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Difficult Challenge (difficult + challenge)
Selected AbstractsTactics-Based Behavioural Planning for Goal-Driven Rigid Body ControlCOMPUTER GRAPHICS FORUM, Issue 8 2009Stefan Zickler Computer Graphics [I.3.7]: Animation-Artificial Intelligence; [I.2.8]: Plan execution, formation, and generation; Computer Graphics [I.3.5]: Physically based modelling Abstract Controlling rigid body dynamic simulations can pose a difficult challenge when constraints exist on the bodies' goal states and the sequence of intermediate states in the resulting animation. Manually adjusting individual rigid body control actions (forces and torques) can become a very labour-intensive and non-trivial task, especially if the domain includes a large number of bodies or if it requires complicated chains of inter-body collisions to achieve the desired goal state. Furthermore, there are some interactive applications that rely on rigid body models where no control guidance by a human animator can be offered at runtime, such as video games. In this work, we present techniques to automatically generate intelligent control actions for rigid body simulations. We introduce sampling-based motion planning methods that allow us to model goal-driven behaviour through the use of non-deterministic,Tactics,that consist of intelligent, sampling-based control-blocks, called,Skills. We introduce and compare two variations of a Tactics-driven planning algorithm, namely behavioural Kinodynamic Rapidly Exploring Random Trees (BK-RRT) and Behavioural Kinodynamic Balanced Growth Trees (BK-BGT). We show how our planner can be applied to automatically compute the control sequences for challenging physics-based domains and that is scalable to solve control problems involving several hundred interacting bodies, each carrying unique goal constraints. [source] Role of meta-analysis of clinical trials for Alzheimer's diseaseDRUG DEVELOPMENT RESEARCH, Issue 3 2002Jesús M. López Arrieta Abstract Alzheimer's disease (AD) is a growing worldwide medical, social, and economic problem. In all countries, both prevalence and incidence of this disorder increase with age. The task of translating scientific clinical research into effective interventions for dementia has proved to be a difficult challenge. Data about the effects of therapeutic interventions come from several sources of evidence, ranging from studies with little potential for systematic bias and minimal random error, such as well-designed randomized controlled trials, through controlled but nonrandomized cohort and case-control studies, all the way to opinions based on laboratory evidence or theory. Although clinical trials are widespread in AD, there is increasing recognition that the results of studies do not necessarily apply to the type of patients that are seen by clinicians because of differences in patient characteristics, comorbidities, cotherapies, severity of disease, compliance, local circumstances, and patients preferences, which may differ sufficiently from those in the trial situation to attenuate or change the benefit-to-risk ratio. There are several methods to address those issues, like pragmatic trials and n-of-1 trials. When data from randomized clinical trials do not provide clear answers from sufficiently similar studies in the magnitude of effect sizes, lack of statistical significance, or identification of subgroups, systematic reviews and meta-analysis may help to provide a better summary of the data. A major difference between a traditional review and a systematic is the systematic nature in which studies are chosen and appraised. Traditional reviews are written by experts in the field who use differing and often subjective criteria to decide what studies to include and what weight to give them, and hence the conclusions are often very diverse, depending on the reviewer. Publication and selection bias is a major concern of traditional reviews. Systematic reviews and meta-analysis are being increasingly used in dementia, propelled by the Cochrane Dementia and Cognitive Improvement Group, to make decisions about treatment, management, and care and to guide future research. This narrative review describes the rationale for randomized clinical trials and systematic reviews in dementia, particularly AD. Drug Dev. Res. 56:401,411, 2002. © 2002 Wiley-Liss, Inc. [source] Does Glucocorticoid Administration Prevent Late Seizures after Head Injury?EPILEPSIA, Issue 6 2004Nathaniel F. Watson Summary: Purpose: Preventing posttraumatic epilepsy has been a difficult challenge. In this study we evaluated the association between glucocorticoid administration after traumatic brain injury (TBI) and posttraumatic seizures. Methods: We examined a seizure-prevention trial database of 404 patients with severe TBI for exposure to glucocorticoids in the early (<1 week) posttraumatic period. After controlling for seizure risk, we compared the odds of developing first and second late posttraumatic seizures between those that received glucocorticoids and those that did not. Results: Patients dosed with glucocorticoids within 1 day of their TBI were more likely to develop first late seizures than were those without [p = 0.04; hazard ratio = 1.74; 95% confidence interval (CI), 1.01,2.98]; whereas those receiving glucocorticoids ,2 days after their injury had no similar association (p = 0.66; hazard ratio = 0.77; 95% CI, 0.23,2.56; p = 0.10 among the three groups). Receiving glucocorticoids within 1 day, or ,2 days after TBI was not associated with second late seizure development. Conclusions: Glucocorticoid treatment after TBI is not associated with decreased late posttraumatic seizures, and early treatment is associated with increased seizure activity. [source] Estimating nationwide burden of stroke: the exciting but difficult challenge for the 21st centuryEUROPEAN JOURNAL OF NEUROLOGY, Issue 12 2008Y. Béjot No abstract is available for this article. [source] Polypyrimidine tract binding protein regulates alternative splicing of an aberrant pseudoexon in NF1FEBS JOURNAL, Issue 24 2008Michela Raponi In disease-associated genes, understanding the functional significance of deep intronic nucleotide variants represents a difficult challenge. We previously reported that an NF1 intron 30 exonization event is triggered from a single correct nomenclature is ,c.293-279 A>G' mutation [Raponi M, Upadhyaya M & Baralle D (2006) Hum Mutat 27, 294,295]. In this paper, we investigate which characteristics play a role in regulating inclusion of the aberrant pseudoexon. Our investigation shows that pseudoexon inclusion levels are strongly downregulated by polypyrimidine tract binding protein and its homologue neuronal polypyrimidine tract binding protein. In particular, we provide evidence that the functional effect of polypyrimidine tract binding protein is proportional to its concentration, and map the cis -acting elements that are principally responsible for this negative regulation. These results highlight the importance of evaluating local sequence context for diagnostic purposes, and the utility of developing therapies to turn off activated pseudoexons. [source] Controlling Electron and Hole Charge Injection in Ambipolar Organic Field-Effect Transistors by Self-Assembled MonolayersADVANCED FUNCTIONAL MATERIALS, Issue 15 2009Xiaoyang Cheng Abstract Controlling contact resistance in organic field-effect transistors (OFETs) is one of the major hurdles to achieve transistor scaling and dimensional reduction. In particular in the context of ambipolar and/or light-emitting OFETs it is a difficult challenge to obtain efficient injection of both electrons and holes from one injecting electrode such as gold since organic semiconductors have intrinsically large band gaps resulting in significant injection barrier heights for at least one type of carrier. Here, systematic control of electron and hole contact resistance in poly(9,9-di- n -octylfluorene- alt -benzothiadiazole) ambipolar OFETs using thiol-based self-assembled monolayers (SAMs) is demonstrated. In contrast to common believe, it is found that for a certain SAM the injection of both electrons and holes can be improved. This simultaneous enhancement of electron and hole injection cannot be explained by SAM-induced work-function modifications because the surface dipole induced by the SAM on the metal surface lowers the injection barrier only for one type of carrier, but increases it for the other. These investigations reveal that other key factors also affect contact resistance, including i) interfacial tunneling through the SAM, ii) SAM-induced modifications of interface morphology, and iii) the interface electronic structure. Of particular importance for top-gate OFET geometry is iv) the active polymer layer thickness that dominates the electrode/polymer contact resistance. Therefore, a consistent explanation of how SAM electrode modification is able to improve both electron and hole injection in ambipolar OFETs requires considering all mentioned factors. [source] Psychological aspects and coping styles of parents with Haemophilic child undergoing a programme of counselling and psychological supportHAEMOPHILIA, Issue 3 2007A. M. BOTTOS Summary., Parents of children affected by haemophilia must face, often without prior knowledge, the difficult challenge imposed by such a pathology. To satisfy the need of information, guideline and psychological support for a better quality of life, 30 parents with haemophiliac children have participated in a programme of counselling and psychological support. Such a programme has the aim of guiding the group trough a process of discovery, comparison and personal growth and stimulating adaptive processes of problem,solving and decision,making. The aim of this paper was to verify how the programme influenced coping strategies and other psychological constructs such as depression and anxiety. Subjects of this study were administered the following psychological tests: COPE (coping, orientation to problems experienced), BDI (beck depression inventory), STAI-Y form (state,trait anxiety inventory) at the beginning and at the end of the programme. The results show that by the end of the programme subjects are characterized by a greater use of problem,focused coping strategies, typical of individuals who think that the situation is susceptible to change, and a minor use of emotion,focused coping strategies, related to individuals who regard the situation as immutable. The use of avoidance ,focused coping strategies seems to remain at the same level even if it was low. Also the other psychological aspects investigated, namely depression and anxiety, did receive a positive influence. The results show how significant such programme has been for parents. [source] Cardiovascular Risk Assessment and TriptansHEADACHE, Issue 2004Vasilios Papademetriou MD Identifying the patient for whom triptans are contraindicated because of recognized, diagnosed cardiovascular disease is relatively straightforward. Determining whether a patient with potential unrecognized cardiovascular disease is an appropriate candidate for triptan therapy, however, constitutes a difficult challenge, especially in the absence of a framework for workup of patients. This article discusses the pathophysiology of coronary heart disease and issues involved in assessing cardiovascular risk, and it attempts to provide a framework for cardiovascular risk assessment that can be applied to decisions for prescribing triptans. Current guidelines for cardiovascular risk assessment allow stratification of patients to low, intermediate, or high risk of coronary heart disease events. This framework for risk assessment can be applied to decisions for prescribing triptans. Cardiovascular risk-assessment algorithms discussed elsewhere in this supplement suggest that patients at low risk (1 or no risk factors) of coronary heart disease can be prescribed triptans without the need for a more intensive cardiovascular evaluation. Conversely, patients with established coronary heart disease or coronary heart disease risk equivalents should not be prescribed triptans according to the current prescribing recommendations. Patients at intermediate risk (2 or more risk factors) of coronary heart disease require cardiovascular evaluation before triptans can be prescribed. Current understanding suggests that the risk of future acute coronary events is a function of the absolute number of vulnerable plaques present, a variable that cannot be accurately determined using available technology or risk-prediction models. Cardiovascular risk-assessment guidelines should be evaluated in the context of this limitation. [source] Pattern recognition and financial time-seriesINTELLIGENT SYSTEMS IN ACCOUNTING, FINANCE & MANAGEMENT, Issue 3 2006Dave Elliman This paper investigates financial time-series from the perspective of a practitioner in artificial intelligence methods and pattern recognition. It presents results from statistical experiments which suggest that financial markets operate with a measure of inefficiency and predictability. However, identifying the nature of any regularities and patterns presents a difficult challenge to the artificial intelligence community, in that established techniques make assumptions about the underlying process that mostly prove to be invalid for this class of data. Copyright © 2007 John Wiley & Sons, Ltd. [source] Current controversies surrounding liver transplantation for hepatocellular carcinomaJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7 2010Mauricio F Silva Abstract Liver transplantation (LT) for hepatocellular carcinoma (HCC) has progressed rapidly over the last decade from a futile therapy to the first choice therapy for suitable patients. Excellent outcomes of LT for HCC can be largely attributed to the use of the Milan Criteria, which have restricted LT to patients with early stage tumors. These criteria may be conservative, and it is likely that a subset of patients with tumors beyond these criteria can have acceptable outcomes. However, there is currently insufficient data to accept more liberal criteria as a standard of care, and a higher quality evidence base must be achieved to prevent poor utilization of valuable donor liver resources. In the future, it is probable that more sophisticated selection criteria will emerge incorporating aspects of tumor biology beyond tumor size and number. Dropout from the waiting list due to tumor progression remains a clinical challenge particularly in regions with prolonged waiting times. Priority allocation using HCC MELD points is a practical and transparent solution that has successfully reduced waitlist dropout for HCC patients. Further refinements of the HCC MELD point system are required to ensure equity of access to LT for non-HCC patients and prioritization of HCC patients with the highest risk of dropout. Improving the evidence base for pre-LT locoregional therapy to prevent waitlist dropout is an urgent and difficult challenge for the LT community. In the interim transplant clinicians must restrict the use of these therapies to those patients who are most likely to benefit from them. [source] Experiences of U.S. Military Nurses in the Iraq and Afghanistan Wars, 2003,2009JOURNAL OF NURSING SCHOLARSHIP, Issue 1 2010Elizabeth Scannell-Desch RN Abstract Purpose: The purpose of this study is to describe the lived experience of U.S. military nurses who served in Iraq or Afghanistan during the war years 2003 to 2009, and life after returning from war. Methods: Colaizzi's phenomenological method guided discovery. This method includes elements of both descriptive and interpretive phenomenology. The sample consisted of 37 military nurses who served in the Army, Navy, or Air Force in the Iraq or Afghanistan wars. Four data-generating questions guided the interview process. Most interviews were face-to-face and conducted in naturalistic settings chosen by the participants. Several interviews were conducted telephonically due to geographic constraints. Data analysis followed Colaizzi's method of analysis. Seven themes emerged from the data, including "deploying to war;""remembrance of war: most chaotic scene;""nurses in harm's way: more than I bargained for;""kinship and bonding: my military family;""my war stress: I'm a different person now;""professional growth: expanding my skills;" and "listen to me: advice to deploying nurses." Analysis continued until data saturation was achieved. Results: Results indicated that wartime deployment was a difficult challenge, lessons learned should be shared with nurses deploying in future years, homecoming was more difficult than most nurses anticipated, and reintegration after coming home takes time and effort. Conclusions: Nursing in war is a unique experience regardless of education, preparation and training. There are a myriad of variables that enter into the experience and effect outcomes, both personal and professional. Clinical Relevance: Wartime nursing is a reality in the current clinical practice arena. War takes its toll on everyone involved, including the caregivers. Nurses returning from war can provide valuable insights to those that follow. [source] High Conflict Divorce, Violence, and Abuse: Implications for Custody and Visitation DecisionsJUVENILE AND FAMILY COURT JOURNAL, Issue 4 2003CLARE DALTON ABSTRACT Today, judges are faced with the daunting task of determining the best interests of the child and making appropriate custody awards to that end. The best interests of children becomes a critical question when domestic violence is involved; yet, determining what constitutes domestic violence is often debated. Research is often divided on what constitutes domestic violence. One body of research focuses on conflict, another focuses on domestic violence. What the first group identifies as intense emotional distress and disagreement, the other identifies as abuse. Judges making custody determinations in such cases are faced with the difficult challenge of distinguishing between a divorce with "high conflict" and a domestic violence case with ongoing abuse. This article will summarize the legal, philosophical, and historical understandings of the "high conflict" family and its potential impact on children. It will also provide practical judicial guidelines for making the important distinction between high conflict and domestic violence and subsequently crafting appropriate and safe child custody awards. [source] Chronic lung disease in human immunodeficiency virus (HIV) infected children,PEDIATRIC PULMONOLOGY, Issue 1 2008Heather J. Zar Abstract The development of chronic lung disease is common in HIV-infected children. The spectrum of chronic HIV-associated lung disease includes lymphocytic interstitial pneumonia (LIP), chronic infections, immune reconstitution inflammatory syndrome (IRIS), bronchiectasis, malignancies, and interstitial pneumonitis. Chronic lung disease may result from recurrent or persistent pneumonia due to bacterial, mycobacterial, viral, fungal or mixed infections. In high tuberculosis (TB) prevalence areas, M. tuberculosis is an important cause of chronic respiratory illness. With increasing availability of highly active antiretroviral therapy (HAART) for children in developing countries, a rise in the incidence of IRIS due to mycobacterial or other infections is being reported. Diagnosis of chronic lung disease is based on chronic symptoms and persistent chest X-ray changes but definitive diagnosis can be difficult as clinical and radiological findings may be non-specific. Distinguishing LIP from miliary TB remains a difficult challenge in HIV-infected children living in high TB prevalence areas. Treatment includes therapy for specific infections, pulmonary clearance techniques, corticosteroids for children with LIP who are hypoxic or who have airway compression from tuberculous nodes and HAART. Children who are taking TB therapy and HAART need adjustments in their drug regimes to minimize drug interactions and ensure efficacy. Preventative strategies include immunization, chemoprophylaxis, and micronutrient supplementation. Early use of HAART may prevent the development of chronic lung disease. Pediatr Pulmonol. 2008; 43:1,10. © 2007 Wiley-Liss, Inc. [source] Theories of and in the Policy ProcessPOLICY STUDIES JOURNAL, Issue 4 2008David L. Weimer Like public administration before it, public policy has an uneasy place in the discipline of political science. The stress is most obvious in the distinction between theories that attempt to explain the policy process and theories that are useful to those who seek to operate within the policy process. Accommodating this stress within the disciplinary boundaries of political science poses a difficult challenge. [source] Knowledge Life Cycle, Knowledge Inventory, and Knowledge Acquisition Strategies,DECISION SCIENCES, Issue 1 2010Andrew N. K. Chen ABSTRACT For a knowledge- and skill-centric organization, the process of knowledge management encompasses three important and closely related elements: (i) task assignments, (ii) knowledge acquisition through training, and (iii) maintaining a proper level of knowledge inventory among the existing workforce. Trade-off on choices between profit maximization in the short run and agility and flexibility in the long term is a vexing problem in knowledge management. In this study, we examine the effects of different training strategies on short-term operational efficiency and long-term workforce flexibility. We address our research objective by developing a computational model for task and training assignment in a dynamic knowledge environment consisting of multiple distinct knowledge dimensions. Overall, we find that organizational slack is an important variable in determining the effectiveness of training strategies. Training strategies focused on the most recent skills are found to be the preferred option in most of the considered scenarios. Interestingly, increased efficiencies in training can actually create preference conflict between employees and the firm. Our findings indicate that firms facing longer knowledge life cycles, higher slack in workforce capacity, and better training efficiencies actually face more difficult challenges in knowledge management. [source] Diversified Agriculture, Land Use, and Agrofood Networks in Hawaii,ECONOMIC GEOGRAPHY, Issue 1 2002Krisnawati Suryanata Abstract: Agriculture dominated the culture and economy of Hawaii until the mid-twentieth century, but has since been in a prolonged state of decline. This article examines strategies in Hawaii's diversified agriculture that seek to revitalize its agrarian sector and the difficult challenges these efforts face within the globalized agrofood systems. Drawing from the actor-network perspective, this article suggests an alternative approach to developing Hawaii's diversified agriculture. Networks of social actors that include growers, processors, gourmet chefs, retailers, and consumers have been able to create viable diversified agriculture in spite of the globalized agrofood systems. The article then discusses how the politics of land use and land development could condition Hawaii's ability to build networks that are critical to the maintenance of a diversified agricultural sector. [source] Valuation of biodiversity effects from reduced pesticide useINTEGRATED ENVIRONMENTAL ASSESSMENT AND MANAGEMENT, Issue 2 2006Jesper S. Schou Abstract This study deals with the effects on biodiversity of pesticide-free buffer zones along field margins. Using choice modeling, the majority of respondents to a survey on pesticide use in the environment are willing to accept an increase in the price of bread if the survival of partridge chicks and the number of wild plants increase. The study identifies the need for further empirical work with respect to methodological validation, price estimation, and the use of survey results in policy analysis. In particular, the environmental effects of pesticide use are complex and, therefore, present difficult challenges when presenting information to lay people. Forty-one percent of respondents changed their responses regarding willingness to pay more for bread when references to pesticide use were introduced in the questionnaire. This indicates that scenarios depicting changes in pesticide use can be difficult to present to lay people in an economically rational and well-defined context. Thus, in the study of valuation related to changes in pesticide use, much attention should be devoted to the design and definition of the context. Furthermore, the effects of providing different background information, e.g., with or without the mention of pesticides, should be tested. [source] The challenges of commissioning healthcare: a discussion paperINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2009Article first published online: 5 JUN 200, Sheila Peskett Abstract The UK's Department of Health Independent Sector Programme to procure healthcare for National Health Service (NHS) patients from the independent sector revealed many of the challenges of commissioning, particularly assessing governance arrangements and identifying the organisational attributes of high quality healthcare providers. These issues were first discussed in a workshop at the British Association of Medical Managers (BAMM) Medical Directors Conference in Dublin in November 2007 (Dale, et al., 2009). The more difficult challenges of achieving effective clinical engagement, including motivational factors, organisational environment and systems and partnership working, in the complex field of commissioning healthcare in the UK are also explored here with particular reference to systems in other countries. Copyright © 2009 John Wiley & Sons, Ltd. [source] The Life Satisfaction Matrix: an instrument and procedure for assessing the subjective quality of life of individuals with profound multiple disabilitiesJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 10 2005G. Lyons Abstract Background Assessing and measuring subjective quality of life (QOL) for individuals with profound multiple disabilities (PMD) remain amongst the most difficult challenges for theorists and practitioners in the field. The usual approaches using proxy reporting by familiar others have been demonstrated to be of questionable reliability and validity for persons with PMD. Method The author's continuing research into understanding the nature of subjective QOL of these individuals has led to the development and evaluating the Life Satisfaction Matrix (LSM), an instrument and procedure for assessing the subjective QOL of these individuals. Results Qualitative research that provides empirical evidence to support the assumptions underpinning, and face validity of, the LSM is described in this article. Conclusion Results of the study described herein demonstrate some potential to meet and overcome the above-mentioned challenges to assess and measure the subjective QOL of individuals with PMD. [source] Trauma in organizations: Prevention and treatment with emergent strategies from alternative psychologyJOURNAL OF PSYCHOLOGICAL ISSUES IN ORGANIZATIONAL CULTURE, Issue 1 2010John Hartung Ph.D. Effective organizations intend to select employees who are already emotionally healthy and can be resilient in the face of difficult challenges. There is also growing interest in helping employees learn to be even more resilient, on the principle that prevention is preferred to subsequent treatment. Plans are also made for treatment for situations where selection and prevention efforts prove inadequate and when employees become negatively affected by difficult events. This article describes innovative strategies that can be used for both prevention and treatment. [source] WICKED WATER PROBLEMS: SOCIOLOGY AND LOCAL WATER ORGANIZATIONS IN ADDRESSING WATER RESOURCES POLICY,JOURNAL OF THE AMERICAN WATER RESOURCES ASSOCIATION, Issue 3 2000David M. Freeman ABSTRACT: Water policy problems are wicked, not in an ethically deplorable sense, but in the sense that they present us with especially difficult challenges of becoming more effective in our interdisciplinary collaboration, of integrating two very different types of knowledge, of working across several socio-political units of analysis simultaneously, and of better organizing water as a common property resource. Sociology, as a discipline, does not have a particularly rich history of successful interdisciplinary collaboration on water resources research and teaching, but it potentially has a most useful contribution to make by focusing on the analysis of local common property resource organizations that operate in the interface between individual resource users and State-Federal entities. These organizations (e.g., water user associations, mutual companies, irrigation districts, acequias, conservancy districts) have been the orphans of water policy discourse but their operations are critical to undertaking more effective 21st century social analysis, research work, and action programs. Sociologists who work to better comprehend the operations of, and constraints upon, these organizations build a sociology that can better collaborate with other water-related disciplines in addressing the challenges posed by the wickedness of our water problems. [source] When Systems Collide: Improving Court Practices and Programs in Dual Jurisdiction CasesJUVENILE AND FAMILY COURT JOURNAL, Issue 2 2005GENE SIEGEL ABSTRACT The purpose of this article is to identify promising court-based or court-linked practices and programs that can effectively address the difficult challenges posed by dual jurisdiction cases. It is an initial effort to present what courts are currently doing or what courts can do to improve coordination of dual jurisdiction matters. [source] Universal access to water and sanitation: Why the private sector must participateNATURAL RESOURCES FORUM, Issue 4 2003Terence Lee Abstract Against the background of the current state of provision of drinking water and sanitation in the world , with one billion lacking safe water, and 2.2 billion not having adequate sanitation , this article argues that private participation is necessary. The most important issues for the management of water utilities in the 21st century are identified as mobilizing investment for the highly capital intensive operation of water supply and sanitation infrastructure, and achieving efficiency in the delivery of services. The article highlights the issues that need to be raised if private investment is to be seriously considered as an alternative. Case studies, especially from Latin America (Argentina, Chile, Peru, Bolivia), illustrate different modes of private participation, and possible reasons for successes and failures are discussed. The article stresses that regardless of the modality of private sector involvement, on-going government regulatory responsibility in the water sector is crucial. It suggests that regulatory policy must go beyond just setting tariffs, to develop standards for drinking water quality and waste treatment, as well as other standards. In conclusion, the article recognizes that numerous and increasingly difficult challenges face utilities in fulfilling their responsibility to deliver drinking water of adequate quality, in sufficient quantity, and at affordable prices, as well as safe and sustainable disposal of wastewaters for members of urban and rural communities. [source] Beyond Access: Persistence Challenges and the Diversity of Low-Income StudentsNEW DIRECTIONS FOR HIGHER EDUCATION, Issue 121 2003Melanie E. Corrigan Public policy often emphasizes access to higher education, but low-income students face more difficult challenges on the path to degree attainment. Adult low-income students have different obligations and goals than their younger counterparts. Institutional leaders and policymakers can encourage persistence among low-income students with flexible policies that accommodate new enrollment patterns, diverse family structures, and differing educational and economic goals. [source] Acute Stroke Care at Rural Hospitals in Idaho: Challenges in Expediting Stroke CareTHE JOURNAL OF RURAL HEALTH, Issue 1 2006James G. Gebhardt MD ABSTRACT:,Context: Thrombolytics are currently the most effective treatment for stroke. However, the National Institute for Neurological Disorders and Stroke criteria for initiation of thrombolytic therapy, most notably the 3-hour time limit from symptom onset, have proven challenging for many rural hospitals to achieve. Purpose: To provide a snapshot of stroke care at rural hospitals in Idaho and to investigate the experiences of these hospitals in expediting stroke care. Methods: Using a standard questionnaire, a telephone survey of hospital staff at 21 rural hospitals in Idaho was performed. The survey focused on acute stroke care practices and strategies to expedite stroke care. Findings: The median number of stroke patients treated per year was 23.3. Patient delays were reported by 77.8% of hospitals, transport delays by 66.7%, in-hospital delays by 61.1%, equipment delays by 22.2%, and ancillary services delays by 61.1%. Approximately 67% of hospitals had implemented a clinical pathway for stroke and 80.0% had provided staff with stroke-specific training. No hospitals surveyed had a designated stroke team, and only 33.3% reported engaging in quality improvement efforts to expedite stroke care. Thrombolytics (tPA) were available and indicated for stroke at 55.6% of the hospitals surveyed. Conclusions: Rural hospitals in Idaho face many difficult challenges as they endeavor to meet the 3-hour deadline for thrombolytic therapy, including limited resources and experience in acute stroke care, and many different types of prehospital and in-hospital delays. [source] The quest for the mechanisms of lifeBIOTECHNOLOGY & BIOENGINEERING, Issue 7 2003Maria I. Klapa Abstract The genomic revolution, manifested by the sequencing of the complete genome of many organisms, along with technological advances, such as DNA microarrays and developments in high-throughput analysis of proteins, metabolites, and isotopic tracer distribution patterns, challenged the conventional ways in which questions are approached in the biological sciences: (a) rather than examining a small number of genes and/or reactions at any one time;, we can now analyze gene expression and protein activity in the context of systems of interacting genes and gene products; (b) comprehensive analysis of biological systems requires the integration of all cellular fingerprints: genome sequence, maps of gene expression, protein expression, metabolic output, and in vivo enzymatic activity; and (c) collecting, managing, and analyzing comparable data from various cellular profiles requires expertise from several fields that transcend traditional discipline boundaries. While researchers in systems biology have still to address difficult challenges in both experimental and computational arenas, they possess, for the first time, the opportunity to unravel the mechanisms of life. The enormous impact of these discoveries in diverse areas, such as metabolic engineering, strain selection, drug screening and development, bioprocess development, disease prognosis and diagnosis, gene and other medical therapies, is an obvious motivation for pursuing integrated analyses of cellular systems. © 2003 Wiley Periodicals, Inc. [source] | ||||||||||||||||||||||