Great Difficulty (great + difficulty)

Distribution by Scientific Domains

Selected Abstracts

The needs of physically disabled young people during transition to adult services

B. Ko
Abstract Objectives, The needs and provisions for health service and housing adaptation of a cohort of school leavers with physical disabilities in two inner city London health districts are described in this cross-sectional study. Methods, Fourteen young people were assessed by two consultant community paediatricians during their last year at school, using a structured proforma that includes the British Association of Community Child Health standards of functional levels. Results, Great difficulty was encountered in identifying the subjects, partly because of inadequate information systems. Only 16 were identified out of over 12 000 school leavers. Important discrepancies were found between the needs assessed and the services provided. For the total sample, the need for 49 potential referrals to adult specialist services was identified, but 17 were not made as such services did not exist, in contrast to what had been available within paediatric services. Adult physiotherapy and occupational therapy services were particularly under-provided for young people with physical disabilities. Only a minority were eligible for housing adaptations. Conclusions, Suggestions are made for improvements in information systems, the transition process, revised provision of services and closer involvement of general practitioners. [source]

Regional development policies and the constructions of gender equality: The Swedish case

Drawing on Carole Bacchi's ,What's the Problem? Approach', we explore how arguments concerning the new forms of regional policy are assigning different categories of people different subject positions and, in particular, we focus on the kind of subject positions that are being given to women as a group in this context. The discourse being shaped in national policy is, however, interpreted in specific contexts. Accordingly, we compare the way this new discourse is being (re)interpreted and (re)constructed and the subject positions being ascribed to women in the regional development partnerships and growth strategies in two Swedish regions: Västerbotten and Jönköping. Finally, we draw attention to how both the form and the content of Swedish regional development policies create great difficulties for politicizing gender as a power dimension in society. We suggest that regional politics has become de-politicized and argue for the need for it to be re-politicized with gender included as a conflict dimension. [source]

Blindness and bulimia nervosa: A description of a case report and its treatment

Fernando Fernández-Aranda PhD
Abstract Objective Blindness has rarely been described in the eating disorder (ED) literature. In case reports in which this condition has been reported before an ED, it was concluded that visual body image was not essential for the development of the ED. This is the first report in which bulimia nervosa (BN) and its treatment in a blind woman were described. Method We report a single diagnosed and treated case of BN in a blind, 47-year-old Spanish woman. This case presented as its main characteristics the late onset of the ED, restrictive dieting, binging, and consequent purging behavior characterized by vomiting and great difficulties of coping with stress. From the beginning, the woman's body image was not essential. The treatment consisted of 21 individual outpatient sessions, which followed a non,symptom-oriented cognitive-behavioral approach, in which problem solving and stress management strategies were employed. Results Before, after the treatment, and at the 6-month and 1-year follow-up, the clinical evolution of the patient was assessed. Conclusion Although a few descriptions of single case reports on blindness in individuals with anorexia nervosa (AN) have already been reported in the literature, to the authors' knowledge, this is the first reported case in which this condition and its treatment have specifically been reported in an individual with BN. © 2006 by Wiley Periodicals, Inc., Int J Eat Disord, 2006 [source]

Adaptation in new technology-based ventures: Insights at the company level

Petra Andries
Recent research shows that, owing to the presence of uncertainty and ambiguity, new ventures have great difficulties in defining a viable business model from the outset and that minor or major adaptations to this initial business model are needed as the venture evolves. Technology-based companies are confronted with particularly high degrees of uncertainty and ambiguity. This paper therefore focuses on new technology-based ventures as a special case worth investigating. Most of the entrepreneurship literature studies adaptation at the individual level. However, many new technology-based firms are founded by a team of entrepreneurs. This paper therefore looks at how existing literature at the company level can inform us about adaptation in new technology-based companies. It starts by relating the concept of adaptation in new technology-based ventures to the existing literature on organizational adaptation at the firm level. Based on an overview of existing literature at the firm level, a propositional model is then put forward, describing (1) the process of adaptation and (2) the factors enabling adaptation in new technology-based ventures. [source]

A novel QoS routing protocol for LEO and MEO satellite networks

Yunhui Zhou
Abstract The rapid advance of communication and satellite technology pushes broadband satellite networks to carry on multimedia traffic. However, the function of onboard routing cannot be provided in existing satellite networks with inter-satellite links, and quality of service (QoS) of satellite networks cannot be reliably guaranteed because of great difficulties in processing of long distance-dependent traffic. In this paper, a two-layered low-Earth orbit and medium-Earth orbit satellite network (LMSN) is presented. A novel hierarchical and distributed QoS routing protocol (HDRP) is investigated, and an adaptive bandwidth-constrained minimum-delay path algorithm is developed to calculate routing tables efficiently using the QoS metric information composed of delays and bandwidth. The performance of LMSN and HDRP is also evaluated through simulations and theoretical analysis. Copyright © 2007 John Wiley & Sons, Ltd. [source]

CLO-PLA: the database of clonal and bud bank traits of Central European flora,

Jitka Klime
Abstract: Clonal growth of plants is mainly a result of the vegetative growth of organs hidden beneath the soil surface and producing potentially independent vegetative offspring. Clonal traits are difficult to measure due to inaccessibility of the space they inhabit and their morphological diversity. This causes great difficulties with descriptions, standardization of measurements across plant growth forms and, probably, a lack of appropriate questions that should be answered using them. The freely available CLO-PLA database ( can help to assess the roles of vegetative means of regeneration and spread in plant communities under the effect of various biotic and abiotic filters. It can serve as a source of reference on persistence traits of European temperate flora and, eventually, as a guide for trait sampling in other regions of the world. [source]

Maximum Likelihood Estimation in Dynamical Models of HIV

BIOMETRICS, Issue 4 2007
J. Guedj
Summary The study of dynamical models of HIV infection, based on a system of nonlinear ordinary differential equations (ODE), has considerably improved the knowledge of its pathogenesis. While the first models used simplified ODE systems and analyzed each patient separately, recent works dealt with inference in non-simplified models borrowing strength from the whole sample. The complexity of these models leads to great difficulties for inference and only the Bayesian approach has been attempted by now. We propose a full likelihood inference, adapting a Newton-like algorithm for these particular models. We consider a relatively complex ODE model for HIV infection and a model for the observations including the issue of detection limits. We apply this approach to the analysis of a clinical trial of antiretroviral therapy (ALBI ANRS 070) and we show that the whole algorithm works well in a simulation study. [source]

CPA assessment , the regional assessors' experience

E. Welsh
Many individuals within Laboratory Medicine will be unaware that CPA conducts assessments to two different sets of CPA Standards. There are the Standards for the Medical Laboratory and the Standards for EQA Schemes in Laboratory Medicine. The style and format of both sets of standards is very similar with each being presented in eight sections A , H. The EQA standards are almost identical to the laboratory standards with the exception of the E.F and G standards which are specific to EQA schemes. There are approximately 40 EQA Schemes registered with CPA compared with almost 2 500 laboratories. These EQA schemes vary from very large national/international schemes with numerous analytes to small interpretive schemes run by one individual with a personal interest in that specific subject. The large schemes usually come under the UKNEQAS consortia banner and due to their size and configuration do not present undue problems in the assessment process. Smaller interpretive EQA schemes present a challenge both for the scheme and CPA in gaining accreditation. These schemes are usually within the discipline of Histopathology and are regarded as educational rather than proficiency testing schemes. Very frequently, the scheme is organized by a single individual with a collection of microscope slides, storage facilities for the slides and a computer. This presents the Scheme Organizer with great difficulty in complying with the Quality Management System requirements of the CPA Standards. There are a number of models which can be applied in order to satisfy the requirement of the Quality Management System, but ultimately it must be recognized that in some circumstances it is not possible to accredit these small schemes. The NHSCSP Gynae Cytology EQA Scheme is probably the largest EQA scheme within the UK, in respect of the number of participants and the number of staff supporting the scheme. Scheme Management decided that all nine regions of England would apply for accreditation under one CPA Reference Number. This process meant that the scheme would be assessed as a Managed Pathology Network. This is unique in terms of EQA schemes and presented a number of problems not previously encountered in EQA scheme accreditation. This decision meant that all nine regions must comply with a single Quality Management System and other CPA standards whilst allowing flexibility within the system for each region to facilitate the assessment process specific to their user's requirements. The process worked in a satisfactory manner and the overall outcome was not dissimilar to that of other large EQA schemes. The assessment to the current EQA Standards only commenced in April 2006 whilst the Standards for Medical Laboratories commenced in 2003, and it is perhaps not surprising to find that the principal non-conformities are related to the Quality Management System. This parallels the findings encountered in laboratory accreditation. There is an ongoing educational process for Scheme Management and the Facilitators in each region in how to comply fully with the standards and a commitment to quality improvement which ultimately is beneficial to the participant's of the scheme and to patient safety. [source]

Hybrid expert,fuzzy approach for evaluation of complex systems

EXPERT SYSTEMS, Issue 3 2009
Veysi Öztürk
Abstract: Evaluation of complex systems is generally complicated and time consuming. Evaluation is needed for nearly all engineering tasks and the obstacles related to evaluation increase in proportion to complexity. New techniques can be used to automate manual evaluation and to overcome the obstacles related to evaluation that cannot be solved (or can only be solved with great difficulty) with conventional computing. In this study, a methodology was developed to handle the heuristic knowledge of experts for evaluation purposes. In this method, knowledge was represented as a reference model of evaluation objectives, production rules, measures, methods and parameters. A ,common evaluation process' and ,common evaluation model', which simplify and speed up the evaluation process and decrease evaluation cost, were proposed and developed. A hybrid expert,fuzzy system, called ,intelligent evaluation system' (INES), which can be used for evaluation of complex systems was developed. To define a process and develop a system that simplifies and speeds up evaluation can save time, decrease cost and provide reusability. As the evaluation of complex systems includes uncertainty in some aspects, fuzzy logic was incorporated with an expert system for reasoning. INES was implemented successfully for the evaluation of an air defence system, which is a complex system used to protect a region from all air threats. [source]

Mapping snow characteristics based on snow observation probability

Bahram Saghafian
Abstract Measurement/estimation of snow water equivalent (SWE) is a difficult task in water resources studies of snowy regions. SWE point data is measured at snow courses that are normally operated with low density owing to high costs and great difficulty in reaching the stations in cold seasons. Moreover, snow is known to exhibit high spatial variability, which makes SWE studies based solely on sparse station data more uncertain. Ever-increasing availability of satellite images is a promising tool to overcome some of the difficulties associated with analyzing spatial variability of snow. Although National Oceanic and Atmospheric Administration (NOAA) satellite images have low spatial resolution with approximately 1.1-km pixel size, they are adequate for mapping snow cover at regional scales and enjoy a moderate length of record period. In this paper, rain and snow records of synoptic stations and the time series of NOAA-based snow cover maps were used to map average SWE of a vast area in southwestern Iran. First, monthly and annual snow coefficient (SC) at synoptic stations were determined on the basis of analysis of hourly observation of type and amount of precipitation. Then, two new spatially distributed snow characteristics were introduced, namely, average frequency of snow observation (FSO) and monthly frequency of maximum snow observation (FMSO), on the basis of existing satellite snow observations. FSO and monthly FMSO maps were prepared by a geographic information system on the basis of snow map time series. Correlation of these two parameters with SC was studied and spatial distribution of SC was estimated on the basis of the best correlation. Moreover, the distribution of mean annual precipitation was derived by comparing a number of interpolation methods. SWE map was generated by multiplying SC and precipitation maps and its spatial variability in the region was analyzed. Copyright © 2007 Royal Meteorological Society [source]

Stuck long-term indwelling central venous catheters in adolescents: three cases and a short topical review

We present three cases of fixated vascular injection ports. Two patients had cystic fibrosis and one had an immunological defect. All catheters were made from polyurethane and implanted in adolescent patients. Indwelling time were 6,8 years. One patient's catheter was entirely integrated in the vessel wall and impossible to remove. In the other two cases, catheters were removed with great difficulty by the interventional radiologists. These cases raise important questions concerning the maximum indwelling time and the choice of catheter material when implanting permanent central venous catheters (CVCs) in adolescents. Furthermore, it highlights the importance of not breaking a CVC in the attempt to remove it. [source]

Dependence of Fructooligosaccharide Content on Activity of Fructooligosaccharide-Metabolizing Enzymes in Yacon (Smallanthus sonchifolius) Tuberous Roots during Storage

A. Narai-Kanayama
ABSTRACT:, Tuberous roots of yacon (Smallanthus sonchifolius) accumulate about 10%, on a fresh weight basis, of inulin-type fructooligosacharides (FOSs), known as a food ingredient with various healthy benefits. However, we have a great difficulty to ensure these benefits because FOSs with a lower degree of polymerization (DP) decreased remarkably, and fructose increased when the tuberous roots were stored after harvesting even under previously recommended storage conditions of low temperature with high humidity. In the present study, to elucidate the involvement of FOS-metabolizing enzymes in FOS reduction during storage at 90% relative humidity and 8°C, we extracted a crude protein from yacon tuberous roots and measured the activities of invertase (,-fructofuranosidase, EC, sucrose:sucrose 1-fructosyltransferase (1-SST, EC, fructan:fructan 1-fructosyltransferase (1-FFT, EC, and fructan 1-exohydrolase (1-FEH, EC The enzyme activities acting on sucrose, both invertase and 1-SST, were weakened after storage for a month. In addition, the activity of 1-FEH acting on short FOSs such as 1-kestose (GF2) and 1-nystose (GF3) was higher than that of 1-FFT. These results suggest that the continuous decline in FOSs of low DP during storage was dependent mainly on the 1-FEH activity. On the other hand, FOSs with a DP of , 9 only slightly decreased in stored yacon tuberous roots during storage, though distinct 1-FEH activity was observed in vitro toward a high-DP inulin-type substrate, indicating that highly polymerized FOSs content was unlikely to be closely connected with the 1-FEH activity. [source]

Consideration of regional difference in design and analysis of multi-regional trials,,

H. M. James Hung
Abstract Clinical trial strategy, particularly in developing pharmaceutical products, has recently expanded to a global level in the sense that multiple geographical regions participate in the trial simultaneously under the same study protocol. The possible benefits of this strategy are obvious, at least from the cost and efficiency considerations. The challenges with this strategy are many, ranging from trial or data quality assurance to statistical methods for design and analysis of such trials. In many regulatory submissions, the presence of regional differences in the estimated treatment effect, whether they are different only in magnitude or in direction, often presents great difficulty in interpretation of the global trial results, particularly for the acceptability by the local regulatory authorities. This article presents a number of useful statistical analysis tools for exploration of regional differences and a method that may be worth consideration in designing a multi-regional clinical trial. Published in 2010 by John Wiley & Sons, Ltd. [source]

Subjective pain experience of people with chronic back pain

Professor Lorraine H De Souza Chair of Rehabilitation
Abstract Background and Purpose Studies into the effect of pain experience on those who have it have largely focused on the views and interpretations of researchers gained by the use of assessment tools aimed at measuring pain. The purpose of this study was to explore and describe pain, as experienced by those with chronic back pain, and to document ,insider' accounts of how pain is perceived and understood by those who have it. Method Unstructured interviews using the framework approach. Subjects were sampled for age, sex, ethnicity and occupation, from new referrals with back pain to a rheumatology outpatient clinic. Eleven subjects (5 M; 6 F) agreed to be interviewed. Interviews were unstructured, but followed a topic guide. Subjects were interviewed in English (nine) or their preferred language (two). Tape-recordings of interviews were transcribed verbatim and read in depth twice to identify the topics or concepts. Data were extracted in the form of words and phrases by use of thematic content analysis. The themes were pain description and amount of pain. An independent researcher reviewed the data and confirmed or contended the analysis. Results All subjects, except one, provided descriptors of the quality of their pain. The use of simile was common to emphasize both what the pain was, and what it was not. Five subjects expressed a loss of words in trying to describe their pain. Only 13 of 29 different pain descriptors used were commensurate with those in the McGill Pain Questionnaire (Melzack, 1983). Subjects had great difficulty quantifying their pain intensity. Several explained how the pain fluctuated, thus, quantifying pain at one point in time was problematic. Only one subject offered a numerical description of pain intensity. Conclusions Subjects provided graphic and in-depth descriptions of their pain experience, but these bore little resemblance to commonly used assessment tools. The findings challenge the appropriateness of such formal instruments. Copyright © 2000 Whurr Publishers Ltd. [source]

Terms used to describe urinary tract infections , the importance of conceptual clarification,

APMIS, Issue 2 2003
Inaccuracies in medical language are detrimental to communication and statistics in medicine, and thereby to clinical practice, medical science and public health. The purpose of this article is to explore inconsistencies in the use of some medical terms: urinary tract infection, bacteriuria and urethral syndrome. The investigated literature was collected from medical dictionaries, textbooks, and articles indexed in Medline®. We found various practices regarding how the medical terms should be defined, and had great difficulty in interpreting the status of the statements under the heading of ,definition'. The lesson to be learned, besides a reminder of the importance of clearly defined medical concepts, is that it must be explicitly stated whether what is presented as a definition is to be considered as defining criterion, as recognising criterion or as characteristic of the disease entity. [source]

Clinical application of the multifocal visual evoked potential

David P. Crewther PhD
Background: Measures of visual function thresholds such as visual acuity and visual fields are generally dependent on subjective responses and assume maintenance of fixation, attention and motivation. In the young, elderly, cognitively impaired or malingering populations, such measures may be inaccurate or difficult to obtain. The Visual Evoked Response Imaging System (VERIS) has been claimed to give more objective topographic recordings of retinal and cortical function. This paper aims to explore the adequacy of this technique in four unusual, unrelated, clinically difficult cases. Methods: Multifocal visual evoked potentials (mfVEPs) recorded on the VERIS System 3.01 are used to assess visual function in four cases with contradictory clinical findings or unreliable subjective responses. Results: Patient 1 had sustained a head injury and had normal ocular and pupil examination but light perception in the right eye and 6/5 acuity in the left. Multifocal VEPs showed a marked depression of the right visual field with little macular response. Patient 2 had sustained a head injury, had a left field hemianopia, possible macular sparing and loss of much of the right field, reduced but variable visual acuities, good near vision and normal ocular fundi. Multifocal VEPs showed a severe depression in both visual fields (L more than R) with little macular response. Patient 3 had a left optic nerve meningioma and experienced great difficulty with visual field assessment. mfVEPs showed a bilateral depression in the superior field particularly the left field, with a larger deficit in the left eye. Patient 4 had unexplained visual acuity and peripheral field deficits. mfVEP results were inconclusive in this case. Discussion: Where there is difficulty performing traditional techniques or conflicting clinical findings, mfVEPs may provide additional objective information to aid in the assessment of patients. [source]