissions of greenhouse gases emissions which in turn is a consequence of in particular, the use of fossil fuels, has made EU decision makers to act decisively, e.g. the EU 2020 primary energy target of reducing primary energy use with 20% from 2005 to 2020. The aim of this paper is to present major challenges related to the development and formation of energy policies towards the Swedish industrial and building sector in order to fulfill the EU 2020 primary energy target. This paper is approaching the presented challenges by introducing the theory of Asymmetric Energy Policy Shocks (AEPSs), and addresses some key challenges which are of particular relevance for the fulfilment of the EU 2020 primary energy target for Member States like Sweden which from an energy end-use perspective substantially differs from the EU-25's energy end-use structure. In conclusion, overcoming AEPSs, and moving towards a more Long-Term Energy Policy Approach (LTEPA) will be of key importance for individual Member States, if the 2020 primary energy target is to be fulfilled. - Highlights: ► The paper presents major challenges in regard to the formation of Swedish energy policy for the industry and building sectors. ► The theory of Asymmetric Energy Policy Shocks is introduced. ► Regional differences are important to take into account when designing energy policies for the industry and building sectors.

Strategies and challenges for safe injection practice in developing countries

OpenAIRE

Gyawali, Sudesh; Rathore, Devendra Singh; Shankar, P Ravi; Kumar, KC Vikash

2013-01-01

Injection is one of the important health care procedures used globally to administer drugs. Its unsafe use can transmit various blood borne pathogens. This article aims to review the history and status of injection practices, its importance, interventions and the challenges for safe injection practice in developing countries. The history of injections started with the discovery of syringe in the early nineteenth century. Safe injection practice in developed countries was initiated in the earl...

Developing a facilitation model to promote organisational development in primary care practices

Directory of Open Access Journals (Sweden)

Elwyn Glyn

2006-06-01

Full Text Available Abstract Background The relationship between effective organisation of general practices and health improvement is widely accepted. The Maturity Matrix is an instrument designed to assess organisational development in general practice settings and to stimulate quality improvement. It is undertaken by a practice team with the aid of a facilitator. There is a tradition in the primary care systems in many countries of using practice visitors to educate practice teams about how to improve. However the role of practice visitors as facilitators who enable teams to plan practice-led organisational development using quality improvement instruments is less well understood. The objectives of the study were to develop and explore a facilitation model to support practice teams in stimulating organisational development using a quality improvement instrument called the Maturity Matrix. A qualitative study based on transcript analysis was adopted. Method A model of facilitation was constructed based on a review of relevant literature. Audio tapes of Maturity Matrix assessment sessions with general practices were transcribed and facilitator skills were compared to the model. The sample consisted of two facilitators working with twelve general practices based in UK primary care. Results The facilitation model suggested that four areas describing eighteen skills were important. The four areas are structuring the session, obtaining consensus, handling group dynamics and enabling team learning. Facilitators effectively employed skills associated with the first three areas, but less able to consistently stimulate team learning. Conclusion This study suggests that facilitators need careful preparation for their role and practices need protected time in order to make best use of practice-led quality improvement instruments. The role of practice visitor as a facilitator is becoming important as the need to engender ownership of the quality improvement process by

Developing a facilitation model to promote organisational development in primary care practices.

Science.gov (United States)

Rhydderch, Melody; Edwards, Adrian; Marshall, Martin; Elwyn, Glyn; Grol, Richard

2006-06-19

The relationship between effective organisation of general practices and health improvement is widely accepted. The Maturity Matrix is an instrument designed to assess organisational development in general practice settings and to stimulate quality improvement. It is undertaken by a practice team with the aid of a facilitator. There is a tradition in the primary care systems in many countries of using practice visitors to educate practice teams about how to improve. However the role of practice visitors as facilitators who enable teams to plan practice-led organisational development using quality improvement instruments is less well understood. The objectives of the study were to develop and explore a facilitation model to support practice teams in stimulating organisational development using a quality improvement instrument called the Maturity Matrix. A qualitative study based on transcript analysis was adopted. A model of facilitation was constructed based on a review of relevant literature. Audio tapes of Maturity Matrix assessment sessions with general practices were transcribed and facilitator skills were compared to the model. The sample consisted of two facilitators working with twelve general practices based in UK primary care. The facilitation model suggested that four areas describing eighteen skills were important. The four areas are structuring the session, obtaining consensus, handling group dynamics and enabling team learning. Facilitators effectively employed skills associated with the first three areas, but less able to consistently stimulate team learning. This study suggests that facilitators need careful preparation for their role and practices need protected time in order to make best use of practice-led quality improvement instruments. The role of practice visitor as a facilitator is becoming important as the need to engender ownership of the quality improvement process by practices increases.

Ocean OSSEs: recent developments and future challenges

Science.gov (United States)

Kourafalou, V. H.

2012-12-01

Atmospheric OSSEs have had a much longer history of applications than OSSEs (and OSEs) in oceanography. Long standing challenges include the presence of coastlines and steep bathymetric changes, which require the superposition of a wide variety of space and time scales, leading to difficulties on ocean observation and prediction. For instance, remote sensing is critical for providing a quasi-synoptic oceanographic view, but the coverage is limited at the ocean surface. Conversely, in situ measurements are capable to monitor the entire water column, but at a single location and usually for a specific, short time. Despite these challenges, substantial progress has been made in recent years and international initiatives have provided successful OSSE/OSE examples and formed appropriate forums that helped define the future roadmap. These will be discussed, together with various challenges that require a community effort. Examples include: integrated (remote and in situ) observing system requirements for monitoring large scale and climatic changes, vs. short term variability that is particularly important on the regional and coastal spatial scales; satisfying the needs of both global and regional/coastal nature runs, from development to rigorous evaluation and under a clear definition of metrics; data assimilation in the presence of tides; estimation of real-time river discharges for Earth system modeling. An overview of oceanographic efforts that complement the standard OSSE methodology will also be given. These include ocean array design methods, such as representer-based analysis and adaptive sampling. Exciting new opportunities for both global and regional ocean OSSE/OSE studies have recently become possible with targeted periods of comprehensive data sets, such as the existing Gulf of Mexico observations from multiple sources in the aftermath of the DeepWater Horizon incident and the upcoming airborne AirSWOT, in preparation for the SWOT (Surface Water and Ocean

The Global Energy Challenge:A Contextual Framework

OpenAIRE

Connolly, David

2011-01-01

This report gives a brief overview of the global energy challenge and subsequently outlines how and where renewable energy could be developed to solve these issues. The report does not go into a lot of detail on these issues and hence, it is meant as an overview only.The report begins by outlining the causes of global climate change, concluding that energy-related emissions are the primary contributors to the problem. As a result, global energy production is analysed in more detail, discussin...

Enhancing energy security in Malayia: the challenges towards sustainable environment

International Nuclear Information System (INIS)

Sahid, E J M; Peng, L Y; Siang, C Ch

2013-01-01

Energy is known as one of the essential ingredients for economic development and security of energy supply is crucial in ensuring continuous economic development of a country. Malaysia's proven domestic oil reserves are estimated to last for another 25 years, while that of gas for another 39 years as of 2011. Despite the depleting indigenous energy resources, the primary energy demand has continued to grow robustly, at an annual rate of 6.3 percent per year from 1990 to 2010, while the primary energy import has grown 7.2% per year and the primary energy export has grown at a slower rate of 1.9% per year. This worrying trend is further compounded by the faster rate of primary oil import averaging 10.5% per year while the primary energy export has shrink at a rate of 1.4% per year. This paper has identified two main concerns namely overdependence on fossil fuel and increasing energy import dependency in creating a precarious position towards energy self-sufficiency. The study will analyse the energy security of the country and explore possible options and challenges in enhancing the energy supply security toward sustainable environment.

Environmental Education in Serbian Primary Schools: Challenges and Changes in Curriculum, Pedagogy, and Teacher Training

Science.gov (United States)

Stanišic, Jelena; Maksic, Slavica

2014-01-01

The protection of human health and the preservation of the environment are topics that form an integral part of the primary school curriculum in Serbia. However, research studies have shown that students do not have enough knowledge to contribute to the development of a healthy lifestyle and environmental awareness. The latest changes in school…

Economic Analysis on Key Challenges for Sustainable Aquaculture Development

DEFF Research Database (Denmark)

Gedefaw Abate, Tenaw

challenges that could obstruct its sustainable development, such as a lack of suitable feed, which includes fishmeal, fish oil and live feed, and negative environmental externalities. If the aquaculture industry is to reach its full potential, it must be both environmentally and economically sustainable...... environmental externalities. A sustainable supply of high-quality live feeds at reasonable prices is absolutely essential for aquaculture hatcheries because many commercially produced high-value marine fish larval species, such as flounder, grouper, halibut, tuna and turbot, require live feed for their early...... developmental stage. The key challenge in this regard is that the conventional used live feed items, Artemia and rotifers, are nutritionally deficient. Thus, the first main purpose of the thesis is carrying out an economic analysis of the feasibility of commercial production and the use of an alternative live...

relevance and challenges of primary education to the overall ...

African Journals Online (AJOL)

PROF EKWUEME

consequential effects one is forced to ask certain questions. Some such ... providing opportunities for genuine learning to children .... demonstrated their political will through the declaration of Universal Primary Education (UPE) programmes in their zones. The post independent era revealed that the 1976 UPE programme ...

Accident tolerant fuel cladding development: Promise, status, and challenges

Science.gov (United States)

Terrani, Kurt A.

2018-04-01

The motivation for transitioning away from zirconium-based fuel cladding in light water reactors to significantly more oxidation-resistant materials, thereby enhancing safety margins during severe accidents, is laid out. A review of the development status for three accident tolerant fuel cladding technologies, namely coated zirconium-based cladding, ferritic alumina-forming alloy cladding, and silicon carbide fiber-reinforced silicon carbide matrix composite cladding, is offered. Technical challenges and data gaps for each of these cladding technologies are highlighted. Full development towards commercial deployment of these technologies is identified as a high priority for the nuclear industry.

Zika Virus: Medical Countermeasure Development Challenges.

Directory of Open Access Journals (Sweden)

Robert W Malone

2016-03-01

Full Text Available Reports of high rates of primary microcephaly and Guillain-Barré syndrome associated with Zika virus infection in French Polynesia and Brazil have raised concerns that the virus circulating in these regions is a rapidly developing neuropathic, teratogenic, emerging infectious public health threat. There are no licensed medical countermeasures (vaccines, therapies or preventive drugs available for Zika virus infection and disease. The Pan American Health Organization (PAHO predicts that Zika virus will continue to spread and eventually reach all countries and territories in the Americas with endemic Aedes mosquitoes. This paper reviews the status of the Zika virus outbreak, including medical countermeasure options, with a focus on how the epidemiology, insect vectors, neuropathology, virology and immunology inform options and strategies available for medical countermeasure development and deployment.Multiple information sources were employed to support the review. These included publically available literature, patents, official communications, English and Lusophone lay press. Online surveys were distributed to physicians in the US, Mexico and Argentina and responses analyzed. Computational epitope analysis as well as infectious disease outbreak modeling and forecasting were implemented. Field observations in Brazil were compiled and interviews conducted with public health officials.

Zika Virus: Medical Countermeasure Development Challenges

Science.gov (United States)

Malone, Robert W.; Homan, Jane; Callahan, Michael V.; Glasspool-Malone, Jill; Damodaran, Lambodhar; Schneider, Adriano De Bernardi; Zimler, Rebecca; Talton, James; Cobb, Ronald R.; Ruzic, Ivan; Smith-Gagen, Julie; Janies, Daniel; Wilson, James

2016-01-01

Introduction Reports of high rates of primary microcephaly and Guillain–Barré syndrome associated with Zika virus infection in French Polynesia and Brazil have raised concerns that the virus circulating in these regions is a rapidly developing neuropathic, teratogenic, emerging infectious public health threat. There are no licensed medical countermeasures (vaccines, therapies or preventive drugs) available for Zika virus infection and disease. The Pan American Health Organization (PAHO) predicts that Zika virus will continue to spread and eventually reach all countries and territories in the Americas with endemic Aedes mosquitoes. This paper reviews the status of the Zika virus outbreak, including medical countermeasure options, with a focus on how the epidemiology, insect vectors, neuropathology, virology and immunology inform options and strategies available for medical countermeasure development and deployment. Methods Multiple information sources were employed to support the review. These included publically available literature, patents, official communications, English and Lusophone lay press. Online surveys were distributed to physicians in the US, Mexico and Argentina and responses analyzed. Computational epitope analysis as well as infectious disease outbreak modeling and forecasting were implemented. Field observations in Brazil were compiled and interviews conducted with public health officials. PMID:26934531

Primary care physician insights into a typology of the complex patient in primary care.

Science.gov (United States)

Loeb, Danielle F; Binswanger, Ingrid A; Candrian, Carey; Bayliss, Elizabeth A

2015-09-01

Primary care physicians play unique roles caring for complex patients, often acting as the hub for their care and coordinating care among specialists. To inform the clinical application of new models of care for complex patients, we sought to understand how these physicians conceptualize patient complexity and to develop a corresponding typology. We conducted qualitative in-depth interviews with internal medicine primary care physicians from 5 clinics associated with a university hospital and a community health hospital. We used systematic nonprobabilistic sampling to achieve an even distribution of sex, years in practice, and type of practice. The interviews were analyzed using a team-based participatory general inductive approach. The 15 physicians in this study endorsed a multidimensional concept of patient complexity. The physicians perceived patients to be complex if they had an exacerbating factor-a medical illness, mental illness, socioeconomic challenge, or behavior or trait (or some combination thereof)-that complicated care for chronic medical illnesses. This perspective of primary care physicians caring for complex patients can help refine models of complexity to design interventions or models of care that improve outcomes for these patients. © 2015 Annals of Family Medicine, Inc.

Challenges of Engaging Local Stakeholders for Statewide Program Development Process

Science.gov (United States)

Martin, Michael J.; Leuci, Mary; Stewart, Mark

2014-01-01

The University of Missouri Extension needed to develop an annual program review process that collaboratively engaged county-level stakeholders. The results from the first 2 years highlight the results, challenges, and implications of the design process. The annual review process needs to be adaptive, responsive, and reflective from year to year…

EVALUATION OF SUSTAINABLE DEVELOPMENT FRAMEWORK FOR VOCATIONAL COLLEGES: IMPLEMENTATION AND CHALLENGES

OpenAIRE

Minghat, Asnul Dahar; Safie, Siti Nadia Mohd; Mustakim, Siti Salina

2018-01-01

The main purpose of this study was to explore the extensive growth of courses among the Vocational Colleges developed by the Ministry of Education since 2012. In order to determine the sustainability of the development, this study specifically seeks to explore the scope and quality of Vocational Colleges’ Curriculum Standard implementation via the integration of sustainability development among educators, and to investigate challenges occurred during the implementation of the college ever sin...

Challenges in horizontal integration of eye care services into the pre-existing rural primary care structure: an operations research perspective from Nigeria

Directory of Open Access Journals (Sweden)

Chinyere Nkemdilim Ezisi

2017-12-01

Full Text Available Background . The provision of population-wide, accessible, affordable, acceptable and evenly distributed qualitative eye care services remains a recurrent challenge to eye care organizations worldwide. Objectives . To report the challenges encountered in setting up eye care service in a pre-existing primary health care facility in rural Nigeria and also audit the common causes of eye disorders in rural setting southeast of Nigeria. Material and methods . The study was an operations research study conducted at Akpuoga-Nike between February and April 2011. Demographic and ophthalmic clinical data were collected. Health system-, community- and patient-determined challenges were catalogued and analyzed using Epi Info Statistical software for Windows, version 6. Univariate analysis was performed for data distribution testing. Analytical statistics were performed, with p < 0.05 considered statistically significant. Results . A total of 481 (males, 144 (29.9%; females, 377(70.1% patients aged 42.3 ± 20.2 SD years (range 4–80 years were seen. The leading eye disorders were refractive error – 28.9%, and cataract – 16.4%. The operations challenges encountered included difficulties with community sensitization/advocacies, inadequate infrastructure and mobile equipment, as well as lack of eye care manpower, consumables and funding deficits. Conclusions . Health system-related issues were the main challenges encountered. Recruitment of an adequate number of rural eye care workforce, provision of needed material resources, adequate funding and engendering community participation in rural eye care delivery through grass roots advocacy and health service public education would overcome the challenges.

Challenges of Transit Oriented Development (TOD in Iran. The Need for a Paradigm Shift

Directory of Open Access Journals (Sweden)

Mahta Mirmoghtadaee

2016-10-01

The major contention of this paper is to discuss the general concept of TOD, its benefits and challenges in Iranian urban context. It is discussed here that TOD has several positive outcomes considering the existing urbanization trends in Iran. It may be used as a practical instrument to deal with rapidly urbanizing country in which motorization rate is increasing and air pollution is the serious cause of life loss. However there are several challenges which should be faced. The need for an Iranian version of TOD, which re-narrated the theory according to local situation, is the first challenge. A paradigm shift in the government, shifting the priority from housing schemes to mass transit systems is the second challenge needed to be taken into consideration. The third challenge is the overlapping and parallel institutions dealing with mass transit systems in urban and regional transportation planning and insufficient planning instruments. The integrated transportation and urban planning system is necessary here, and there is an urgent need to develop a national TOD guideline with the potential to develop local versions for each city.

Development of water chemistry diagnosis system for BWR primary loop

International Nuclear Information System (INIS)

Nagase, Makoto; Asakura, Yamato; Sakagami, Masaharu; Uchida, Shunsuke; Ohsumi, Katsumi.

1988-01-01

The prototype of a water chemistry diagnosis system for BWR primary loop has been developed. Its purposes are improvement of water chemistry control and reduction of the work burden on plant chemistry personnel. It has three main features as follows. (1) Intensifying the observation of water chemistry conditions by variable sampling intervals based on the on-line measured data. (2) Early detection of water chemistry data trends using a second order regression curve which is calculated from the measured data, and then searching the cause of anomaly if anything (3) Diagnosis of Fe concentration in feedwater using model simulations, in order to lower the radiation level in the primary system. (author)

Meeting the Challenges of Personal Development and Character Building in University Students

OpenAIRE

Chong, Yen Wan; Hamid, Siti Norasyikin Binti Abdul

2016-01-01

Graduate unemployment and corruption are two major challenges faced by Malaysia. One of the top reasons for graduate unemployment in Malaysia, according to a recent survey of Malaysian employers, is poor character or attitude among university graduates. Despite intensifying anti-corruption efforts, corruption in Malaysia has remained a serious challenge. Character education and personal development programs which instil good values in our future leaders can be effective tools in the fight aga...

Pubertal breast development in primary school girls in Sokoto, North ...

African Journals Online (AJOL)

Background. There is wide variation in normal pubertal timing among various populations. Objectives. To determine the mean age of pubertal stages of breast development and menarche, and the influence of nutrition and ethnicity on pubertal onset in primary school girls in Sokoto, North-Western Nigeria. Methods.

Development of an educational tool to teach primary school pupils multiplication tables

CSIR Research Space (South Africa)

Smith, S

2015-11-01

Full Text Available This work addresses the need for the development of skills and interest in mathematics, particularly for students in the early years of primary school where core mathematical knowledge is formed. The development and implementation of Maths Mat...

Problem Space Matters: The Development of Creativity and Intelligence in Primary School Children

Science.gov (United States)

Welter, Marisete Maria; Jaarsveld, Saskia; Lachmann, Thomas

2017-01-01

Previous research showed that in primary school, children's intelligence develops continually, but creativity develops more irregularly. In this study, the development of intelligence, measured traditionally, i.e., operating within well-defined problem spaces (Standard Progressive Matrices) was compared with the development of intelligence…

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

Science.gov (United States)

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

2010-12-13

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

Development and validation of the primary care team dynamics survey.

Science.gov (United States)

Song, Hummy; Chien, Alyna T; Fisher, Josephine; Martin, Julia; Peters, Antoinette S; Hacker, Karen; Rosenthal, Meredith B; Singer, Sara J

2015-06-01

To develop and validate a survey instrument designed to measure team dynamics in primary care. We studied 1,080 physician and nonphysician health care professionals working at 18 primary care practices participating in a learning collaborative aimed at improving team-based care. We developed a conceptual model and administered a cross-sectional survey addressing team dynamics, and we assessed reliability and discriminant validity of survey factors and the overall survey's goodness-of-fit using structural equation modeling. We administered the survey between September 2012 and March 2013. Overall response rate was 68 percent (732 respondents). Results support a seven-factor model of team dynamics, suggesting that conditions for team effectiveness, shared understanding, and three supportive processes are associated with acting and feeling like a team and, in turn, perceived team effectiveness. This model demonstrated adequate fit (goodness-of-fit index: 0.91), scale reliability (Cronbach's alphas: 0.71-0.91), and discriminant validity (average factor correlations: 0.49). It is possible to measure primary care team dynamics reliably using a 29-item survey. This survey may be used in ambulatory settings to study teamwork and explore the effect of efforts to improve team-based care. Future studies should demonstrate the importance of team dynamics for markers of team effectiveness (e.g., work satisfaction, care quality, clinical outcomes). © Health Research and Educational Trust.

EUV mask process specifics and development challenges

Science.gov (United States)

Nesladek, Pavel

2014-07-01

EUV lithography is currently the favorite and most promising candidate among the next generation lithography (NGL) technologies. Decade ago the NGL was supposed to be used for 45 nm technology node. Due to introduction of immersion 193nm lithography, double/triple patterning and further techniques, the 193 nm lithography capabilities was greatly improved, so it is expected to be used successfully depending on business decision of the end user down to 10 nm logic. Subsequent technology node will require EUV or DSA alternative technology. Manufacturing and especially process development for EUV technology requires significant number of unique processes, in several cases performed at dedicated tools. Currently several of these tools as e.g. EUV AIMS or actinic reflectometer are not available on site yet. The process development is done using external services /tools with impact on the single unit process development timeline and the uncertainty of the process performance estimation, therefore compromises in process development, caused by assumption about similarities between optical and EUV mask made in experiment planning and omitting of tests are further reasons for challenges to unit process development. Increased defect risk and uncertainty in process qualification are just two examples, which can impact mask quality / process development. The aim of this paper is to identify critical aspects of the EUV mask manufacturing with respect to defects on the mask with focus on mask cleaning and defect repair and discuss the impact of the EUV specific requirements on the experiments needed.

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

Science.gov (United States)

Otsubo, Yasuto; Ishiguro, Akihiro; Uyama, Yoshiaki

2013-01-01

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

Effects of Continuing Professional Development on Group Work Practices in Scottish Primary Schools

Science.gov (United States)

Thurston, A.; Christie, D.; Howe, C. J.; Tolmie, A.; Topping, K. J.

2008-01-01

The present study investigated the effects of a continuing professional development (CPD) initiative that provided collaborative group work skills training for primary school teachers. The study collected data from 24 primary school classrooms in different schools in a variety of urban and rural settings. The sample was composed of 332 pupils,…

Challenges and strategies in anti-cancer nanomedicine development : An industry perspective

NARCIS (Netherlands)

Hare, Jennifer I.; Lammers, Twan|info:eu-repo/dai/nl/304824577; Ashford, Marianne B.; Puri, Sanyogitta; Storm, G|info:eu-repo/dai/nl/073356328; Barry, Simon T.

2017-01-01

Successfully translating anti-cancer nanomedicines from pre-clinical proof of concept to demonstration of therapeutic value in the clinic is challenging. Having made significant advances with drug delivery technologies, we must learn from other areas of oncology drug development, where patient

Challenges and strategies in anti-cancer nanomedicine development: An industry perspective

NARCIS (Netherlands)

Hare, J.I.; Lammers, Twan Gerardus Gertudis Maria; Ashford, M.B.; Puri, S.; Storm, Gerrit; Barry, S.T.

2017-01-01

Successfully translating anti-cancer nanomedicines from pre-clinical proof of concept to demonstration of therapeutic value in the clinic is challenging. Having made significant advances with drug delivery technologies, we must learn from other areas of oncology drug development, where patient

Challenges in the development of market-based pipeline investments

International Nuclear Information System (INIS)

Von Bassenheim, G.; Mohitpour, M.; Klaudt, D.; Jenkins, A.

2000-01-01

The challenges, risks and uncertainties that the natural gas industry faces in developing market-based pipeline projects were discussed. Market-based pipeline investments are fundamentally different from user-driven projects. Market-based projected involve finding enough energy users and linking them with a pipeline infrastructure to viable supplies of natural gas. Each unique project is developed individually and requires a strong corporate vision and support before it can be successfully implemented. The three phases of a pipeline investment include the business development phase, the project development phase, and the implementation/operations phase. Market-based companies will need a clear vision for long-term goals and the desire to succeed. The company will have to prepare a detailed strategy and policies that clearly define geographic areas of operations, risk tolerance, availability of capital and expected project performance. 3 refs., 3 tabs., 2 figs

Renewable energies and the challenge for a sustainable development

International Nuclear Information System (INIS)

2002-01-01

After a presentation of some basic definitions and data (locations, assessment, utilisation), this collective report proposes a first set of contributions about perspectives for renewable energies: their role in middle- and long-term world scenarios, their relationship with greenhouse effect, the relentless technological pursuit through the example of hydrogen. A second set of contributions deals with the relationship between renewable energies and sustainable development: in northern countries (an environmental responsibility and a society issue), in southern countries (the challenge of access to energy), the promotion of renewable energies in the North-South cooperation, the chaotic decentralized electrification program in South Africa, the relationship between energy and struggle against poverty, the search for instruments to stimulate renewable electricity development, the sociological constraints to renewable energy development, the sustainable development at the service of new industries in countries of the North

Free Primary Education Policy: Coping Strategies in Public Primary Schools in Kakamega South District, Kakamega County, Kenya

Science.gov (United States)

Mulinya, Lidoro Charles; Orodho, John Aluko

2015-01-01

This study examined the challenges of implementing free primary education and copping strategies in public primary schools in Kakamega South District, Kakamega County, Kenya. The study was premised on the demand and supply theory. A descriptive survey research design was adopted. The sample comprised 23 headteachers, 92 teachers and one Ministry…

Promotion of trade in service in developing economy: challenges and prospects

Directory of Open Access Journals (Sweden)

AA Okharedia

2014-01-01

Full Text Available In the past, trade in services was not considered important by international Economists. One of the main arguments put forward for ignoring the concept of trade in service was that services were non- tradable In view of this, this paper attempts to investigate the role played by service industries and the associated challenges in a developing economy with particular reference to the SADC countries. This investigation shows that the service industries are uncompetitive and inefficient when compared with their peers in developed economy. This paper recommends that there is an urgent need for a major-shake up especially within the core economic infrastructure services. This paper also highlights that the service industries in the SADC region contributes greatly to GDP, creates employment opportunity, improved access to transport which translates into improved access to customers and suppliers. The transport sector is of crucial importance in poverty alleviation and regional economic integration. Some of the challenges identified include, the need for SADC countries to conform to international standards in delivery of its services since most SADC countries are members of GATS, ILO and WTO. The other challenge is the different legislative framework in the service industries within the SADC region. There is an urgent need to harmonise the different legislative framework.

Challenges and Strategies to Develop a Positive Image of the Library

Directory of Open Access Journals (Sweden)

Anisa Sri Restanti

2018-01-01

Full Text Available Information technology has been used in the management of the library. There are several libraries have been integrated with the internet to provide services. But the library still image as an institution or an old building that contains the bookshelves and librarian profession under other professions. This article is presented to determine some of the challenges and strategies that can be done in fostering a positive image of the library. Based on the literature study and observation, it’s known, that the challenges are differences in educational background librarians, foster a positive image has not been planned, the development of information technology, the implementation of the code of ethics of librarians is not maximal. In the face of the challenges in creating a positive image, there are strategies that can be done that in terms of internal and external libraries. Thus, it can be concluded that, to foster a positive image of the library is needed strategies and synergies as well as the responsibility of all aspects of the library. Recommendation for librarians are important to develop personal branding. Furthermore, for the library after successfully building a positive image should be able to maintain and restore the image when a crisis.

Challenges and Strategies to Develop a Positive Image of the Library

Directory of Open Access Journals (Sweden)

Anisa Sri Restanti

2017-01-01

Full Text Available Information technology has been used in the management of the library. There are several libraries have been integrated with the internet to provide services. But the library still image as an institution or an old building that contains the bookshelves and librarian profession under other professions. This article is presented to determine some of the challenges and strategies that can be done in fostering a positive image of the library. Based on the literature study and observation, its known, that the challenges are differences in educational background librarians, foster a positive image has not been planned, the development of information technology, the implementation of the code of ethics of librarians is not maximal. In the face of the challenges in creating a positive image, there are strategies that can be done that in terms of internal and external libraries. Thus, it can be concluded that, to foster a positive image of the library is needed strategies and synergies as well as the responsibility of all aspects of the library. Recommendation for librarians are important to develop personal branding. Furthermore, for the library after successfully building a positive image should be able to maintain and restore the image when a crisis.

The Australian stock market development: Prospects and challenges

Directory of Open Access Journals (Sweden)

Sheilla Nyasha

2013-06-01

Full Text Available This paper highlights the origin and development of the Australian stock market. The country has three major stock exchanges, namely: the Australian Securities Exchange Group, the National Stock Exchange of Australia, and the Asia-Pacific Stock Exchange. These stock exchanges were born out of a string of stock exchanges that merged over time. Stock-market reforms have been implemented since the period of deregulation, during the 1980s; and the Exchanges responded largely positively to these reforms. As a result of the reforms, the Australian stock market has developed in terms of the number of listed companies, the market capitalisation, the total value of stocks traded, and the turnover ratio. Although the stock market in Australia has developed remarkably over the years, and was spared by the global financial crisis of the late 2000s, it still faces some challenges. These include the increased economic uncertainty overseas, the downtrend in global financial markets, and the restrained consumer confidence in Australia.

Drugs in development for toxoplasmosis: advances, challenges, and current status.

Science.gov (United States)

Alday, P Holland; Doggett, Joseph Stone

2017-01-01

Toxoplasma gondii causes fatal and debilitating brain and eye diseases. Medicines that are currently used to treat toxoplasmosis commonly have toxic side effects and require prolonged courses that range from weeks to more than a year. The need for long treatment durations and the risk of relapsing disease are in part due to the lack of efficacy against T. gondii tissue cysts. The challenges for developing a more effective treatment for toxoplasmosis include decreasing toxicity, achieving therapeutic concentrations in the brain and eye, shortening duration, eliminating tissue cysts from the host, safety in pregnancy, and creating a formulation that is inexpensive and practical for use in resource-poor areas of the world. Over the last decade, significant progress has been made in identifying and developing new compounds for the treatment of toxoplasmosis. Unlike clinically used medicines that were repurposed for toxoplasmosis, these compounds have been optimized for efficacy against toxoplasmosis during preclinical development. Medicines with enhanced efficacy as well as features that address the unique aspects of toxoplasmosis have the potential to greatly improve toxoplasmosis therapy. This review discusses the facets of toxoplasmosis that are pertinent to drug design and the advances, challenges, and current status of preclinical drug research for toxoplasmosis.

Family-centered depression treatment for older men in primary care: a qualitative study of stakeholder perspectives.

Science.gov (United States)

Hinton, Ladson; Sciolla, Andrés F; Unützer, Jürgen; Elizarraras, Edward; Kravitz, Richard L; Apesoa-Varano, Ester Carolina

2017-09-29

Family members often play important roles in the lives of depressed older men and frequently attend primary care visits with their loved ones, yet surprisingly little is known about how to most effectively engage and include family members in depression treatment. However, including family in depression treatment may be difficult due to several factors, such as depression stigma and family conflicts. The objective of this study was to describe challenges in engaging family members in older men's depression treatment and potential strategies to overcome those challenges. A cross-sectional, qualitative descriptive interview study was conducted in a safety-net, Federally Qualified Health Center in California's Central Valley. A total of 37 stakeholders were recruited, including 15 depressed older (i.e. age ≥ 60) men, 12 family members, and 10 clinic staff. Depressed men were identified through mail outreach, waiting room screening, and referral. Depressed men identified family members who were later approached to participate. We also recruited a purposeful sample of clinic staff. Interviews explored stakeholder perspectives on family involvement in men's depression treatment as part of a primary care intervention. Interviews were conducted using a semi-structured interview guide, tape-recorded, transcribed verbatim, and translated if the interview was conducted in Spanish. Four themes were identified representing core challenges: engaging men at the right time; preserving men's sense of autonomy; managing privacy concerns; and navigating family tensions. Stakeholders also provided practical suggestions and advice about how each of these challenges might be addressed. While engaging family is a promising approach to strengthen depression care for older men in primary care settings, several potential challenges exist. Family- centered depression intervention development and clinical practice need to anticipate these challenges and to develop approaches and

Loss of life estimation – Review, developments and challenges

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Jonkman S.N. (Bas

2016-01-01

Full Text Available This paper presents an overview and review of methods developed for loss of life estimation in flood risk assessment. These methods range from empirical to simulation based approaches that are used to support flood risk analyses and emergency management. Similarities and differences between the modelling approaches, input and output types and applications are discussed. Challenges to the field are summarized, including empirical data collection for validation and benchmarking and comparison studies.

US DOE Grand Challenge in Computational Accelerator Physics

International Nuclear Information System (INIS)

Ryne, R.; Habib, S.; Qiang, J.; Ko, K.; Li, Z.; McCandless, B.; Mi, W.; Ng, C.; Saparov, M.; Srinivas, V.; Sun, Y.; Zhan, X.; Decyk, V.; Golub, G.

1998-01-01

Particle accelerators are playing an increasingly important role in basic and applied science, and are enabling new accelerator-driven technologies. But the design of next-generation accelerators, such as linear colliders and high intensity linacs, will require a major advance in numerical modeling capability due to extremely stringent beam control and beam loss requirements, and the presence of highly complex three-dimensional accelerator components. To address this situation, the U.S. Department of Energy has approved a ''Grand Challenge'' in Computational Accelerator Physics, whose primary goal is to develop a parallel modeling capability that will enable high performance, large scale simulations for the design, optimization, and numerical validation of next-generation accelerators. In this paper we report on the status of the Grand Challenge

The challenge of developing thin mirror shells for future x-ray telescopes

Science.gov (United States)

Döhring, Thorsten; Stollenwerk, Manfred; Gong, Qingqing; Proserpio, Laura; Winter, Anita; Friedrich, Peter

2015-09-01

Previously used mirror technologies are not able to fulfil the requirements of future X-ray telescopes due to challenging requests from the scientific community. Consequently new technical approaches for X-ray mirror production are under development. In Europe the technical baseline for the planned X-ray observatory ATHENA is the radical new approach of silicon pore optics. NASÁs recently launched NuSTAR mission uses segmented mirrors shells made from thin bended glasses, successfully demonstrating the feasibility of the glass forming technology for X-ray mirrors. For risk mitigation also in Europe the hot slumping of thin glasses is being developed as an alternative technology for lightweight X-ray telescopes. The high precision mirror manufacturing requires challenging technical developments; several design trades and trend-setting decisions need to be made and are discussed within this paper. Some new technical and economic aspects of the intended glass mirror serial production are also studied within the recently started interdisciplinary project INTRAAST, an acronym for "industry transfer of astronomical mirror technologies". The goal of the project, embedded in a cooperation of the Max-Planck-Institute for extraterrestrial Physics and the University of Applied Sciences Aschaffenburg, is to master the challenge of producing thin mirror shells for future X-ray telescopes. As a first project task the development of low stress coatings for thin glass mirror substrates have been started, the corresponding technical approach and first results are presented.

An Overview of the EPRI PWR Primary Chemistry Program

International Nuclear Information System (INIS)

Perkins, David; Fruzzetti, Keith; Haas, Carey; Wells, Dan

2012-09-01

Primary chemistry controls continue to evolve, impacting long term equipment reliability goals, optimized core designs, and radiation dose management practices. Chemistry initiatives include increased primary system pH (T) , zinc injection, and optimization of primary system hydrogen concentration. Nevertheless, utilities are faced with ever changing challenges as fuel vendors continue to optimize core power densities coupled with longer operating cycles and material replacement efforts. These challenges must be collaboratively addressed by the plant chemists, engineers, and operators. Operational chemistry has changed dramatically over the years with increased primary pH (T) programs requiring some utilities to operate with up to 6 ppm lithium or slightly higher. Coupled with primary pH (T) program optimization, are ongoing EPRI research efforts attempting to develop an optimized hydrogen control program balancing material issues associated with primary water stress corrosion cracking (PWSCC) crack growth rate against fuel concerns associated with increased hydrogen concentrations. One of the most significant primary chemistry changes that effectively balances the demands of materials, fuels, chemistry and dose management strategies is zinc injection into the primary coolant. Since 1994 when Farley initiated zinc injection, zinc injection has been successfully injected at over 70 pressurized water reactors world-wide. Combining operational chemistry with shutdown chemistry controls provides the plant chemist with a technically based and balanced approach to fuel and material integrity as well as dose management strategies. Shutdown chemistry has continually evolved since the 1970's when the chemist was primarily concerned with fission products. Now the chemist must manage corrosion product release, and support Outage Management and Radiation Protection through the performance of a controlled shutdown. In part, this change was driven as plant materials evolved

Review and challenges of policies of environmental protection and sustainable development in China.

Science.gov (United States)

Zhang, Kun-Min; Wen, Zong-Guo

2008-09-01

China is confronted with the dual task of developing its national economy and protecting its ecological environment. Since the 1980s, China's policies on environmental protection and sustainable development have experienced five changes: (1) progression from the adoption of environmental protection as a basic state policy to the adoption of sustainable development strategy; (2) changing focus from pollution control to ecological conservation equally; (3) shifting from end-of-pipe treatment to source control; (4) moving from point source treatment to regional environmental governance; and (5) a turn away from administrative management-based approaches and towards a legal means and economic instruments-based approach. Since 1992, China has set down sustainable development as a basic national strategy. However, environmental pollution and ecological degradation in China have continued to be serious problems and have inflicted great damage on the economy and quality of life. The beginning of the 21st century is a critical juncture for China's efforts towards sustaining rapid economic development, intensifying environmental protection efforts, and curbing ecological degradation. As the largest developing country, China's policies on environmental protection and sustainable development will be of primary importance not only for China, but also the world. Realizing a completely well-off society by the year 2020 is seen as a crucial task by the Chinese government and an important goal for China's economic development in the new century, however, attaining it would require a four-fold increase over China's year 2000 GDP. Therefore, speeding up economic development is a major mission during the next two decades and doing so will bring great challenges in controlling depletion of natural resources and environmental pollution. By taking a critical look at the development of Chinese environmental policy, we try to determine how best to coordinate the relationship between the

A challenge for the world - The sustainable development goals at issue

International Nuclear Information System (INIS)

Caron, Patrick; ); Chataigner, Jean-Marc; Le Drian, Jean-Yves; Jean, Michaelle; Moatti, Jean-Paul; )

2017-01-01

Changing lives with preserving the world is the ambition of the 17 sustainable development goals (SDG) adopted by all UN member countries in September 2015. SDGs are universal and concern the economy, the societies' development and the environmental protection of both Northern and Southern countries. This book proposes a critical analysis of each of the 17 goals, of their interactions and contradictions. The climatic change and the populations' access to energy are some of the sustainable development challenges among many others

Use of a design challenge to develop postural support devices for intermediate wheelchair users

Directory of Open Access Journals (Sweden)

Brenda N. Onguti

2017-09-01

Full Text Available The provision of an appropriate wheelchair, one that provides proper fit and postural support, promotes wheelchair users’ physical health and quality of life. Many wheelchair users have postural difficulties, requiring supplemental postural support devices for added trunk support. However, in many low- and middle-income settings, postural support devices are inaccessible, inappropriate or unaffordable. This article describes the use of the design challenge model, informed by a design thinking approach, to catalyse the development of an affordable, simple and robust postural support device for low- and middle-income countries. The article also illustrates how not-for-profit organisations can utilise design thinking and, in particular, the design challenge model to successfully support the development of innovative solutions to product or process challenges.

BSN completion barriers, challenges, incentives, and strategies.

Science.gov (United States)

Duffy, Marie T; Friesen, Mary Ann; Speroni, Karen Gabel; Swengros, Diane; Shanks, Laura A; Waiter, Pamela A; Sheridan, Michael J

2014-04-01

The objectives of this study were to explore RN perceptions regarding barriers/challenges and incentives/supports for BSN completion and identify recommendations to increase RN BSN completion. The Institute of Medicine's 2011 The Future of Nursing report recommended the proportion of RNs with a BSN increase to 80% by 2020. This qualitative study included 41 RNs who participated in 1 of 6 focus groups based on their BSN completion status. Primary themes were sacrifices, barriers/challenges, incentives/supports, value, how to begin, and pressure. Primary BSN completion barriers/challenges were work-life balance and economic issues. Incentives/supports identified were financial compensation, assistance from employer and academic institution, and encouragement from family. Institutional strategies recommended for increasing BSN completion rates were improved access to education and financial support facilitated by collaboration between hospitals and academic institutions. Exploring RN barriers/challenges and incentives/supports for BSN completion can lead to implementation of institutional strategies, such as tuition reimbursement and academic collaboration.

Workplace Challenges: The Impact of Personal Beliefs and the Birth Environment.

Science.gov (United States)

Adams, Ellise D

This article reviews 2 workplace challenges faced by the perinatal nurse: the impact of personal beliefs and issues within the birth environment. It also explores how these challenges inform the birth practices of the perinatal nurse. The methods employed for this review are focus groups and a concept analysis. Two focus groups (n = 14) and a concept analysis based on a process defined by Walker and Avant provided a set of birth practices performed by the perinatal nurse who facilitates normal birth. Assertiveness was identified as a primary attribute of the perinatal nurse and several suggestions are identified as empirical referents or methods of measuring the abstract concepts, to identify the workplace challenges of the perinatal nurse. Development of effective processes, designed to overcome the many challenges facing the perinatal nurse, will assist in improving perinatal care for women and newborns.

Inquiry-based science education: towards a pedagogical framework for primary school teachers

Science.gov (United States)

van Uum, Martina S. J.; Verhoeff, Roald P.; Peeters, Marieke

2016-02-01

Inquiry-based science education (IBSE) has been promoted as an inspiring way of learning science by engaging pupils in designing and conducting their own scientific investigations. For primary school teachers, the open nature of IBSE poses challenges as they often lack experience in supporting their pupils during the different phases of an open IBSE project, such as formulating a research question and designing and conducting an investigation. The current study aims to meet these challenges by presenting a pedagogical framework in which four domains of scientific knowledge are addressed in seven phases of inquiry. The framework is based on video analyses of pedagogical interventions by primary school teachers participating in open IBSE projects. Our results show that teachers can guide their pupils successfully through the process of open inquiry by explicitly addressing the conceptual, epistemic, social and/or procedural domain of scientific knowledge in the subsequent phases of inquiry. The paper concludes by suggesting further research to validate our framework and to develop a pedagogy for primary school teachers to guide their pupils through the different phases of open inquiry.

Resilience of primary healthcare professionals: a systematic review.

Science.gov (United States)

Robertson, Helen D; Elliott, Alison M; Burton, Christopher; Iversen, Lisa; Murchie, Peter; Porteous, Terry; Matheson, Catriona

2016-06-01

Modern demands and challenges among healthcare professionals can be particularly stressful and resilience is increasingly necessary to maintain an effective, adaptable, and sustainable workforce. However, definitions of, and associations with, resilience have not been examined within the primary care context. To examine definitions and measures of resilience, identify characteristics and components, and synthesise current evidence about resilience in primary healthcare professionals. A systematic review was undertaken to identify studies relating to the primary care setting. Ovid(®), Embase(®), CINAHL, PsycINFO, and Scopus databases were searched in December 2014. Text selections and data extraction were conducted by paired reviewers working independently. Data were extracted on health professional resilience definitions and associated factors. Thirteen studies met the inclusion criteria: eight were quantitative, four qualitative, and one was an intervention study. Resilience, although multifaceted, was commonly defined as involving positive adaptation to adversity. Interactions were identified between personal growth and accomplishment in resilient physicians. Resilience, high persistence, high self-directedness, and low avoidance of challenges were strongly correlated; resilience had significant associations with traits supporting high function levels associated with demanding health professional roles. Current resilience measures do not allow for these different aspects in the primary care context. Health professional resilience is multifaceted, combining discrete personal traits alongside personal, social, and workplace features. A measure for health professional resilience should be developed and validated that may be used in future quantitative research to measure the effect of an intervention to promote it. © British Journal of General Practice 2016.

Resilience of primary healthcare professionals: a systematic review

Science.gov (United States)

Robertson, Helen D; Elliott, Alison M; Burton, Christopher; Iversen, Lisa; Murchie, Peter; Porteous, Terry; Matheson, Catriona

2016-01-01

Background Modern demands and challenges among healthcare professionals can be particularly stressful and resilience is increasingly necessary to maintain an effective, adaptable, and sustainable workforce. However, definitions of, and associations with, resilience have not been examined within the primary care context. Aim To examine definitions and measures of resilience, identify characteristics and components, and synthesise current evidence about resilience in primary healthcare professionals. Design and setting A systematic review was undertaken to identify studies relating to the primary care setting. Method Ovid®, Embase®, CINAHL, PsycINFO, and Scopus databases were searched in December 2014. Text selections and data extraction were conducted by paired reviewers working independently. Data were extracted on health professional resilience definitions and associated factors. Results Thirteen studies met the inclusion criteria: eight were quantitative, four qualitative, and one was an intervention study. Resilience, although multifaceted, was commonly defined as involving positive adaptation to adversity. Interactions were identified between personal growth and accomplishment in resilient physicians. Resilience, high persistence, high self-directedness, and low avoidance of challenges were strongly correlated; resilience had significant associations with traits supporting high function levels associated with demanding health professional roles. Current resilience measures do not allow for these different aspects in the primary care context. Conclusion Health professional resilience is multifaceted, combining discrete personal traits alongside personal, social, and workplace features. A measure for health professional resilience should be developed and validated that may be used in future quantitative research to measure the effect of an intervention to promote it. PMID:27162208

Helicobacter pylori infection: approach of primary care physicians in a developing country

Directory of Open Access Journals (Sweden)

Ali Shah Hasnain

2009-04-01

Full Text Available Abstract Background The aim of the study was to assess the knowledge and practices of primary care physicians in diagnosis and management of Helicobacter pylori (H. pylori infection in developing country. Methods This convenient sample based, cross sectional study was conducted in primary care physicians of Karachi, Pakistan from March 2008 to August 2008 through a pretested self-designed questionnaire, which contained 11 items pertaining to H. pylori route of transmission, diagnosis, indication for testing, treatment options, follow up and source of information. Results Out of 509 primary care physicians, 451 consented to participate with the response rate of 88.6%. Responses of 426 primary care physicians were analyzed after excluding 19 physicians. 78% of the physicians thought that contaminated water was the source of spread of infection, dyspepsia was the most frequent indication for investigating H. pylori infection (67% of the physicians, while 43% physicians were of the view that serology was the most appropriate test to diagnose active H. pylori infection. 77% of physicians thought that gastric ulcer was the most compelling indication for treatment, 61% physicians preferred Clarithromycin based triple therapy for 7–14 days. 57% of the physicians would confirm H. pylori eradication after treatment in selected patients and 47% physicians preferred serological testing for follow-up. In case of treatment failure, only 36% of the physicians were in favor of gastroenterologist referral. Conclusion The primary care physicians in this study lacked in knowledge regarding management of H. pylori infection. Internationally published guidelines and World gastroenterology organization (WGO practice guideline on H. pylori for developing countries have little impact on current practices of primary care physicians. We recommend more teaching programs, continuous medical education activities regarding H. pylori infection.

Improving primary teachers’ attitudes toward science by attitude-focused professional development

NARCIS (Netherlands)

van Aalderen-Smeets, Sandra; Walma van der Molen, Julie Henriëtte

2015-01-01

This article provides a description of a novel, attitude-focused, professional development intervention, and presents the results of an experimental pretest-posttest control group study investigating the effects of this intervention on primary teachers’ personal attitudes toward science, attitudes

`All We Did was Things Like Forces and Motion …': Multiple Discourses in the development of primary science teachers

Science.gov (United States)

Danielsson, Anna; Warwick, Paul

2014-01-01

Previous research has highlighted challenges associated with embracing an inquiry approach to science teaching for primary teachers, often associating these challenges with insecurity linked to the lack of content knowledge. We argue that in order to understand the extent to which primary student teachers are able to embrace science teaching informed by scientific literacy for all, it is important to take into account various, sometimes competing, science teacher and primary teacher Discourses. The aim of this paper is to explore how such Discourses are constituted in the context of learning to teach during a 1-year university-based Post Graduate Certificate of Education course. The empirical data consist of semi-structured interviews with 11 student teachers. The analysis identifies 5 teacher Discourses and we argue that these can help us to better understand some of the tensions involved in becoming a primary teacher with a responsibility for teaching science: for example, in terms of the interplay between the student teachers' own educational biographies and institutionally sanctioned Discourses. One conclusion is that student teachers' willingness and ability to embrace a Discourse of science education, informed by the aim of scientific literacy for all, may be every bit as constrained by their experience of learning science through 'traditional schooling' as it is by their confidence with respect to their own subject knowledge. The 5 Discourses, with their complex interrelations, raise questions about which identity positions are available to students in the intersections of the Discourses and which identity positions teacher educators may seek to make available for their students.

Triple synchronous primary lung cancer: a case report and review of the literature.

Science.gov (United States)

Kashif, Muhammad; Ayyadurai, Puvanalingam; Thanha, Luong; Khaja, Misbahuddin

2017-09-01

Multiple primary lung cancer may present in synchronous or metachronous form. Synchronous multiple primary lung cancer is defined as multiple lung lesions that develop at the same time, whereas metachronous multiple primary lung cancer describes multiple lung lesions that develop at different times, typically following treatment of the primary lung cancer. Patients with previously treated lung cancer are at risk for developing metachronous lung cancer, but with the success of computed tomography and positron emission tomography, the ability to detect both synchronous and metachronous lung cancer has increased. We present a case of a 63-year-old Hispanic man who came to our hospital for evaluation of chest pain, dry cough, and weight loss. He had recently been diagnosed with adenocarcinoma in the right upper lobe, with a poorly differentiated carcinoma favoring squamous cell cancer based on bronchoalveolar lavage of the right lower lobe for which treatment was started. Later, bronchoscopy incidentally revealed the patient to have an endobronchial lesion that turned out to be mixed small and large cell neuroendocrine lung cancer. Our patient had triple synchronous primary lung cancers that histologically were variant primary cancers. Triple synchronous primary lung cancer management continues to be a challenge. Our patient's case suggests that multiple primary lung cancers may still occur at a greater rate than can be detected by high-resolution computed tomography.

Preventing and managing challenging behaviour.

Science.gov (United States)

Hallett, Nutmeg

2018-02-21

Patients exhibiting challenging behaviour, which includes any non-verbal, verbal or physical behaviour, is a significant issue in healthcare settings. Preventing such behaviour and the harm it can cause is important for healthcare organisations and individuals, and involves following a public health model comprised of three tiers: primary, secondary and tertiary prevention. Primary prevention aims to reduce the risk of challenging behaviour occurring in the first instance; secondary prevention involves reducing the risk associated with imminent challenging behaviour and its potential escalation; and tertiary prevention focuses on minimising the physical and emotional harm caused by challenging behaviours, during and after an event. De-escalation should be the first-line response to challenging behaviour, and healthcare staff should use a range of techniques - maintaining safety, self-regulation, effective communication, and assessment and actions - to reduce the incidence of challenging behaviour. In some situations, physical interventions may be required to protect the safety of the individual, healthcare staff and other individuals involved, and healthcare staff should be aware of local policies and procedures for this. Following a serious incident, where there was potential or actual harm to patients and healthcare staff, healthcare organisations should use post-incident reviews to learn from the situation, while healthcare staff should be offered the opportunity for debriefing. Positive responses to challenging behaviour at an organisational and individual level can lead to improved work environments for healthcare staff and optimal patient care and outcomes. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Comparing varieties of in-service English Language Training for primary school teachers in Norway

Directory of Open Access Journals (Sweden)

James Coburn

2014-09-01

Full Text Available International trends show the formal teaching of English beginning at an increasingly early age. This presents challenges for national education systems and in particular, for primary schools and for primary school teachers who are not necessarily trained as English teachers. This paper looks at two different responses to the situation in Norway, through research into two different ways of organising, designing and implementing in-service English Training (INSET for primary school teachers. One is a nationally organised program, the other is a local initiative. The contexts for the two different kinds of courses are outlined and the designs of the courses presented through document analysis interspersed with extracts from interviews with teacher trainers. Strengths and weaknesses of the two different kinds of courses are compared. The study concludes that if English teaching in primary schools in Norway is to improve towards 2030, there is a need for the introduction of new programs and structures for the development of teacher trainers with primary school teaching experience, and for the systematic development of networks of primary school English teachers with the aim of nurturing and sustaining their professional development

The challenge of tetradic relationships in medically interpreted pediatric primary care visits: A descriptive study of communication practices.

Science.gov (United States)

Pope, C A; Escobar-Gomez, M; Davis, B H; Roberts, J R; O'Brien, E S; Hinton, E; Darden, P M

2016-04-01

To examine spoken interactions between pediatricians and community-based interpreters speaking with adolescents and parents with Limited English proficiency (LEP) in primary care to identify the challenges of interpreting in a four-person or tetradic visit, its sources of co-constructed errors, and specific practices for educational intervention. As part of a larger study of vaccine decision-making at six clinical sites in two states, this descriptive study used discourse analysis to examine 20 routine primary care visits in a Latino Clinic in interactions between adolescents, parents, community-based interpreters, and pediatricians. Specific patterns of communication practices were identified that contributed to inaccuracies in medical interpretation Practices needing improvement were tallied for simple frequencies and included: omissions; false fluency; substitutions; editorializing; added clarification, information, or questions; medical terminology; extra explanation to mother; and, cultural additions. Of these speaking practices, omissions were the most common (123 out of 292 total) and the most affected by pediatricians. The dynamics of both pediatricians and interpreters contributed to identification of areas for improvement, with more adolescent participation in bilingual than monolingual visits. These observations provide opportunities for mapping a communication skills training intervention based on observations for future testing of an evidence-based curriculum. Published by Elsevier Ireland Ltd.

How the Project Approach Challenges Young Children

Science.gov (United States)

Burns, Marcia V.; Lewis, Alisha L.

2016-01-01

In this article, educators at University Primary School in Champaign, Illinois, share examples and understandings of the ways The Project Approach challenges young children to think critically about topics of importance in their world. Project investigations that provoke academic and social challenges for individuals and classroom communities of…

Diagnostic challenges in primary brain stem glioblastoma multiform; a case report

Directory of Open Access Journals (Sweden)

Muhammad Taimur Malik, MD

2017-12-01

Full Text Available Brainstem gliomas are rare form of primary brain tumors in adult and represent <2% of gliomas. Glioblastomas (GBM are much less common in pediatric patients; adult GBM vary in presentation and response to therapy, and generally have a very poor prognosis. GBM is less common in the brainstem, comprising <2% gliomas and there is therefore limited data available to provide a standard of care. Here we present a case report of a patient who presented with aggressive primary pontine GBM.

Global challenges

International Nuclear Information System (INIS)

Blix, H.

1990-01-01

A major challenge now facing the world is the supply of energy needed for growth and development in a manner which is not only economically viable but also environmentally acceptable and sustainable in view of the demands of and risks to future generations. The internationally most significant pollutants from energy production through fossil fuels are SO 2 and NO x which cause acid rain, and CO 2 which is the most significant contributor to the greenhouse effect. Nuclear power, now providing about 17% of the world's electricity and 5% of the primary energy already is making a notable contribution to avoiding these emissions. While the industrialized countries will need more energy and especially electricity in the future, the needs of the developing countries are naturally much larger and present a tremendous challenge to the shaping of the world's future energy supply system. The advanced countries will have to accept special responsibilities, as they can most easily use advanced technologies and they have been and remain the main contributors to the environmental problems we now face. Energy conservation and resort to new renewable energy sources, though highly desirable, appear inadequate alone to meet the challenges. The world can hardly afford to do without an increased use of nuclear power, although it is strongly contested in many countries. The objections raised against the nuclear option focus on safety, waste management and disposal problems and the risk for proliferation of nuclear weapons. These issues are not without their problems. The risk of proliferation exists but will not appreciably diminish with lesser global reliance on nuclear power. The waste issue is more of a political than a technical problem. The use of nuclear power, or any other energy source, will never be at zero risk, but the risks are constantly reduced by new techniques and practices. The IAEA sees it as one of its priority tasks to promote such techniques. (author)

Biomass energy development in California: Accomplishments and challenges

International Nuclear Information System (INIS)

Miller, W.G.

1994-01-01

The recent and rapid growth of biomass power development in California has created the largest contiguous biomass fueled electrical generating capacity in U.S. This growth has been fostered by resource availability, federal (PURPA) incentives, and the entrepeneurial response of independent power producers. California's environment has benefited from reduced air emissions, wildfire suppression, landfill reduction and the sequestering of carbon. The state has benefited economically through capital investment, employment for several thousand, and the generation of over $100 million in state and local tax revenues. Along with the benefits have come serious challenges brought about largely due to changes in the utility and regulatory environment. These changes threaten the continued existence and economic viability of the developed biomass power industry in California and threatens to establish national precedents. Specific issues are identified and recommended actions are presented

Addressing complex challenges using a co-innovation approach

NARCIS (Netherlands)

Vereijssen, Jessica; Srinivasan, M.S.; Dirks, Sarah; Fielke, Simon; Jongmans, C.T.; Agnew, Natasha; Klerkx, Laurens; Pinxterhuis, Ina; Moore, John; Edwards, Paul; Brazendale, Rob; Botha, Neels; Turner, James A.

2017-01-01

Co-innovation can be effective for complex challenges – involving interactions amongst multiple stakeholders, viewpoints, perceptions, practices and interests across programmes, sectors and national systems. Approaches to challenges in the primary sector have tended to be linear, where tools and

Raising Awareness of Urban Environment Development in Primary Schools

Directory of Open Access Journals (Sweden)

Rosi Maja

2016-12-01

Full Text Available In the past few years, excessive efforts have been made to increase the city’s attractiveness and its international positioning. Also studies on the so-called city destination branding are on the rise. Theorists, as Ramirez (2001, Marzano and Scott (2009, among many others, are discussing different aspects of this complex process. Many approaches and strategies are dealing with the positioning of urban environments and city destinations, trying to provide at least some partial answers about achieving this objective. With proper marketing and branding, cities can do a lot to attract tourists and visitors. For successful city marketing and branding and for the successful long-term positioning of the destination in general, it is necessary to involve the key stakeholders and collaborate with as many as possible despite the fact that the branding of a city destination (or any destination for that matter is a complex process. It is significant that all the stakeholders, who are always carriers of different interests, are invited to collaborate in the planning of the tourism development and tourism development strategies, from the government, the private sector, schools etc. It is also important to involve the citizens, who can provide a valuable opinion about the environment they live in – what they like about their environment, what suggestion would they give to tourists about gastronomy, attractions, shops, events, etc. It is significant that citizens are proud of their urban environment, that they know their own environment, and that they have the motivation for the involvement in the process of improvement of their home environment (through projects, discussions, etc.. It is impossible to create attractive urban environments or cities if residents do not have a positive opinion about the place they live in. That is why it is essential for the education institutions at all levels, but especially for the institutions at the primary levels to

Challenges facing procurement professionals in developing economies: Unlocking value through professional international purchasing

Directory of Open Access Journals (Sweden)

Marian Tukuta

2015-04-01

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.

Challenges in educating patients and parents about differences in sex development.

Science.gov (United States)

McCauley, Elizabeth

2017-06-01

This article reviews practical approaches to talking with parents and youth about Differences in Sex Development (DSD) which are conditions that affect chromosomal, gonadal, or anatomic sexual development, one of the most personal, and in our society, private areas of life. Talking with parents and patients about these conditions can be challenging given the complexity of sexual development and the sensitive nature of the information being shared. Changing approaches to disclosing or communicating information about conditions, such as DSD are reviewed as well as factors leading to revision in the diagnostic nomenclature. Building on these developments, strategies used by an established DSD team to enhance shared decision making and partnership with families and patients are presented followed by examples of how some particularly challenging, but not uncommon clinical situations were approached. The paper concludes by endorsing the importance of understanding the social and cultural needs and beliefs of the parents and patients with DSD to set the stage for effective disclosure of medical facts. To be most useful to parents and youth, medical disclosure needs to include discussion of practical implications and strategies to help families and patients digest, understand, and work with the information provided. © 2017 Wiley Periodicals, Inc.

The challenges of primary health care nurse leaders in the wake of New Health Care Reform in Norway.

Science.gov (United States)

Tingvoll, Wivi-Ann; Sæterstrand, Torill; McClusky, Leon Mendel

2016-01-01

The local municipality, whose management style is largely inspired by the New Public Management (NPM) model, has administrative responsibilities for primary health care in Norway. Those responsible for health care at the local level often find themselves torn between their professional responsibilities and the municipality's market-oriented funding system. The introduction of the new health care reform process known as the Coordination Reform in January 2012 prioritises primary health care while simultaneously promoting a more collaborative and multidisciplinary approach to health care. Nurse leaders experience constant cross-pressure in their roles as members of the municipal executive team, the execution of their professional and administrative duties, and the overall political aims of the new reform. The aim of this article is to illuminate some of the major challenges facing nurse leaders in charge of nursing homes and to draw attention to their professional concerns about the quality of nursing care with the introduction of the new reform and its implementation under NPM-inspired municipal executive leadership. This study employs a qualitative design. In-depth interviews were conducted with 10 nurse leaders in 10 municipalities, with a phenomenological-hermeneutic approach used for data analysis and interpretation. Findings highlighted the increasingly complex challenges facing nurse leaders operating in the context of the municipality's hierarchical NPM management structure, while they are required to exercise collaborative professional interactions as per the guidelines of the new Coordination Reform. The interview findings were interpreted out of three sub-themes 1) importance of support for the nurse leader, 2) concerns about overall service quality, and 3) increased tasks unrelated to nursing leadership. The priorities of municipal senior management and the focus of the municipality's care service need clarification in the light of this reform. The voices

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

Directory of Open Access Journals (Sweden)

Hogg William

2010-12-01

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

Intervening: Managerial Issues and Challenges in an Educational Management Development Program.

Science.gov (United States)

Barrilleaux, Louis E.; Schermerhorn, John R., Jr.

The literature on intervention theory tends to overlook the pragmatic managerial issues and challenges of intervening. This paper analyzes the formative period of a school management development program to establish crucial differences between the program director's espoused theory and the actual experience of the intervention. These differences…

Development trends in the Azerbaijan oil and gas sector: Achievements and challenges

International Nuclear Information System (INIS)

Ciarreta, Aitor; Nasirov, Shahriyar

2012-01-01

This article is study of Azerbaijan oil and gas industry. It illustrates the business climate, the impact of this sector on Azerbaijan's economy including role of SOFAZ and highlights recent developments in the energy production and the main concepts of . Meanwhile, the article establishes the government policy by indentifying several factors that influenced to attract foreign investment to oil and gas sector and examines significant challenges that still remain for further development of the country's oil industry. - Highlights: ► In this study, we review the oil and gas sector in Azerbaijan and describe the main government policies for attracting foreign investment to the sector. ► We showed that providing a predictable legislative and regulatory framework and attractive conditions for oil contracting encourages foreign investment inflows to the country. ► Issues such as the lack of independent regulatory institutions, rehabilitation of oil refineries and resolution of the legal status of the Caspian Sea remain major challenges for further development of the oil and gas industries.

Developing Strategies for Islamic Banks to Face the Future Challenges of Financial Globalization

OpenAIRE

Al Ajlouni, Ahmed

2004-01-01

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 ...

Challenges in developing a comprehensive, automated and flexible oil accounting system

Energy Technology Data Exchange (ETDEWEB)

Nordell, L.F.; Ruda, H. [Enbridge Pipelines Inc., Edmonton, AB (Canada)

2004-07-01

Enbridge Pipelines Inc. operates a long and complex system of pipelines which transport hydrocarbon liquid commodities, including crude oils, refined products and natural gas liquids across provincial and national boundaries. Due to growing internal demands for the addition of pipelines, the company developed a comprehensive oil accounting (OA) system in 1998. The OA accommodated changing business requirements by incorporating more complex tariff agreements and the demand for customized system reporting for customers. The new OA was also compatible with the company's technology direction, which focused on aligning information technology (IT) with business drivers and upgrading the flexibility of the entire OA system. This paper summarized the business improvement and redevelopment study; the OA system redevelopment project; challenges of integrating new system components with the legacy system during system development; specific process improvement results that were targeted and achieved by the new system development team; and, the project development challenges. The project team adopted a software development approach that was responsive to changes in the requirements and in the project direction introduced by key stakeholders during the life of the project. The project management approaches and logic of the SCRUM and extreme programming (XP) methods were combined to incorporate the principles of agile development to ensure a quality product. The result was an automated crude oil balancing and revenue accounting system that interfaced with other pipeline management software systems. 6 refs., 5 figs.

The Challenges of Good Governance, Accountability of Governmental Agencies and Development in Nigeria

Directory of Open Access Journals (Sweden)

Daniel E. GBEREVBIE

2014-12-01

Full Text Available Some scholars have argued that the enhanced performance of governmental agencies in any nation is a product of good governance, accountability, transparency and trust, which in turn brings about the improvement in the living standard of the people. The implication of this position is that where good governance is absent, accountability of governmental agencies and development in such a society is likely to be affected negatively. With the analysis of secondary data, the paper examines the challenges of good governance, accountability of governmental agencies and development in Nigeria. It observes the manifestation of unethical behaviour amongst public officials as the major challenge hindering development in the country. It therefore recommend among others the need for the government to strengthen the existing anti-corruption agencies to enable them enforce proper ethical standard.

Development and psychometric testing of the Nurse Practitioner Primary Care Organizational Climate Questionnaire.

Science.gov (United States)

Poghosyan, Lusine; Nannini, Angela; Finkelstein, Stacey R; Mason, Emanuel; Shaffer, Jonathan A

2013-01-01

Policy makers and healthcare organizations are calling for expansion of the nurse practitioner (NP) workforce in primary care settings to assure timely access and high-quality care for the American public. However, many barriers, including those at the organizational level, exist that may undermine NP workforce expansion and their optimal utilization in primary care. This study developed a new NP-specific survey instrument, Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), to measure organizational climate in primary care settings and conducted its psychometric testing. Using instrument development design, the organizational climate domain pertinent for primary care NPs was identified. Items were generated from the evidence and qualitative data. Face and content validity were established through two expert meetings. Content validity index was computed. The 86-item pool was reduced to 55 items, which was pilot tested with 81 NPs using mailed surveys and then field-tested with 278 NPs in New York State. SPSS 18 and Mplus software were used for item analysis, reliability testing, and maximum likelihood exploratory factor analysis. Nurse Practitioner Primary Care Organizational Climate Questionnaire had face and content validity. The content validity index was .90. Twenty-nine items loaded on four subscale factors: professional visibility, NP-administration relations, NP-physician relations, and independent practice and support. The subscales had high internal consistency reliability. Cronbach's alphas ranged from.87 to .95. Having a strong instrument is important to promote future research. Also, administrators can use it to assess organizational climate in their clinics and propose interventions to improve it, thus promoting NP practice and the expansion of NP workforce.

Development of a meta-algorithm for guiding primary care encounters for patients with multimorbidity using evidence-based and case-based guideline development methodology.

Science.gov (United States)

Muche-Borowski, Cathleen; Lühmann, Dagmar; Schäfer, Ingmar; Mundt, Rebekka; Wagner, Hans-Otto; Scherer, Martin

2017-06-22

The study aimed to develop a comprehensive algorithm (meta-algorithm) for primary care encounters of patients with multimorbidity. We used a novel, case-based and evidence-based procedure to overcome methodological difficulties in guideline development for patients with complex care needs. Systematic guideline development methodology including systematic evidence retrieval (guideline synopses), expert opinions and informal and formal consensus procedures. Primary care. The meta-algorithm was developed in six steps:1. Designing 10 case vignettes of patients with multimorbidity (common, epidemiologically confirmed disease patterns and/or particularly challenging health care needs) in a multidisciplinary workshop.2. Based on the main diagnoses, a systematic guideline synopsis of evidence-based and consensus-based clinical practice guidelines was prepared. The recommendations were prioritised according to the clinical and psychosocial characteristics of the case vignettes.3. Case vignettes along with the respective guideline recommendations were validated and specifically commented on by an external panel of practicing general practitioners (GPs).4. Guideline recommendations and experts' opinions were summarised as case specific management recommendations (N-of-one guidelines).5. Healthcare preferences of patients with multimorbidity were elicited from a systematic literature review and supplemented with information from qualitative interviews.6. All N-of-one guidelines were analysed using pattern recognition to identify common decision nodes and care elements. These elements were put together to form a generic meta-algorithm. The resulting meta-algorithm reflects the logic of a GP's encounter of a patient with multimorbidity regarding decision-making situations, communication needs and priorities. It can be filled with the complex problems of individual patients and hereby offer guidance to the practitioner. Contrary to simple, symptom-oriented algorithms, the meta

Clinical diagnostic model for sciatica developed in primary care patients with low back-related leg pain

Science.gov (United States)

Konstantinou, Kika; Ogollah, Reuben; Hay, Elaine M.; Dunn, Kate M.

2018-01-01

Background Identification of sciatica may assist timely management but can be challenging in clinical practice. Diagnostic models to identify sciatica have mainly been developed in secondary care settings with conflicting reference standard selection. This study explores the challenges of reference standard selection and aims to ascertain which combination of clinical assessment items best identify sciatica in people seeking primary healthcare. Methods Data on 394 low back-related leg pain consulters were analysed. Potential sciatica indicators were seven clinical assessment items. Two reference standards were used: (i) high confidence sciatica clinical diagnosis; (ii) high confidence sciatica clinical diagnosis with confirmatory magnetic resonance imaging findings. Multivariable logistic regression models were produced for both reference standards. A tool predicting sciatica diagnosis in low back-related leg pain was derived. Latent class modelling explored the validity of the reference standard. Results Model (i) retained five items; model (ii) retained six items. Four items remained in both models: below knee pain, leg pain worse than back pain, positive neural tension tests and neurological deficit. Model (i) was well calibrated (p = 0.18), discrimination was area under the receiver operating characteristic curve (AUC) 0.95 (95% CI 0.93, 0.98). Model (ii) showed good discrimination (AUC 0.82; 0.78, 0.86) but poor calibration (p = 0.004). Bootstrapping revealed minimal overfitting in both models. Agreement between the two latent classes and clinical diagnosis groups defined by model (i) was substantial, and fair for model (ii). Conclusion Four clinical assessment items were common in both reference standard definitions of sciatica. A simple scoring tool for identifying sciatica was developed. These criteria could be used clinically and in research to improve accuracy of identification of this subgroup of back pain patients. PMID:29621243

Non-dental primary care providers’ views on challenges in providing oral health services and strategies to improve oral health in Australian rural and remote communities: a qualitative study

Science.gov (United States)

Barnett, Tony; Hoang, Ha; Stuart, Jackie; Crocombe, Len

2015-01-01

Objectives To investigate the challenges of providing oral health advice/treatment as experienced by non-dental primary care providers in rural and remote areas with no resident dentist, and their views on ways in which oral health and oral health services could be improved for their communities. Design Qualitative study with semistructured interviews and thematic analysis. Setting Four remote communities in outback Queensland, Australia. Participants 35 primary care providers who had experience in providing oral health advice to patients and four dental care providers who had provided oral health services to patients from the four communities. Results In the absence of a resident dentist, rural and remote residents did present to non-dental primary care providers with oral health problems such as toothache, abscess, oral/gum infection and sore mouth for treatment and advice. Themes emerged from the interview data around communication challenges and strategies to improve oral health. Although, non-dental care providers commonly advised patients to see a dentist, they rarely communicated with the dentist in the nearest regional town. Participants proposed that oral health could be improved by: enabling access to dental practitioners, educating communities on preventive oral healthcare, and building the skills and knowledge base of non-dental primary care providers in the field of oral health. Conclusions Prevention is a cornerstone to better oral health in rural and remote communities as well as in more urbanised communities. Strategies to improve the provision of dental services by either visiting or resident dental practitioners should include scope to provide community-based oral health promotion activities, and to engage more closely with other primary care service providers in these small communities. PMID:26515687

Practices and Challenges in the Provision of Pre-Primary Education ...

African Journals Online (AJOL)

DrNneka

An International Multidisciplinary Journal, Ethiopia. Vol. 10(1), Serial ... This study concludes that only few schools in Monduli district provided pre-primary ... 1990). Hallinger (1992) asserts that one way to create education change is to improve.

Primary cilia and coordination of signaling pathways in heart development and tissue Homeostasis

DEFF Research Database (Denmark)

Clement, Christian Alexandro

of primary cilia in coordinating Hh signaling in human pancreatic development and postnatal tissue homeostasis. In cultures of human pancreatic duct adenocarcinoma cell lines PANC-1 and CFPAC-1, Ptc in addition to Gli2 and Smo localize to primary cilia. These findings are consistent with the idea...... that the primary cilium continues to coordinate Hh signaling in cells derived from the mature pancreas. The fact that the Hh signaling pathway is active in the CFPAC-1 and PANC-1 cell lines without Hh stimulation suggests that ciliary Hh signaling plays a potential role in tumorigenesis. In conclusion, this thesis...

Grand Challenges and Chemical Engineering Curriculum--Developments at TU Dortmund University

Science.gov (United States)

Kockmann, Norbert; Lutze, Philip; Gorak, Andrzej

2016-01-01

Chemical processing industry is progressively focusing their research activities and product placements in the areas of Grand Challenges (or Global Megatrends) such as mobility, energy, communication, or health care and food. Innovation in all these fields requires solving high complex problems, rapid product development as well as dealing with…

Development Challenges in Bhutan

DEFF Research Database (Denmark)

This book provides essential insights into Bhutan’s developmental challenges. It analyzes and scrutinizes the sovereign state’s developmental approach, including the idea of Gross National Happiness (GNH), which has replaced Gross National Product (GNP) as a measurement of prosperity. The authors...... also explore and deconstruct ideational and cultural aspects of knowledge production and present a critical overall assessment of the political economy of education policy, health, ICT and migration in Bhutan. The book is divided into five parts all taking a critical approach towards inequality: Part...

Cell-mediated and humoral immune responses in pigs following primary and challenge-exposure to Lawsonia intracellularis

DEFF Research Database (Denmark)

Hvass, Henriette Cordes; Riber, Ulla; Jensen, Tim Kåre

2012-01-01

not boosted by the re-inoculation, since identical intestinal IgA responses developed in response to the inoculation in both the susceptible CC pigs and the protected RE pigs. A memory recall cell-mediated immune response developed in RE pigs which was significantly stronger compared to the primary response...... responses are likely mediators of protective immunity against L. intracellularis, with CD8+ effector cells and CD4+CD8+ double positive memory T cells as main contributors to the antigen-specific IFN-γ production....

Development of Hyperthyroidism Following Primary Hypothyroidism: A Case Report

Directory of Open Access Journals (Sweden)

Yueh-Hua Chung

2004-04-01

Full Text Available Development of hyperthyroidism following primary hypothyroidism is uncommon, and only a few documented cases have been reported. Alterations in thyroid-stimulating hormone receptor antibodies in serum are currently considered to play the main role in the pathophysiology, but the exact mechanism is still unknown. Here, we report the case of a 60-year-old man with disturbed consciousness due to hyponatremia. Thyroid function tests showed primary hypothyroidism with a high anti-microsomal antibody titer (1:6,400. The patient experienced weight loss and exophthalmos 6 years later. Serum thyroid hormone levels were increased and thyroxine treatment was discontinued, but the patient remained thyrotoxic 2 months later. 131I thyroid uptake was 40.9% at 24 hours, and bilateral thyroid lobes were not enlarged with diffuse radioactivity. Six months later, the patient was still thyrotoxic and therapy with methimazole 10 mg/day was started. He is now taking methimazole and is euthyroid.

Complex Challenges in the Less-Developed World

Science.gov (United States)

Webster, P. J.

2016-12-01

The developing world faces special challenges in a changing climate. The immediate impacts of possible increased precipitation, more frequent and severe hazard events and sea-level rise are compounded by lack of resources and, often, rapidly growing populations. We examine the concept that the society that learns to deal with hazards in the current climate will be best placed to deal with possibly more frequent and more intense hazards in the future. We use as an example the conundrum facing Bangladesh where global sea-level rise is exaggerated by delta subsidence of river sediment. Sedimentation is expected to increase with increased river flow. We explore how authorities may deal with these multifaceted threats and how they need to carefully thread a strategy that leads to solutions and not exaggerations of the problem.

The development of an RME-based geometrycourse for Indonesian Primary schools

NARCIS (Netherlands)

Fauzan, A.; Plomp, T.; Gravemeijer, K.P.E.; Plomp, T.; Nieveen, N.

2013-01-01

The aim of this study was to develop and implement a valid, practical, and effective RME-based geometry course for Indonesian primary schools using design research approach. The research activities were divided into three stages namely front-end analysis, prototyping stage, and assessment stage that

Improving Primary Teachers' Attitudes toward Science by Attitude-Focused Professional Development

Science.gov (United States)

van Aalderen-Smeets, Sandra I.; van der Molen, Juliette H. Walma

2015-01-01

This article provides a description of a novel, attitude-focused, professional development intervention, and presents the results of an experimental pretest-posttest control group study investigating the effects of this intervention on primary teachers' personal attitudes toward science, attitudes toward teaching science, and their science…

Challenge in environmentally sustainable development in some southern African developing countries

International Nuclear Information System (INIS)

Chiburre, J.A.

2005-01-01

This paper examines the challenges in attaining environmentally sustainable development in some southern African developing countries, with main focus on environmentally degrading activities carried out by the poor rural communities as the only way of scaling down poverty. The typical examples include, among others, charcoal burning, firewood gathering and hunting. These activities are practiced by poor rural communities for commercial purposes, with the main market being the urban areas; whose population increase and the inability to afford electricity for domestic purposes have made the demand for charcoal and firewood to increase. While recognising the right for the basic needs for everyone, efforts have been made to reduce the pressure exerted by rural communities on to natural resources, and alternative income generating activities have been adopted. However, successes in these fields are still not observable. The paper also discusses the need for integrated approaches that might reduce the demand on natural forest resources-based energy, which consist of subsidized electricity, fast growing tree plantation, and energy efficiency, among others. (author)

Challenges of developing and conducting clinical trials in rare disorders.

Science.gov (United States)

Kempf, Lucas; Goldsmith, Jonathan C; Temple, Robert

2018-04-01

Rare disease drug development is a rapidly expanding field. Clinical researchers in rare diseases face many challenges when conducting trials in small populations. Disease natural history is often poorly understood and the ability to detect clinically meaningful outcomes requires understanding of their rate of occurrence and variability, both of which contribute to difficulties in powering a study. Standard trial designs are not optimized to obtain adequate safety and efficacy data from small numbers of patients, so alternative designs (enrichment, crossover, adaptive, N-of 1) need to be considered. The affected patients can be hard to identify, especially early in the course of their disease, are generally geographically dispersed, and are often children. Trials are frequently conducted on an international scale and may be subject to complex or multiple regulatory agency oversights and may be affected by local customs, cultures, and practices. A basic understanding of the FDA programs supporting development of drugs for rare diseases is provided by this review and the role of early consultation with the FDA is emphasized. Of recent FDA New Molecular Entities (NME) approvals, 41% (17 approvals) in 2014, 47% (21 approvals) in 2015, and 41% (9 approvals) in 2016 were for rare disease indications. Through effective interactions and collaborations with physicians, institutions, and patient groups, sponsors have been successful in bringing new treatments to market for individuals affected by rare diseases. Challenges to drug development have been overcome through the focused efforts of patients/families, non-profit patient advocacy groups, drug developers, and regulatory authorities. © 2017 Wiley Periodicals, Inc.

Development of a virtual training simulator for a challenging refurbishment task

International Nuclear Information System (INIS)

Mort, P.E.

1996-01-01

An overview is presented of the technology, developed by British Nuclear Fuels Limited (BNFL), to create a virtual training simulator for refurbishment tasks. It focuses on the Raffinate Project, a challenging plant modification take, performed remotely, during which component removal, welding and installation of new components are all undertaken. The Training Simulator developed required fast multiprocessor computing with system intercommunication. Operators responded well to the Training Simulator and further improvements to the system are underway. (UK)

Implementing Free Primary Education Policy in Malawi and Ghana: Equity and Efficiency Analysis

Science.gov (United States)

Inoue, Kazuma; Oketch, Moses

2008-01-01

Malawi and Ghana are among the numerous Sub-Saharan Africa countries that have in recent years introduced Free Primary Education (FPE) policy as a means to realizing the 2015 Education for All and Millennium Development Goals international targets. The introduction of FPE policy is, however, a huge challenge for any national government that has…

Priorities for health services research in primary care.

NARCIS (Netherlands)

Schäfer, W.; Groenewegen, P.P.; Hansen, J.; Black, N.

2011-01-01

Background: All European health systems face several common challenges related to increases in lifestyle and chronic diseases, a decreasing future workforce, inequalities in health and the consequences of societal changes. Primary care, which has the potential to help meet these challenges, would

Review: New Vaccine Against Tuberculosis: Current Developments and Future Challenges

Science.gov (United States)

Liu, Jun

2009-04-01

Tuberculosis (TB) continues to be a global health threat. BCG was developed as an attenuated live vaccine for tuberculosis control nearly a century ago. Despite being the most widely used vaccine in human history, BCG is not an ideal vaccine and has two major limitations: its poor efficacy against adult pulmonary TB and its disconcerting safety in immunocompromised individuals. A safer and more effective TB vaccine is urgently needed. This review article discusses current strategies to develop the next generation of TB vaccines to replace BCG. While some progresses have been made in the past decade, significant challenges lie ahead.

Enhancing Teacher Education in Primary Mathematics with Mobile Technologies

Science.gov (United States)

Schuck, Sandy

2016-01-01

A challenge of teacher education is to produce graduate primary school teachers who are confident and competent teachers of mathematics. Various approaches to primary school teacher education in mathematics have been investigated, but primary teacher education graduates still tend to be diffident in their teaching of mathematics. In an age where…

Bridging the gap in ageing: Translating policies into practice in Malaysian Primary Care

Directory of Open Access Journals (Sweden)

Ambigga Krishnapillai S

2011-03-01

Full Text Available Abstract Population ageing is poised to become a major challenge to the health system as Malaysia progresses to becoming a developed nation by 2020. This article aims to review the various ageing policy frameworks available globally; compare aged care policies and health services in Malaysia with Australia; and discuss various issues and challenges in translating these policies into practice in the Malaysian primary care system. Fundamental solutions identified to bridge the gap include restructuring of the health care system, development of comprehensive benefit packages for older people under the national health financing scheme, training of the primary care workforce, effective use of electronic medical records and clinical guidelines; and empowering older people and their caregivers with knowledge, skills and positive attitudes to ageing and self care. Ultimately, family medicine specialists must become the agents for change to lead multidisciplinary teams and work with various agencies to ensure that better coordination, continuity and quality of care are eventually delivered to older patients across time and settings.

Health psychology in primary care: recent research and future directions.

Science.gov (United States)

Thielke, Stephen; Thompson, Alexander; Stuart, Richard

2011-01-01

Over the last decade, research about health psychology in primary care has reiterated its contributions to mental and physical health promotion, and its role in addressing gaps in mental health service delivery. Recent meta-analyses have generated mixed results about the effectiveness and cost-effectiveness of health psychology interventions. There have been few studies of health psychology interventions in real-world treatment settings. Several key challenges exist: determining the degree of penetration of health psychology into primary care settings; clarifying the specific roles of health psychologists in integrated care; resolving reimbursement issues; and adapting to the increased prescription of psychotropic medications. Identifying and exploring these issues can help health psychologists and primary care providers to develop the most effective ways of applying psychological principles in primary care settings. In a changing health care landscape, health psychologists must continue to articulate the theories and techniques of health psychology and integrated care, to put their beliefs into practice, and to measure the outcomes of their work.

Blanket/first wall challenges and required R&D on the pathway to DEMO

International Nuclear Information System (INIS)

Abdou, Mohamed; Morley, Neil B.; Smolentsev, Sergey; Ying, Alice; Malang, Siegfried; Rowcliffe, Arthur; Ulrickson, Mike

2015-01-01

The breeding blanket with integrated first wall (FW) is the key nuclear component for power extraction, tritium fuel sustainability, and radiation shielding in fusion reactors. The ITER device will address plasma burn physics and plasma support technology, but it does not have a breeding blanket. Current activities to develop “roadmaps” for realizing fusion power recognize the blanket/FW as one of the principal remaining challenges. Therefore, a central element of the current planning activities is focused on the question: what are the research and major facilities required to develop the blanket/FW to a level which enables the design, construction and successful operation of a fusion DEMO? The principal challenges in the development of the blanket/FW are: (1) the Fusion Nuclear Environment – a multiple-field environment (neutrons, heat/particle fluxes, magnetic field, etc.) with high magnitudes and steep gradients and transients; (2) Nuclear Heating in a large volume with sharp gradients – the nuclear heating drives most blanket phenomena, but accurate simulation of this nuclear heating can be done only in a DT-plasma based facility; and (3) Complex Configuration with blanket/first wall/divertor inside the vacuum vessel – the consequence is low fault tolerance and long repair/replacement time. These blanket/FW development challenges result in critical consequences: (a) non-fusion facilities (laboratory experiments) need to be substantial to simulate multiple fields/multiple effects and must be accompanied by extensive modeling; (b) results from non-fusion facilities will be limited and will not fully resolve key technical issues. A DT-plasma based fusion nuclear science facility (FNSF) is required to perform “multiple effects” and “integrated” experiments in the fusion nuclear environment; and (c) the Reliability/Availability/Maintainability/Inspectability (RAMI) of fusion nuclear components is a major challenge and is one of the primary reasons

Blanket/first wall challenges and required R&D on the pathway to DEMO

Energy Technology Data Exchange (ETDEWEB)

Abdou, Mohamed, E-mail: abdou@fusion.ucla.edu; Morley, Neil B.; Smolentsev, Sergey; Ying, Alice; Malang, Siegfried; Rowcliffe, Arthur; Ulrickson, Mike

2015-11-15

The breeding blanket with integrated first wall (FW) is the key nuclear component for power extraction, tritium fuel sustainability, and radiation shielding in fusion reactors. The ITER device will address plasma burn physics and plasma support technology, but it does not have a breeding blanket. Current activities to develop “roadmaps” for realizing fusion power recognize the blanket/FW as one of the principal remaining challenges. Therefore, a central element of the current planning activities is focused on the question: what are the research and major facilities required to develop the blanket/FW to a level which enables the design, construction and successful operation of a fusion DEMO? The principal challenges in the development of the blanket/FW are: (1) the Fusion Nuclear Environment – a multiple-field environment (neutrons, heat/particle fluxes, magnetic field, etc.) with high magnitudes and steep gradients and transients; (2) Nuclear Heating in a large volume with sharp gradients – the nuclear heating drives most blanket phenomena, but accurate simulation of this nuclear heating can be done only in a DT-plasma based facility; and (3) Complex Configuration with blanket/first wall/divertor inside the vacuum vessel – the consequence is low fault tolerance and long repair/replacement time. These blanket/FW development challenges result in critical consequences: (a) non-fusion facilities (laboratory experiments) need to be substantial to simulate multiple fields/multiple effects and must be accompanied by extensive modeling; (b) results from non-fusion facilities will be limited and will not fully resolve key technical issues. A DT-plasma based fusion nuclear science facility (FNSF) is required to perform “multiple effects” and “integrated” experiments in the fusion nuclear environment; and (c) the Reliability/Availability/Maintainability/Inspectability (RAMI) of fusion nuclear components is a major challenge and is one of the primary reasons

Future Primary Teachers’ Beliefs, Understandings and Intentions to Teach STEM

Directory of Open Access Journals (Sweden)

Premnadh M. Kurup

2017-08-01

Full Text Available The development of integrated skills and knowledge in science, technology, engineering, and mathematics (STEM are necessary in order to deal with challenging complex situations and should be developed from primary school. It is expected that early experiences can influence and foster a deep and ongoing interest in STEM. In order to provide these early experiences in their future classrooms, preservice teachers need subject matter knowledge, pedagogical content knowledge and expertise to innovate and deal with STEM in their own future classrooms This research focused on the beliefs and understandings preservice primary teachers (n=119 have about teaching and to what extent they are prepared to teach STEM subjects in primary schools. A questionnaire based on the position paper on STEM issued by the Australian Office of the Chief Scientist (Prinsley & Johnston, 2015 and guided by the theory of reasoned action was used as the basis of this study. The data was analysed qualitatively and quantitatively. The results suggest the preservice teachers in this study believed there should be STEM in the curriculum, but they were not confident in their ability to teach STEM without more professional preparation and development.

The development of English primary care group governance. A scenario analysis.

Science.gov (United States)

Sheaff, R

1999-01-01

At present there is a policy vacuum about what English Primary Care Groups' (PCGs) governance will be when they develop into Primary Care Trusts (PCTs). Draft legislation leaves many options open, so PCT governance is likely to 'emerge' as PCTs are created. It also remains uncertain how general practitioners (GPs) will react to the formation of PCTs and how the UK government will then respond in turn. A scenario analysis suggests three possible lines of development. The base (likeliest) scenario predicts a mainly networked form of PCT governance. An alternative scenario is of PCT governance resembling the former National Health Service internal market. A third scenario predicts 'franchise model' PCTs employing some GPs and subcontracting others. To different degrees all three scenarios predict that PCTs will retain elements of networked governance. If it fails to make GPs as accountable to NHS management as the UK government wishes, networked governance may prove only a transitional stage before English PCTs adopt either quasi-market or hierarchical governance.

Future Oceans: Meeting the Challenges of Securing Aquatic Food Resources

OpenAIRE

Dieckmann, U.

2012-01-01

Seafood is the primary source of animal protein for more than one billion people. Many economies and communities, in particular those in developing nations and coastal regions, depend on fisheries. Whereas the dire effects of overfishing on open-access ocean fisheries are already recognized, impacts of catches on freshwater systems are still underestimated. IIASA’s fisheries research elucidates how to secure and expand aquatic food resources, emphasizing three topical challenges. First, impro...

Environmental impact assessment (EIA) in development cooperation. A presentation of development challenges and research issues in developing countries and donor agencies

Energy Technology Data Exchange (ETDEWEB)

Kristoffersen, Harald

1997-12-31

This document discusses some development challenges and research needs related to environmental impact assessment (EIA) in development cooperation. After a general introduction to basic principles of EIA, the document deals with some general conditions for EIA in developing countries and in donor agencies. Through a presentation of experiences with EIA from selected donor agencies (with emphasis on NORAD) the report ends up with focusing on some research issues that may come up with recommendations for improving EIA practices in developing countries and donor agencies. 37 refs., 6 figs., 3 refs.

Senior Analyst | IDRC - International Development Research Centre

International Development Research Centre (IDRC) Digital Library (Canada)

Primary Duties or Responsibilities Strategic Planning and Development ... Conveys the directions determined by the Board and provides details on IDRC operations ... the opportunities and challenges these present for IDRC's business model; ...

Kabuki syndrome: a challenge for the primary care provider.

Science.gov (United States)

Crane, Bonnie; Alpert, Patricia T; Cyrkiel, Dianne; Jauregui, Alan

2013-10-01

Using a case format, the pathogenesis, clinical manifestations, diagnosis, and management of Kabuki syndrome, a rare genetic condition, is presented. Nurse practitioners (NPs) may encounter patients presenting to the primary care setting with this rare syndrome; understanding this condition may help them to better care for these patients. A case presentation of a pediatric patient supported by the currently available literature from multiple health and medial databases. Kabuki syndrome is a rare phenomenon that occurs in 1 in every 32,000 births. A diagnosis of this syndrome may take several months to years because there are no specific tests, and the physical features may be subtle at birth, becoming more pronounced over a period of time during childhood. The degree of disease severity varies widely. Understanding this syndrome increases the NP's ability to provide primary care to affected patients and their families. Management of this condition requires the NP take on the role of gatekeeper, so timely coordination of specialty or subspecialty services is provided. Special consideration should be given to monitoring caregiver fatigue and impact on siblings so family members can be directed to the appropriate support services. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

Opportunities and Challenges for Drug Development: Public-Private Partnerships, Adaptive Designs and Big Data.

Science.gov (United States)

Yildirim, Oktay; Gottwald, Matthias; Schüler, Peter; Michel, Martin C

2016-01-01

Drug development faces the double challenge of increasing costs and increasing pressure on pricing. To avoid that lack of perceived commercial perspective will leave existing medical needs unmet, pharmaceutical companies and many other stakeholders are discussing ways to improve the efficiency of drug Research and Development. Based on an international symposium organized by the Medical School of the University of Duisburg-Essen (Germany) and held in January 2016, we discuss the opportunities and challenges of three specific areas, i.e., public-private partnerships, adaptive designs and big data. Public-private partnerships come in many different forms with regard to scope, duration and type and number of participants. They range from project-specific collaborations to strategic alliances to large multi-party consortia. Each of them offers specific opportunities and faces distinct challenges. Among types of collaboration, investigator-initiated studies are becoming increasingly popular but have legal, ethical, and financial implications. Adaptive trial designs are also increasingly discussed. However, adaptive should not be used as euphemism for the repurposing of a failed trial; rather it requires carefully planning and specification before a trial starts. Adaptive licensing can be a counter-part of adaptive trial design. The use of Big Data is another opportunity to leverage existing information into knowledge useable for drug discovery and development. Respecting limitations of informed consent and privacy is a key challenge in the use of Big Data. Speakers and participants at the symposium were convinced that appropriate use of the above new options may indeed help to increase the efficiency of future drug development.

Opportunities and challenges for drug development: public-private partnerships, adaptive designs and big data

Directory of Open Access Journals (Sweden)

Oktay Yildirim

2016-12-01

Full Text Available Drug development faces the double challenge of increasing costs and increasing pressure on pricing. To avoid that lack of perceived commercial perspective will leave existing medical needs unmet, pharmaceutical companies and many other stakeholders are discussing ways to improve the efficiency of drug Research & Development. Based on an international symposium organized by the Medical School of the University of Duisburg-Essen (Germany and held in January 2016, we discuss the opportunities and challenges of three specific areas, i.e. public-private partnerships, adaptive designs and big data. Public-private partnerships come in many different forms with regard to scope, duration and type and number of participants. They range from project-specific collaborations to strategic alliances to large multi-party consortia. Each of them offers specific opportunities and faces distinct challenges. Among types of collaboration, investigator-initiated studies are becoming increasingly popular but have legal, ethical and financial implications. Adaptive trial designs are also increasingly discussed. However, adaptive should not be used as euphemism for the repurposing of a failed trial; rather it requires carefully planning and specification before a trial starts. Adaptive licensing can be a counter-part of adaptive trial design. The use of Big Data is another opportunity to leverage existing information into knowledge useable for drug discovery and development. Respecting limitations of informed consent and privacy is a key challenge in the use of Big Data. Speakers and participants at the symposium were convinced that appropriate use of the above new options may indeed help to increase the efficiency of future drug development.

Opportunities and Challenges for Drug Development: Public–Private Partnerships, Adaptive Designs and Big Data

Science.gov (United States)

Yildirim, Oktay; Gottwald, Matthias; Schüler, Peter; Michel, Martin C.

2016-01-01

Drug development faces the double challenge of increasing costs and increasing pressure on pricing. To avoid that lack of perceived commercial perspective will leave existing medical needs unmet, pharmaceutical companies and many other stakeholders are discussing ways to improve the efficiency of drug Research and Development. Based on an international symposium organized by the Medical School of the University of Duisburg-Essen (Germany) and held in January 2016, we discuss the opportunities and challenges of three specific areas, i.e., public–private partnerships, adaptive designs and big data. Public–private partnerships come in many different forms with regard to scope, duration and type and number of participants. They range from project-specific collaborations to strategic alliances to large multi-party consortia. Each of them offers specific opportunities and faces distinct challenges. Among types of collaboration, investigator-initiated studies are becoming increasingly popular but have legal, ethical, and financial implications. Adaptive trial designs are also increasingly discussed. However, adaptive should not be used as euphemism for the repurposing of a failed trial; rather it requires carefully planning and specification before a trial starts. Adaptive licensing can be a counter-part of adaptive trial design. The use of Big Data is another opportunity to leverage existing information into knowledge useable for drug discovery and development. Respecting limitations of informed consent and privacy is a key challenge in the use of Big Data. Speakers and participants at the symposium were convinced that appropriate use of the above new options may indeed help to increase the efficiency of future drug development. PMID:27999543

Management of primary Sjögren's syndrome: recent developments and new classification criteria.

Science.gov (United States)

Del Papa, Nicoletta; Vitali, Claudio

2018-02-01

For many years primary Sjögren's syndrome (pSS) has been considered an orphan disease, since no specific therapies were recognized as being capable of contrasting the development and progression of this disorder. The treatment of oral and ocular features, as well as of the systemic organ involvement, has been entrusted to the joint management of different subspecialty physicians, like ophthalmologists, otolaryngologists, dentists and rheumatologists. These latter subspecialty doctors are usually more involved in the treatment of systemic extraglandular involvement and, to do it, they have long been using the conventional therapies borrowed by the treatment schedules adopted in other systemic autoimmune diseases. The increasing knowledge of the biological pathways that are operative in patients with pSS, and the parallel development of molecular biology technology, have allowed the production and availability of a number of biological agents able to positively act on different disease mechanisms, and thus are candidates for testing in therapeutic trials. Meanwhile, the scientific community has made a great effort to develop new accurate and validated classification criteria and outcome measures to be applied in the selection of patients to be included and monitored in therapeutic studies. Some of the new-generation biotechnological agents have been tested in a number of open-label and randomized controlled trials that have produced in many cases inconclusive or contradictory results. Behind the differences in trial protocols, adopted outcome measures and predefined endpoints, reasons for such unsatisfactory results can be found in the large heterogeneity of clinical subtypes in the examined cohorts. The future challenge for a substantial advancement in the therapeutic approach to pSS could be to identify the pathologic mechanisms, outcome tools and biomarkers that characterize the different subsets of the disease in order to test carefully selected target therapies

Advancing primary care to promote equitable health: implications for China

Directory of Open Access Journals (Sweden)

Hung Li-Mei

2012-01-01

Full Text Available Abstract China is a country with vast regional differences and uneven economic development, which have led to widening gaps between the rich and poor in terms of access to healthcare, quality of care, and health outcomes. China's healthcare reform efforts must be tailored to the needs and resources of each region and community. Building and strengthening primary care within the Chinese health care system is one way to effectively address health challenges. This paper begins by outlining the concept of primary care, including key definitions and measurements. Next, results from a number of studies will demonstrate that primary care characteristics are associated with savings in medical costs, improvements in health outcomes and reductions in health disparities. This paper concludes with recommendations for China on successfully incorporating a primary care model into its national health policy, including bolstering the primary care workforce, addressing medical financing structures, recognizing the importance of evidence-based medicine, and looking to case studies from countries that have successfully implemented health reform.

Effect of foods and drinks on primary tooth enamel after erosive challenge with hydrochloric acid

Directory of Open Access Journals (Sweden)

Késsia Suênia Fidelis de MESQUITA-GUIMARÃES

2015-01-01

Full Text Available The aim of this study was to evaluate the effect of industrialised foods and drinks on primary tooth enamel previously eroded with hydrochloric acid (HCl. The crowns of one hundred two specimens were subjected to an erosive challenge with HCl and randomly divided into six groups (n = 17: Chocolate Milk (Toddynho® - Pepsico - negative control; Petit Suisse Yogurt (Danoninho® - Danone; Strawberry Yogurt (Vigor; Apple puree (Nestlé; Fermented Milk (Yakult® - Yakult; and Home Squeezed Style Orange Juice (del Valle - positive control. The 28-day immersion cycles for the test products were performed twice daily and were interspersed with exposure of the test substrate to artificial saliva. Measurements of enamel surface microhardness (SMH were performed initially, after immersion in HCl and at 7, 14, 21 and 28 days of experimentation. A two-way ANOVA, according to a split-plot design, followed by the sum of squares decomposition and Tukey’s test, revealed a significant effect for the interaction between Foods and Drinks and Length of Exposure (p < 0.00001. Orange juice resulted in greater mineral loss of enamel after 28 days. None of the test products was associated with recovery of tooth enamel microhardness.

Challenges Faced by Development Partners in Supporting the Growth and Development of Commercial Enterprises in Lira District, Northern Uganda

Science.gov (United States)

Eton, Marus; Mwirumubi, Richard; Edaku, Charles

2017-01-01

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…

A Strategy to Support Educational Leaders in Developing Countries to Manage Contextual Challenges

Science.gov (United States)

Wolhuter, Charl; van der Walt, Hannes; Steyn, Hennie

2016-01-01

The central theoretical argument of this paper is that educational leadership and organisational development and change in educational institutions in developing countries will not be effective unless school leaders are aware of the challenges posed by contextual factors that might have an impact on their professional activities. The article…

Health sector reform in South Asia: new challenges and constraints.

Science.gov (United States)

Islam, Anwar; Tahir, M Zaffar

2002-05-01

In early 1990s, Jamison, Mosley and others concluded that a profound demographic and consequent epidemiological transition is taking place in developing countries. According to this classical model, by the year 2015, infectious diseases will account for only about 20% of deaths in developing countries as chronic diseases become more pronounced. These impending demographic and epidemiological transitions were to dominate the health sector reform agenda in developing countries. Following an analysis of fertility, mortality and other demographic and epidemiological data from South Asian and other developing countries, the paper argues that the classical model is in need of re-evaluation. A number of new 'challenges' have complicated the classical interplay of demographic and epidemiological factors. These new challenges include continuing population growth in some countries, rapid unplanned urbanization, the HIV/AIDS pandemic in Sub-Saharan Africa (and its impending threat in South Asia), and globalization and increasing marginalisation of developing countries. While the traditional lack of investment in human development makes the developing countries more vulnerable to the vicissitudes of globalization, increasing economic weakness of their governments forces them to retreat further from the social sector. Pockets of poverty and deprivation, therefore, persist giving rise to three simultaneous burdens for South Asia and much of the rest of the developing world: continuing communicable diseases, increasing burden of chronic diseases, and increasing demand for both primary and tertiary levels of health care services. While these complex factors, on the one hand, underscore the need for health sector reform, on the other, they make the task much more difficult and challenging. The paper emphasizes the need to revisit the classical model of demographic and epidemiological transition. It is argued that the health sector in developing countries must be aware of and

Cyber-Security Challenges with SMEs in Developing Economies: Issues of Confidentiality, Integrity & Availability (CIA)

DEFF Research Database (Denmark)

Yeboah-Boateng, Ezer Osei

The essence of this study is first to highlight the cyber-security challenges confronting SMEs in developing economies, and to model a framework for safeguarding their assets, to ensure continuous optimal business operations, and to participate and compete securely in the ubiquitous cyber......, to develop customer-centric strategies. While connectivity is indispensable for achieving business success, being connected also implies being exposed to a myriad of cyber-security challenges, such as vulnerabilities of confidentiality, integrity and availability (CIA). As vulnerabilities are exploited...... cognitive map (FCM) approach is also used to show the implications of vulnerabilities amongst SMEs asset disposal policies....

Lay health educators within primary care practices to improve cancer screening uptake for South Asian patients: challenges in quality improvement

Directory of Open Access Journals (Sweden)

Lofters AK

2017-03-01

within six months of the first phone calls. Although physicians viewed the health ambassadors positively, they found the study to be time intensive and resource intensive, especially as this work was additional to usual clinical duties.Discussion: Using South Asian lay health educators embedded within primary care practices to telephone patients in their own languages showed promise in this study to increase awareness about willingness to screen and cancer screening uptake, but it was also time intensive and resource intensive with numer­ous challenges. Future quality improvement efforts should further develop the phone call invitation process, as well as explore how to provide infrastructure for lay health educator training and time. Keywords: quality improvement, cancer screening, ethnicity, health equity, health promotion, primary care

Meeting the safeguards challenges of a commercial reprocessing plant

International Nuclear Information System (INIS)

Johnson, S.J.; Chesnay, B.; Pearsall, C.; Takeda, S.; Tomikawa, H.; Fujimaki, K.; Iwamoto, T.

2004-01-01

Never before has the IAEA taken on such a large challenge as implementing a safeguards system at a commercial reprocessing plant. The challenges lay in a wide range of areas. This paper will present an overview of how specific challenges are being met in: Providing an initial and continuing design verification approach that maintains continuity of knowledge for the life-time of the plant; Providing a robust safeguards approach, including added assurance measures to confirm the operational conditions of the facility; Providing verification systems with the highest sensitivity and reliability, while also being cost efficient; Providing timely and accurate analytical laboratory results; Providing sufficient authentication to joint-use, unattended verification systems to assure that independent conclusions can be reached; Providing a comprehensive integrated software system that allows for remote inspector data handling and evaluation and thus reducing inspection effort. A primary prerequisite to developing and implementing a safeguards approach of this magnitude is the transparent and interactive cooperation of the State and the operator. The JNFL Project has been a model example of this cooperation. This cooperation has been in the areas of system security, operational modifications, schedule adjustments, technical development and financial support. (author)

Abandonment: Technological, organisational and environmental challenges

Energy Technology Data Exchange (ETDEWEB)

Twomey, B.G. [Reverse Engineering Ltd., (United Kingdom)

1996-12-31

The paper deals with the abandonment of offshore wells. Decommissioning of offshore installations is a complex multi-disciplined issue, which raises a number of technical, organisational and environmental challenges. The success of a planned decommissioning operation depends on the development of a clear understanding of the complex blend of drivers which control the decommissioning process and their inter-relationship. Due to the complexity of the inter-relationship between the primary drivers one cannot separate the technological, organisational and environmental issues raised by the decommissioning of offshore installations. The optimal solution will be a compromise between all the decommissioning drivers mentioned in this paper. 5 figs., 3 tabs.

Abandonment: Technological, organisational and environmental challenges

International Nuclear Information System (INIS)

Twomey, B.G.

1996-01-01

The paper deals with the abandonment of offshore wells. Decommissioning of offshore installations is a complex multi-disciplined issue, which raises a number of technical, organisational and environmental challenges. The success of a planned decommissioning operation depends on the development of a clear understanding of the complex blend of drivers which control the decommissioning process and their inter-relationship. Due to the complexity of the inter-relationship between the primary drivers one cannot separate the technological, organisational and environmental issues raised by the decommissioning of offshore installations. The optimal solution will be a compromise between all the decommissioning drivers mentioned in this paper. 5 figs., 3 tabs

Challenges of Epidemiologists of Developing Countries in the 21st Century

Directory of Open Access Journals (Sweden)

Mohsen Rezaeian

2016-01-01

Full Text Available There are many published articles which cover current and future challenges of epidemiology. However, up until now, most of them are written by developed world epidemiologists. Therefore, despite a common use of assumptions, they did not have the opportunity to discuss the different range of practical tasks and priorities away from developed countries. The topics covered are; facing poverty, non-democratic government that has links to developed countries, man-made and natural disasters, handling low-quality data and accessing it, and finally improving contribution to the world epidemiological knowledge for the 21st century.

Thoughts on primary care.

Science.gov (United States)

Raskin, Lynne

2010-01-01

The uptake of family health teams in Ontario has been tremendous. And the creation of group practices in primary care has taken root in other provinces as well. For many people, being involved with something new is exciting. At the same time, once they are committed, they discover the challenges that can be simultaneously exhilarating and frustrating. This issue of Healthcare Quarterly offers two articles that provide interesting reflections on what has been learned so far from the perspectives of both team leadership and the team members themselves within a transforming primary care system.

The development and preliminary validation of the Challenge and Threat in Sport (CAT-Sport) Scale

OpenAIRE

Rossato, C.J.L.; Uphill, M.A.; Swain, J.; Coleman, D.

2016-01-01

This paper outlines the development and preliminary validation of a sport-specific measure of\\ud athletes’ experience of challenge and threat. Three independent studies assess the content\\ud validity, factor structure, criterion validity and internal consistency of the Challenge and\\ud Threat in Sport (CAT-Sport) Scale. In study 1, a group of 25 athletes and 2 experts assessed\\ud the content validity of items derived from existing measures of challenge and threat.\\ud Participants examined a p...

Model-based nonlinear control of hydraulic servo systems: Challenges, developments and perspectives

Science.gov (United States)

Yao, Jianyong

2018-06-01

Hydraulic servo system plays a significant role in industries, and usually acts as a core point in control and power transmission. Although linear theory-based control methods have been well established, advanced controller design methods for hydraulic servo system to achieve high performance is still an unending pursuit along with the development of modern industry. Essential nonlinearity is a unique feature and makes model-based nonlinear control more attractive, due to benefit from prior knowledge of the servo valve controlled hydraulic system. In this paper, a discussion for challenges in model-based nonlinear control, latest developments and brief perspectives of hydraulic servo systems are presented: Modelling uncertainty in hydraulic system is a major challenge, which includes parametric uncertainty and time-varying disturbance; some specific requirements also arise ad hoc difficulties such as nonlinear friction during low velocity tracking, severe disturbance, periodic disturbance, etc.; to handle various challenges, nonlinear solutions including parameter adaptation, nonlinear robust control, state and disturbance observation, backstepping design and so on, are proposed and integrated, theoretical analysis and lots of applications reveal their powerful capability to solve pertinent problems; and at the end, some perspectives and associated research topics (measurement noise, constraints, inner valve dynamics, input nonlinearity, etc.) in nonlinear hydraulic servo control are briefly explored and discussed.

Primary care in a new era: disillusion and dissolution?.

Science.gov (United States)

Sandy, Lewis G; Schroeder, Steven A

2003-02-04

The current dilemmas in primary care stem from 1) the unintended consequences of forces thought to promote primary care and 2) the "disruptive technologies of care" that attack the very function and concept of primary care itself. This paper suggests that these forces, in combination with "tiering" in the health insurance market, could lead to the dissolution of primary care as a single concept, to be replaced by alignment of clinicians by economic niche. Evidence already exists in the marketplace for both tiering of health insurance benefits and corresponding practice changes within primary care. In the future, primary care for the top tier will cater to the affluent as "full-service brokers" and will be delivered by a wide variety of clinicians. The middle tier will continue to grapple with tensions created by patient demand and bureaucratic systems but will remain most closely aligned to primary care as a concept. The lower tier will become increasingly concerned with community health and social justice. Each primary care specialty will adapt in a unique way to a tiered world, with general internal medicine facing the most challenges. Given this forecast for the future, those concerned about primary care should focus less on workforce issues and more on macro health care financing and organization issues (such as Medicare reform); appropriate training models; and the development of a conception of primary care that emphasizes values and ethos, not just function.

Accomplishments and challenges in development of an autonomous operation system