Face Additional Challenges Research Articles

Extracting Distribution Network Fault Semantic Labels From Free Text Incident Tickets

Increased monitoring of distribution networks and power system assets present utilities with new opportunities to predict and forestall system failures. Although automated pattern recognition methodologies have given other industries significant advantage, power system operators face additional challenges before these can be realized. The effort of apportioning ground truth to fault data creates a knowledge bottleneck that can make utilizing automatic classification techniques impossible. Surrogate approaches using operational process outputs such as maintenance tickets as labels can be challenging owing to the causal ambiguity of these written records. To approach a solution, this paper demonstrates utilizing natural language processing techniques to disambiguate the free text in maintenance tickets for onward use in supervised learning of fault prediction and classification techniques. A demonstration of this approach on an established power quality fault data set is provided for illustration.

8.6 THE IMPACT OF CHILD MALTREATMENT ON TRANSITIONING TO ADULTHOOD

The transition from adolescence to adulthood is increasingly complicated in the United States. Many individuals suffering childhood maltreatment face additional transition challenges. For instance, one subpopulation of maltreated youth, foster youth, do not usually receive the types of family support their nonfoster peers enjoy when transitioning to adulthood. In addition, foster youth are more likely to be challenged in the areas of social/emotional supports, living skills, finances, housing, education, employment, physical and mental health, and justice system involvement.

"You Never Know What Could Happen": Women's Perspectives of Pre-Exposure Prophylaxis in the Context of Recent Intimate Partner Violence.

Vulnerability to human immunodeficiency virus (HIV) infection is a significant public health issue for women experiencing intimate partner violence (IPV). Despite the increased risk of human immunodeficiency virus infection, women only represent 4.6% of pre-exposure prophylaxis (PrEP) users in the United States. IPV may present additional difficulties to PrEP access. In this qualitative study, we examined how IPV and the relational context shaped women's decisions, attitudes, and engagement in the PrEP care continuum. We conducted semistructured interviews with 19 women residing in Connecticut who participated in a prospective cohort study. We purposively recruited our sample to include women who reported physical and/or sexual IPV in the past 6months, and used a grounded theory approach to analyze the qualitative data. Our findings suggest multiple ways that the relational context can affect women's decisions, attitudes, and engagement in the PrEP care continuum. We identified five aspects of women's relationships that can shape women's interest, intentions, and access to PrEP: 1) relationship power struggles, 2) infidelity, 3) trust and monogamy, 4) male partner's reactions, and 5) "season of risk" (i.e., PrEP use only during times of perceived human immunodeficiency virus risk). Collectively, these findings suggest that women experiencing IPV might face additional relational challenges that need to be adequately addressed in settings administering PrEP. Communication on sexual risk reduction strategies should address relational factors and promote women's autonomy. Future research on long-acting and invisible forms of PrEP may help to circumvent some of the relational barriers women experiencing IPV may face when considering PrEP care.

Supporting Blind and Visually Impaired Persons in Managing Their Medication.

Various reasons lead to non-adherence to drug therapy, such as forgotten reordering of medications or wrong intake behavior. Blind and visually impaired persons face additional challenges, such as recognizing the medication package or reading the package insert which additionally impacts on patient safety. To address these challenges, we developed a concept for supporting medication management. In the center of the concept is the mobile application MyPills. It reminds on drug intake and reordering. These functionalities are made available to blind and visually impaired persons using screen reader functionalities. The current medication is entered into MyPills using the eMediplan, a Swiss national exchange format for eMedication. Beyond, package inserts are made accessible through voice output. MyPills supports in scanning the global trade item number (GTIN) for medication package identification. A usability tests carried out with six participants including two blind persons showed that users get along well with the app and the functionalities are helpful. In future studies with patients, it should be checked whether the MyPills app can improve compliance with drug therapy and impacts on intake behavior.

Adult congenital heart disease: Past, present and future.

The diagnosis and management of congenital heart disease (CHD), the most common inborn defect, has been a tremendous success story of modern medicine. In the 1950s, survival of children born with CHD was only approximately 15%, whereas nowadays more than 90% of these children survive well into adulthood. Consequently, the prevalence of patients with CHD has shifted away from infancy and childhood towards adulthood. Adult CHD cardiology is now encompassing not only young or middle-aged adults but also patients with CHD over 60years old. Many adult patients are afflicted by residual haemodynamic lesions and also face additional opportunities and/or challenges such as pregnancy, acquired heart disease, non-cardiac pathology etc., necessitating integrated care and all medical disciplines. We are faced with a "tsunami" in terms of adult CHD numbers, disease heterogeneity and complexity of work and interventions needed. We need to secure resources, welcome more people in our field, learn from "marching with our patients", and educate better patients, public and ourselves so that every single patient with CHD, born anywhere in the world, may reach their full life potential.

Call to Action: Universal Policy to Support Residents and Fellows Who Are Breastfeeding.

Call to Action: Universal Policy to Support Residents and Fellows Who Are Breastfeeding.

Learn how to manage student conduct, distress involving online learning environments

JACKSONVILLE, FLA. — Student affairs professionals at institutions with online students — especially with multiple campuses in different states or countries — certainly face additional challenges navigating conversations about student conduct. Of course, such difficult topics are best suited to in‐person meetings, but that's usually impossible with far‐flung and online students. But there are other ways you can successfully and effectively manage student conduct cases and academic‐integrity‐related challenges involving the online classroom, according to Jennifer Toof, M.S., M.B.A., assistant director of world campus student affairs at The Pennsylvania State University. She shared her recommendations at the Association for Student Conduct Administration's annual conference.

Implementing a quality management system using good clinical laboratory practice guidelines at KEMRI-CMR to support medical research.

Background: Good Clinical Laboratory Practice (GCLP) is a standard that helps ensure the quality and reliability of research data through principles of Good Laboratory Practice (GLP) and Good Clinical Practice (GCP). The implementation of GCLP includes careful documentation of procedures, competencies and safety measures. Implementation of GCLP is influenced by existing resources and quality systems, thus laboratories in low- and middle-income countries may face additional challenges. Methods: This paper describes implementation of GCLP at the Kenya Medical Research Institute-Center for Microbiology Research (KEMRI-CMR) as part of a quality system to support medical research. This study employed assessment, twinning (institutional mentorship) model, conducting relevant training workshops and Kaizen 5S approaches to implement an effective quality management system using GCLP standard. This was achieved through a collaboration between the KEMRI/Wellcome Trust Research Programme (KWTRP) and KEMRI-CMR. The aim was compliance and continuous monitoring to meet international GCLP standards in a way that could be replicated in other research organizations. Results: Following a baseline assessment in March 2017, training, mentorship and a cycle of quality audit and corrective action using a Kaizen 5S approach (sorting, setting in order, shining, standardizing and sustaining) was established. Laboratory personnel were trained in writing standard operating procedures and analytical plans, microbiological techniques, and good documentation practice. Mid-term and exit assessments demonstrated significant declines in non-conformances across all GCLP elements. KEMRI-CMR achieved GCLP accreditation in May 2018 by Qualogy Ltd (UK). Conclusions: Involving all the laboratory personnel in implementation of quality management system processes is critical to success. An institutional mentorship (twinning) approach shows potential for future collaborations between accredited and non-accredited organizations to accelerate the implementation of high-quality management systems and continuous improvement.

Is “being foreign” a liability for mining companies? Locational liabilities and social conflict in Latin America

Do foreign mining firms face additional challenges and incur additional costs in host environments because of their nationality? This paper draws on the business literature on liability of foreignness (LOF), to examine whether foreign mining firms face a performance liability in comparison to locally-owned mining companies. In order to adapt this literature to the particular context of mining in developing countries, characterized by territorially-uneven costs of doing business abroad, and link it with stakeholder perceptions, we introduce the concept of “locational liabilities”. We show that foreign mining firms do experience a liability of foreignness associated with a higher likelihood of social conflict, than locally-owned firms, and that this effect can only be fully identified with the inclusion of locational liabilities that interact differentially with foreign and local firms. Furthermore, we demonstrate that these liabilities are not easily mitigated by corporate social responsibility practices, suggesting that foreign firms may have greater difficulty obtaining social licence to operate. The article uses an original database of 634 mining properties in five countries of Latin America, and a novel empirical methodology based on highly-localized property-level sources of data drawn in part from geographic information system (GIS) analysis.

Chinese Americans' attitudes toward advance directives: An assessment of outcomes based on a nursing-led intervention

BackgroundThe process of advance care planning (ACP) encompasses learning about and planning for end-of-life (EOL) decisions, documenting preferences through legal forms known as Advance Directives (ADs), and having discussions with loved ones to share these preferences. While most ethnic minority groups have low ACP engagement and AD completion rates, Chinese Americans face additional challenges related to cultural beliefs and ACP. PurposeThe purpose of this study was to estimate the impact of a culturally tailored nurse-driven educational intervention on the relationship between attitudes toward ADs and AD completion and ACP discussions. DesignPre-posttest, repeated measures non-experimental design. MethodsA convenience sample of Chinese Americans participated in a culturally tailored nurse led AD and ACP workshop in English and Mandarin in a Chinese Community Center. Participants completed surveys before and after the workshop and at one-month follow-up. ResultsSeventy-two Chinese Americans participated in this study. Most were female and born in China. Attitudes toward ADs improved after participating in the workshop and remained consistent at one-month follow-up. There was a significant positive relationship between attitudes and AD completion and ACP discussions. ConclusionsNurse-driven interventions improved engagement in the ACP process in Chinese Americans, a population thought to be averse to discussing death and dying and one with lower than average AD completion rates. Using culturally tailored interventions improves engagement in the ACP process.

Financial and Health Insurance Literacy: A Necessary Addition to Health Literacy Programming

The enactment of the Affordable Care Act (ACA) and expansion of Medicaid means that many more consumers are eligible for health insurance coverage, some for the first time. Health insurance has become increasingly complex and consumer-driven, and patients are now responsible for researching and choosing a plan appropriate for their needs. Individuals who struggle with health literacy may face additional challenges in understanding financial and insurance concepts. Deficits in health insurance and financial literacy correlate to poor health outcomes and increased expenditures for patients, similar to those with limited health literacy. Patient advocates and other agencies should consider financial and insurance literacy assessment along with health literacy education.

Community, Towards Dialogue: A Self-Study of Online Teacher Preparation for Special Education

ABSTRACTOnline teacher education is experiencing significant growth worldwide. One of the major challenges accompanying this growth is that many teacher educators find themselves underprepared and under pressure to design online teacher education courses that reflect their beliefs about what constitutes high-quality teacher preparation practice. Further, teacher educators in disciplines such as special education face additional challenges in developing understandings about the legalities of writing and implementing disability service plans and performing additional testing. In this self-study of online special education teacher education practice, two collaborators worked to identify strategies and practices for professional community building in a class about teaching reading to students with disabilities. The findings highlight issues of teacher educator authority and presence online against other needs to model collegiality and promote scholarly thinking. Researchers in online teaching may find insight into both the cognitive and contextual concerns as they work to enhance online teacher education while they plan their own investigations.

Transforming a traditional research organization through public entrepreneurship

Public entrepreneurship is much like its private sector counterpart; however, public entrepreneurs face additional challenges due to weaker competitive forces in the public as compared to private sector, with objectives that often are poorly defined and performance that is difficult to measure. Despite the impact on public good, how to enact changes successfully in public sector organizations to be more entrepreneurial is poorly understood. This article summarizes current research on public entrepreneurship and presents a detailed case study of a successful entrepreneurial change in a public sector organization. A five-step change process used to enhance entrepreneurial behaviors was implemented in a public sector organization and the qualitative and quantitative results demonstrated substantial performance improvements over 4 years (i.e., quantitative performance in some areas was more than 10 times greater). We explain key steps that produced successful outcomes and how to avoid common challenges in the implementation of ongoing entrepreneurial behaviors in public sector contexts.

Health care equity and access for marginalised young people: a longitudinal qualitative study exploring health system navigation in Australia

BackgroundYoung people have unique social, emotional and developmental needs that require a welcoming and responsive health system, and policies that support their access to health care. Those who are socially or culturally marginalised may face additional challenges in navigating health care, contributing to health inequity. The aim of this study was to understand health system navigation, including the role of technology, for young people belonging to one or more marginalised groups, in order to inform youth health policy in New South Wales, Australia.MethodsThis qualitative longitudinal study involved 2–4 interviews each over 6 to 12 months with marginalised young people aged 12–24 years living in NSW. The analysis used Nvivo software and grounded theory.ResultsWe interviewed 41 young people at baseline who were living in rural or remote areas, sexuality and/or gender diverse, refugee, homeless, and/or Aboriginal. A retention rate of over 85% was achieved. Nineteen belonged to more than one marginalised group allowing an exploration of intersectionality. General practitioners (family physicians) were the most commonly accessed service throughout the study period.Participants were ambivalent about their healthcare journeys. Qualitative analysis identified five themes:Technology brings opportunities to understand, connect and engage with servicesHealthcare journeys are shaped by decisions weighing up convenience, engagement, effectiveness and affordability.Marginalised young people perceive and experience multiple forms of discrimination leading to forgone care.Multiple marginalisation makes health system navigation more challengingThe impact of health system complexity and fragmentation may be mitigated by system knowledge and navigation supportConclusionsThe compounding effects of multiple discrimination and access barriers were experienced more strongly for young people belonging to mutiple marginalised groups. We identify several areas for improving clinical practice and policy. Integrating technology and social media into processes that facilitate access and navigation, providing respectful and welcoming services that recognise diversity, improving health literacy and involving professionals in advocacy and navigation support may help to address these issues.

From Social Worker to Social Worker: MSW Mentorship Outcomes

Students returning to graduate school after years in the workforce face multiple challenges, including reviving dormant academic skills, juggling multiple roles and role alterations, and navigating academic structures and procedures. Department of Children and Family Services (DCFS) Children’s Social Workers (CSW’s) returning to school to obtain a Masters in Social Work (MSW) degree face additional unique challenges, including graduate level writing expectations, learning to be a professional social worker as dictated by the standards of the discipline, and making a paradigm shift from social work employee to social work student. A mentoring project was developed to assist students employed as CSW’s in successfully transitioning from employee to MSW student, and aimed to strengthen the public child welfare employee students to ensure that they are better equipped to successfully achieve their MSW, develop strategies to effectively integrate their skills into the DCFS system following graduation and ultimately increase proficiency to effectively serve vulnerable children and families. The purpose of this research study is to explore how the implementation of a mentorship program for CSW’s obtaining an MSW contributed to professional success post-graduation, when social workers returned to their positions with DCFS. This qualitative study was developed using detailed oral interviews with five participants. This research reveals mentorship programs can be both personally and professionally successful, identifying needs germane to this population of students and suggesting a specialized approach to educating current CSW’s to cultivate the skills essential for effective social work practice.

Common maternal health problems among Australian-born and migrant women: A prospective cohort study.

BackgroundMigrant women of non-English speaking background make up an increasing proportion of women giving birth in high income countries, such as Australia, Canada and the United Kingdom. The aim of this study was to assess the prevalence of common physical and psychosocial health problems during pregnancy and up to 18 months postpartum among migrant women of non-English speaking background compared to Australian-born women.MethodsProspective pregnancy cohort study of 1507 nulliparous women. Women completed self-administered questionnaires or telephone interviews in early and late pregnancy and at 3, 6, 9, 12 and 18 months postpartum. Standardised instruments were used to assess incontinence, depressive symptoms and intimate partner violence.FindingsMigrant women of non-English speaking background (n = 243) and Australian-born mothers (n = 1115) reported a similar pattern of physical health problems during pregnancy and postpartum. The most common physical health problems were: exhaustion, back pain, constipation and urinary incontinence. Around one in six Australian-born women (16.9%) and more than one in four migrant women (22.5%) experienced intimate partner abuse in the first 12 months postpartum. Compared to Australian-born women, migrant women were more likely to report depressive symptoms at 12 and 18 months postpartum.ConclusionPhysical and mental health problems are common among women of non-English speaking background and Australian-born women, and frequently persist up to 18 months postpartum. Migrant women experience a higher burden of postpartum depressive symptoms and intimate partner violence, and may face additional challenges accessing appropriate care and support.

How does disability influence child care arrangements for young children? An examination using the NHES ECPP

Affordable child care is an essential support for families with young children, and quality of care impacts a range of child development outcomes. Still, many families face a number of barriers to accessing high-quality care. Given the necessary resources for raising a child with a disability, high-quality child care may be particularly salient for families with a child with a disability. Yet, these families face additional challenges to accessing appropriate care, and children with disabilities may be less likely to be receiving quality care than their nondisabled peers. Despite these challenges, little empirical work has been done to examine differences in child care arrangements between families who have a child with a disability and those who do not. Using data from the National Household Education Surveys (NHES) Early Childhood Program Participation (ECPP) surveys, this paper seeks to understand if there are differences in the types of arrangements used. Results suggest young children with disabilities are 50% more likely to be enrolled in formal, center-based care compared to no enrollment in child care and 25% less likely to be enrolled in informal care compared to center-based care than their nondisabled peers, with additional differences by household income and child's age. Findings offer a crucial first step in understanding child care arrangements for young children with disaiblities and indicate that center-based care may be particularly important for families.

Recovery from Psychosis in a Forensic Service: Assessing Staff and Service Users’ Perspectives Using Q Methodology

ABSTRACTRecovery has become a guiding principle for mental health service delivery. However, the implementation of recovery-oriented services is hindered by conceptual multiplicity, and forensic services in particular face additional challenges. The perspectives of both those receiving and providing services are central in understanding how the recovery approach can best be supported in practice. Therefore, this study used Q methodology to explore staff and service-users’ views regarding factors deemed important to recovery from psychosis in a forensic service. Ten service-users and 13 mental health professionals completed a 60-item Q-sort to obtain their idiosyncratic views about recovery in this context. Q analysis produced a four-factor solution (accounting for 60% of the variance), revealing four distinct perspectives. The first placed emphasis on “personal growth and psychosocial aspects of recovery,” the second on “gaining insight and reducing recidivism,” the third placed importance on “self-focused aspects of recovery,” and the final factor highlighted “making amends & service engagement” as important to recovery. The heterogeneity of recovery beliefs indicated that multiple dimensions of recovery are important in clinical practice. The bio-medical model of care appeared most prominent, suggesting the need for greater choice in alternative treatments and improved access to alternative models of care. To better apply recovery values, service-users and mental health professionals require a better understanding of the various recovery dimensions, and this broad conceptualisation of recovery should be reflected in service provision.

Balancing financial, social and environmental values: can new ventures make an impact without sacrificing profits

What drives entrepreneurial action to create a lasting impact? The creation of new ventures that aim at having an impact beyond their financial performance face additional challenges: achieving economic sustainability and at the same time addressing social or environmental issues. Little is known on how these new hybrid organisations, aiming for multiple impact dimensions, organise and prioritise for their social, environmental, and financial goals. A dataset of 4,125 early-stage ventures is used to gain insights into how blended values are converted into financial, social and environmental impacts, giving shape to different types of hybrid organisations. Our findings suggest new hybrid organisations might opt to sacrifice financial impact to achieve social impact, yet this is not the case when they aim to generate environmental or sustainable impact. Therefore, the tensions and sacrifices related to holding blended values are not homogeneous across all types of new hybrid organisations.

Identification and Assessment of Drug-User Groups Among Nightlife Attendees: Self-Reports, Breathalyzer-Tests and Oral Fluid Drug Tests

Background and Objectives: Even though nightlife studies with potentially intoxicated participants provide the much needed information on drug use, they face additional methodological challenges. This study aimed to explore the utility of such studies by (i) classifying nightlife attendees based on their self-reported drug use and by (ii) examining whether these classifications were meaningful when assessed against other sources of data, including oral fluid drug tests. Methods: Self-reported questionnaires, oral fluid samples and blood alcohol concentration readings were collected in a sample of 1,085 nightlife patrons recruited outside 12 popular nightclubs in Oslo, Norway, in 2014. Patrons were classified using multiple approaches, including latent class analysis. Group differences were examined by logistic regression models. Results: Participants were classified into 5 mutually exclusive groups: 2 among current non-users (“Never-users”; “Previous users”), 2 among current users (“Multiple drugs”; “Cannabis mainly”) and one “Incomplete information” group. Meaningful differences across these groups were observed. For instance, positive tests for any illicit drug were more common in “Multiple drugs” group than in “Cannabis mainly” (62.7 vs. 29.1%, adjusted OR [aOR] 3.77 [2.42–5.84]) or “Incomplete information” groups (62.7 vs. 34.4%, aOR 2.46 [1.26–4.79]). Despite their self-declared non-use, illicit substances were detected in oral fluids of “Never-users” (13.1%; 95% CI 9.9–17.2) and “Previous users” (7.9%; 95% CI 5.1–12.1). Conclusions: Despite some discrepancies between self-reports and biological tests, self-reports proved both suitable and useful in identification of substantively different drug-user typologies, potentially informing targeted policy responses. Still, methodological challenges associated with onsite studies of illicit drug use should be further explored.