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PubMedDate not supplied

The International Space Station human life sciences experiment implementation process.

The selection, definition, and development phases of a Life Sciences flight research experiment has been consistent throughout the past decade. The implementation process, however, has changed significantly within the past two years. This change is driven primarily by the shift from highly integrated, dedicated research missions on platforms with well defined processes to self contained experiments with stand alone operations on platforms which are being concurrently designed. For experiments manifested on the International Space Station (ISS) and/or on short duration missions, the more modular, streamlined, and independent the individual experiment is, the more likely it is to be successfully implemented before the ISS assembly is completed. During the assembly phase of the ISS, science operations are lower in priority than the construction of the station. After the station has been completed, it is expected that more resources will be available to perform research. The complexity of implementing investigations increases with the logistics needed to perform the experiment. Examples of logistics issues include- hardware unique to the experiment; large up and down mass and volume needs; access to crew and hardware during the ascent or descent phases; maintenance of hardware and supplies with a limited shelf life,- baseline data collection schedules with lengthy sessions or sessions close to the launch or landing; onboard stowage availability, particularly cold stowage; and extensive training where highly proficient skills must be maintained. As the ISS processes become better defined, experiment implementation will meet new challenges due to distributed management, on-orbit resource sharing, and adjustments to crew availability pre- and post-increment.

Biological Science Disciplines↗
PubMed2003

Evaluating health care interventions in the European Union.

This paper examines the current state of evaluations of health care interventions in the European Union, from the identification and commissioning of research through to its impact on policy and practice. Material is drawn from a survey conducted for the ASTEC project as well as a review of literature. Although the use of evaluative research has increased substantially in the last decade, both the pace of change and preferred research methodologies employed differ markedly. Much research still concentrates on issues of safety, efficacy and effectiveness, although there is evidence of an increasing emphasis on cost-effectiveness. Many countries are beginning to introduce systems linking economic evaluation to the decision-making process, while networks for the exchange of information continue to evolve. Research capacity in the public sector, although improving, is uneven, in part due to the uncertainty over long term career prospects and competition from industry. Capacity building measures should in particular ensure that dissemination expertise is strengthened, and that more emphasis is placed on developing receptor capacity within different stakeholder groups. Linking knowledge production to changes in practice remains a key challenge. Further research on implementation and impact assessment is required, to help demonstrate the value of evaluations on both policy and practice.

Delivery of Health Care↗
PubMed1999

Mental health care for Hispanic Americans: a current perspective.

In this article, the authors review patterns and challenges in the conceptualization, implementation, and academic support of the mental health services of Hispanic Americans. A critical analysis was conducted on information obtained through manual and computerized searches of published literature and conference reports. New clinical care approaches include the DSM-IV's cultural formulation with its complement of standardized multiaxial diagnosis, integration of services across clinical disorders or conditions and across sources of care, as well as pluralistic criteria and judges for service outcome appraisal. Emerging clinical approaches offer an opportunity to enhance the mental health care of Hispanic Americans within an increasingly multicultural U.S. society.

Attitude to Health↗
PubMed2001

A scheme for efficient quantum computation with linear optics.

Quantum computers promise to increase greatly the efficiency of solving problems such as factoring large integers, combinatorial optimization and quantum physics simulation. One of the greatest challenges now is to implement the basic quantum-computational elements in a physical system and to demonstrate that they can be reliably and scalably controlled. One of the earliest proposals for quantum computation is based on implementing a quantum bit with two optical modes containing one photon. The proposal is appealing because of the ease with which photon interference can be observed. Until now, it suffered from the requirement for non-linear couplings between optical modes containing few photons. Here we show that efficient quantum computation is possible using only beam splitters, phase shifters, single photon sources and photo-detectors. Our methods exploit feedback from photo-detectors and are robust against errors from photon loss and detector inefficiency. The basic elements are accessible to experimental investigation with current technology.

Journal Article↗
PubMed1993

Partnership in education: working toward the baccalaureate degree as entry to nursing practice in Canada.

In the early 1980s Canadian professional nursing associations officially adopted the goal of baccalaureate entry to practice by the year 2000. In the ensuing years, nursing educators have explored a variety of means to work toward achieving this goal. This paper describes a collaborative model of baccalaureate programme delivery developed between a university school and a hospital-based diploma school in Vancouver, British Columbia. The paper documents the history of the collaboration and the organization of human and physical resources for implementation. The issues and challenges encountered in the transition, the strategies used to facilitate the process, and the benefits gained by each partner are discussed.

Communication↗
PubMed2000

Medical education - beyond tomorrow? The new doctor - Asclepiad or Logiatros?

Against a background of the theoretical basis for the contextual approach to medical education, this paper examines and supports the changes that are occurring in undergraduate medical education throughout the world, before putting up for discussion the suggestion that the changes have not gone far enough. Consideration is given to a model of apprenticeship learning within undergraduate medical education, to the benefits it may offer, and to some of the challenges inherent in its implementation.

Education, Medical↗
PubMed2003

Measuring morbidity in schistosomiasis mansoni: relationship between image pattern, portal vein diameter and portal branch thickness in large-scale surveys using new WHO coding guidelines for ultrasound in schistosomiasis.

OBJECTIVE: World Health Organization consensus meetings on 'Ultrasound in Schistosomiasis' in 1996 and 1997 anticipated further challenges in the global implementation of a standardized protocol for morbidity assessment in schistosomiasis mansoni. We evaluated the performance of the qualitative and quantitative components of the new Niamey criteria. METHOD: Use of the Niamey protocol among 3954 subjects in two linked, cross-sectional ultrasound surveys of Schistosoma mansoni-endemic populations in Egypt and Kenya. RESULTS: There were significant differences between Egyptian and Kenyan sites in prevalence and age distribution of S. mansoni-related hepatic fibrosis (36%vs. 3%, P < 0.001). Protocol image pattern scoring could be performed quickly and was stable to interobserver variation. However, there were unintended but systematic differences between study sites in the measurement of portal vein diameter (PVD) and wall thickness. By Niamey criteria, a high prevalence of portal dilation was scored for normal Egyptian subjects, which reduced the predictive value of image pattern for portal hypertension. Using alternative height-indexing of PVD, image pattern plus PVD findings predicted 15% of Egyptians and 2.5% of Kenyans were at risk for variceal bleeding, whereas locally derived PVD norms estimated 25% of Egyptians and 12% of Kenyans to be at possible risk. CONCLUSION: Niamey scoring criteria performed acceptably as a relative grading system for disease in schistosomiasis mansoni, but failed to account fully for site-to-site variation in test performance and morbidity prevalence. Consequently, standardized image pattern scoring appears to provide the most useful tool for detection and comparison of S. mansoni-associated morbidity in large-scale surveys.

Adolescent↗
PubMedDate not supplied

Home visitation practice: models, documentation, and evaluation.

This article presents an evaluation of an in-home support program for at-risk mothers and their children. The program was multidisciplinary and was focused on development of parenting capacity and child-development competencies. The authors examine issues and problems that resulted from the blending of two models of practice-stabilization/crisis intervention and early intervention/health promotion-and describe the outcome-based evaluation that was used to assess initial and ongoing child development, parent-child interaction, family environment, and social support. When documentation and evaluation of practice and its effect on outcomes proved a considerable challenge, the authors developed a classification system to describe practice in three areas: situations addressed, interventions used, and referrals made. The article describes challenges surrounding program development, implementation, and evaluation.

Adult↗
PubMed2001

Responsive assessment: assessing student nurses' clinical competence.

This paper argues for a new approach to continuous assessment of students of nursing clinical competence, which I call responsive assessment. Its argument for this is based on a research study highlighting the problems and concerns students and practitioners identified in relation to the assessment of their nursing practice and clinical competence. It puts forward a case for challenging role boundaries by implementing contract assignments: as an integral part of adult learning and continuous assessment (Neary 1992a, 1998) and for developing a conceptual model called responsive assessment, in which the students' readiness for assessment and their response to patient/client needs is identified.The arguments are developed against the background of Benner's movement from novice to expert (Benner 1984) and Stake's (Stake 1977) three stages of antecedents, transaction and outcome as a process for professional students development.

Clinical Competence↗
PubMed2006

The regulatory context for public education.

The provision of special education and related services in public schools involves the intertwining of federal, state, and local laws, regulations, other levels of policy, and practices. Such a multilayered system can obviously lead to misunderstanding and misinformation regarding school-based services, creating challenges in terms of implementation and advocacy. However, by determining the source of the requirements and the intent of the laws, it is possible not only to remain in compliance with mandates but also to influence implementation decisions and improvements that will ultimately be in the best interest of students. Educators must identify and analyze the source and intentions of requirements, understand the responsibilities of states and localities, and when necessary, identify vehicles for advocating for change. This article provides information regarding major federal mandates that affect public education, with comments specific to speech-language services in the schools.

Child↗
PubMed2003

Reduction in antibiotic prescribing for respiratory tract infections is needed!

In general practice, approximately 25% of consultations are related to infectious diseases. The emergence and spread of resistant bacteria are related to antibiotic use on an individual and on a community level. Antibiotic prescribing differs profoundly from one European country to the next, though there is no evidence of differences in the prevalence of infectious diseases. Most respiratory tract infections are self-limiting conditions, and recent evidence shows that antibiotics only slightly modify the course of most respiratory tract infections. The general practitioner should focus on patients with more severe symptoms who might benefit more from antibiotic treatment. In general, antibiotics should be prescribed for acute pneumonia. In addition, we may offer antibiotics to a selected group of patients with more severe symptoms of maxillary sinusitis, pharyngotonsillitis and acute exacerbation of chronic obstructive pulmonary disease/chronic bronchitis. In the diagnostic procedure, rapid tests of Streptococcus pyogenus and C-reactive protein may be valuable in carefully selected cases. Penicillins (penicillin V, amoxycillin) should be the first choice in most respiratory tract infections. Larger studies in general practice are needed to analyse the impact of antibiotic prescribing on morbidity, the occurrence of rare complications and spread of resistance. The greatest challenge will be to implement current knowledge in daily praxis.

Anti-Bacterial Agents↗
PubMed2001

Challenges for the prevention of primary and secondary stroke: the importance of lowering blood pressure and total cardiovascular risk.

It is well established that blood pressure lowering is effective for the primary prevention of stroke and other cardiovascular disorders in subjects with blood pressures as low as 140/90 mmHg, and up to 80 years of age. Despite this knowledge, blood pressure levels are controlled in less than 25% of the hypertensive population worldwide. It has taken longer to prove that blood pressure lowering is equally effective for the prevention of recurrent stroke. The results of PROGRESS (Perindopril Protection Against Recurrent Stroke Study) have confirmed that a perindopril-based regimen in subjects with cerebrovascular disease substantially reduces the incidence of secondary stroke and primary myocardial infarction. It is daunting to recall that it has taken almost two decades for beta-blockers to be widely used for the secondary prevention of myocardial infarction, since widespread use of the PROGRESS regimen would prevent more than half a million strokes worldwide each year. The real challenge now is to implement novel and effective strategies for the control of blood pressure and other cardiovascular risk factors worldwide. Strategies should include lifestyle measures, such as stopping smoking, exercise and reducing overweight. There is a real need to identify hypertensive subjects and treat them with blood pressure lowering drugs for primary prevention. In subjects with established cardiovascular disease, consideration should be given to a range of proven interventions for secondary prevention, such as blood pressure lowering, irrespective of current blood pressure, anti-platelet drugs, statins for lowering cholesterol and glycaemic control in diabetics. Among new strategies to lower overall cardiovascular risk, consideration should be given to the development of single-pill combinations of drugs of known efficacy, including various combinations of ACE inhibitors, diuretics, beta-blockers, aspirin and statins, among others.

Antihypertensive Agents↗
PubMed2004

Building a socially accountable health professions school: towards unity for health.

In many countries, health systems suffer from fragmentation as different health activities conducted by different stakeholders are poorly coordinated, resulting in a mitigated performance to improve quality, equity, relevance and cost-effectiveness in health care. The impact on health would be enhanced if main stakeholders such as health professional schools, service organizations, professional associations, health policy bodies and the general public shared a common vision on how to best meet people's priority health needs. An approach initiated by WHO in 1999 and developed by The Network: Towards Unity for Health endeavours to create a unity of purpose and action among these stakeholders. This article comments on challenges and opportunities in implementing this approach whose pillars are integration and partnerships. The conditions for each stakeholder to become more socially accountable and the role of a teacher, researcher, manager or community representative in contributing to this process are discussed.

Humans↗
PubMed2003

The complete "how to" guide for selecting a disease management vendor.

Decision-makers in health plans, large medical groups, and self-insured employers face many challenges in selecting and implementing disease management programs. One strategy is the "buy" approach, utilizing one or more of the many vendors to provide disease management services for the purchasing organization. As a relatively new field, the disease management vendor landscape is continually changing, uncovering the many uncertainties about demonstrating outcomes, corporate stability, or successful business models. Given the large investment an organization may make in each disease management program (many cost 1 million dollars or more in annual fees for a moderately sized population), careful consideration must be given in selecting a disease management partner. This paper describes, in detail, the specific steps necessary and the issues to consider in achieving a successful contract with a vendor for full-service disease management.

Contract Services↗
PubMed2004

Formation and operation of a statewide commission on end-of-life care in Minnesota.

BACKGROUND: Innovative approaches to improving end-of-life care are needed. One strategy involves government/community partnerships to improve care. OBJECTIVE: Engage health care provider and health care consumer communities in the State of Minnesota to improve end-of-life care. DESIGN: The Minnesota Commission on End of Life Care was formed to make recommendations that would be used by public and private policy makers to improve care in the state. RESULTS: An innovative selection process brought together a broad group of people to identify, prioritize, and make recommendations regarding end-of-life care in the state. Carefully selected leadership, good planning, and organization ensured a successful process that kept all appointed commission members engaged throughout the 18-month project. Using a consensus process, the Commission endorsed a framework for end-of-life care and made specific recommendations for improving access, education and public policy. This paper describes the process of developing and implementing the Commission, the challenges, successes, and lessons learned.

Advisory Committees↗
PubMedDate not supplied

Novel biphasic elastomeric scaffold for small-diameter blood vessel tissue engineering.

Compliance mismatch, thrombosis, and long culture times in vitro remain important challenges to the clinical implementation of a tissue-engineered small-diameter blood vessel (SDBV). To address these issues, we are developing an implantable elastomeric and biodegradable biphasic tubular scaffold. The scaffold design uses connected nonporous and porous phases as a basis to mimic, respectively, the intimal and medial layers of a blood vessel. Biphasic scaffolds were fabricated from poly(diol citrate), a novel class of biodegradable polyester elastomer. Scaffolds were characterized for tensile and compressive properties, burst pressure, compliance, foreign body reaction (via subcutaneous implantation in rats), and cell distribution and differentiation (via histology, scanning electron microscopy, and immunohistochemistry). Tensile tests, burst pressure, and compliance measurements confirm that the incorporation of a nonporous phase to create a "skin" connected to the porous phase of a scaffold can provide bulk mechanical properties that are similar to those of a native vessel. Compression tests confirm that the scaffolds are soft and recover from deformation. Subcutaneously implanted poly(diol citrate) porous scaffolds produce a thin fibrous capsule and allow for tissue ingrowth. In vitro culture of tubular biphasic scaffolds seeded with human aortic smooth muscle cells (HASMCs) and endothelial cells (HAECs) demonstrates the ability of this design to support cell compartmentalization, coculture, and cell differentiation. The newly formed HAEC monolayer stained positive for von Willebrand factor whereas collagen- and calponin-positive HASMCs were present in the porous phase.

Animals↗
PubMed1998

Integrated clinical experience: University of Nebraska Medical Center.

The Integrated Clinical Experience (ICE) at the University of Nebraska College of Medicine is a required, two-year course of study for first- and second-year students. It provides early clinical experiences in primary care settings in metropolitan and rural areas, and related instruction in the social, behavioral, and ethical foundations of medicine. The authors describe the course goals, teaching format, topics, and evaluation of students and faculty. ICE is based on the assumptions that medicine is an applied behavioral science as well as an applied biological science, that critical reflection is important in professional education, and that early exposure to primary care will promote interest in primary care careers. The authors also describe some of the challenges associated with the implementation of this new course of study. These include student dissatisfaction with behavioral and ethical topics, resistance to critical reflection about their personal attitudes and values, and discomfort with "subjective" grading. ICE has also been controversial with some basic science faculty who feel they have had to sacrifice curriculum time to make room for this new program. Also, recruiting the large number of faculty, particularly physicians, needed to run the program has been difficult. Finally, the organization of the curriculum, with basic sciences in the morning and the ICE in the afternoon, may inadvertently reinforce the conceptual split between the biomedical and psychosocial dimensions of medicine. Efforts are under way to address this problem by exploring ways to intergrate the curriculum better.

Attitude of Health Personnel↗