Facilities Planning Guide for Special Education Programs: Planning Accessibility for the Handicapped in Public Schools.

ERIC Educational Resources Information Center

Brooks, Kenneth W.

The guide details characteristics to provide architecturally accessible special education programs for handicapped students. Impetus for the accessibility movement is traced to legislation, including the Architectural Barriers Act and Sections 503 and 504 of the Rehabilitation Act of 1973. Planning features considered are the development of a…

Planning for Technology Integration in a Professional Learning Community

ERIC Educational Resources Information Center

Thoma, Jennifer; Hutchison, Amy; Johnson, Debra; Johnson, Kurt; Stromer, Elizabeth

2017-01-01

Barriers to technology integration in instruction include a lack of time, resources, and professional development. One potential approach to overcoming these barriers is through collaborative work, or professional learning communities. This article focuses on one group of teachers who leveraged their professional learning community to focus on…

Evaluation and development of tools to quantify the impacts of roadside vegetation barriers on near-road air quality

EPA Science Inventory

Regulatory and urban planning programs require an accurate evaluation of how traffic emissions transport and disperse from roads to fully determine exposures and health risks. Roadside vegetation barriers have shown the potential to reduce near-road air pollution concentrations; ...

Sociotechnical challenges to developing technologies for patient access to health information exchange data

PubMed Central

Ancker, Jessica S; Miller, Melissa C; Patel, Vaishali; Kaushal, Rainu

2014-01-01

Background Providing patients with access to their medical data is widely expected to help educate and empower them to manage their own health. Health information exchange (HIE) infrastructures could potentially help patients access records across multiple healthcare providers. We studied three HIE organizations as they developed portals to give consumers access to HIE data previously exchanged only among healthcare organizations. Objective To follow the development of new consumer portal technologies, and to identify barriers and facilitators to patient access to HIE data. Methods Semistructured interviews of 15 key informants over a 2-year period spanning the development and early implementation of three new projects, coded according to a sociotechnical framework. Results As the organizations tried to develop functionality that fully served the needs of both providers and patients, plans were altered by technical barriers (primarily related to data standardization) and cultural and legal issues surrounding data access. Organizational changes also played an important role in altering project plans. In all three cases, patient access to data was significantly scaled back from initial plans. Conclusions This prospective study revealed how sociotechnical factors previously identified as important in health information technology success and failure helped to shape the evolution of three novel consumer informatics projects. Barriers to providing patients with seamless access to their HIE data were multifactorial. Remedies will have to address technical, organizational, cultural, and other factors. PMID:24064443

Overcoming barriers to exercise among parents: a social cognitive theory perspective.

PubMed

Mailey, Emily L; Phillips, Siobhan M; Dlugonski, Deirdre; Conroy, David E

2016-08-01

Parents face numerous barriers to exercise and exhibit high levels of inactivity. Examining theory-based determinants of exercise among parents may inform interventions for this population. The purpose of this study was to test a social-cognitive model of parental exercise participation over a 12-month period. Mothers (n = 226) and fathers (n = 70) of children <16 completed measures of exercise, barriers self-efficacy, perceived barriers, and exercise planning at baseline and 1 year later. Panel analyses were used to test the hypothesized relationships. Barriers self-efficacy was related to exercise directly and indirectly through perceived barriers and prioritization/planning. Prioritization and planning also mediated the relationship between perceived barriers and exercise. These paths remained significant at 12 months. These results suggest efforts to increase exercise in parents should focus on improving confidence to overcome exercise barriers, reducing perceptions of barriers, and helping parents make specific plans for prioritizing and engaging in exercise.

Planning and Implementing Immunization Billing Programs at State and Local Health Departments: Barriers and Possible Solutions.

PubMed

Corriero, Rosemary; Redmon, Ginger

Before participating in a project funded by the Centers for Disease Control and Prevention, most state and local health departments (LHDs) were not seeking reimbursement or being fully reimbursed by insurance plans for the cost of immunization services (including vaccine costs and administration fees) they provided to insured patients. Centers for Disease Control and Prevention's Billables Project was designed to enable state and LHDs to bill public and private insurance plans for immunization services provided to insured patients. Identify and describe key barriers state and LHDs may encounter while planning and implementing a billing program, as well as possible solutions for overcoming those barriers. This study used reports from Billables Project participants to explore barriers they encountered when planning and implementing a billing program and steps taken to address those barriers. Thirty-eight state immunization programs. Based on project participants' reports, barriers were noted in 7 categories: (1) funding and costs, (2) staff, (3) health department characteristics, (4) third-party payers and insurance plans, (5) software, (6) patient insurance status, and (7) other barriers. Possible solutions for overcoming those barriers included hiring or seeking external help, creating billing guides and training modules, streamlining workflows, and modifying existing software systems. Overcoming barriers during planning and implementation of a billing program can be challenging for state and LHDs, but the experiences and suggestions of past Billables Project participants can help guide future billing program efforts.

Barriers of modern contraceptive practices among Asian women: a mini literature review.

PubMed

Najafi-Sharjabad, Fatemeh; Zainiyah Syed Yahya, Sharifah; Abdul Rahman, Hejar; Hanafiah Juni, Muhamad; Abdul Manaf, Rosliza

2013-07-22

Family planning has been cited as essential to the achievement of Millennium Development Goals (MDG). Family planning has a direct impact on women's health and consequence of each pregnancy. The use of modern contraception among Asian women is less than global average. In Asia a majority of unintended pregnancies are due to using traditional contraceptive or no methods which lead to induced unsafe abortion. Cultural attitudes, lack of knowledge of methods and reproduction, socio demographic factors, and health service barriers are the main obstacles to modern contraceptive practice among Asian women. Culturally sensitive family planning program, reforming health system, and reproductive health education through mass media to create awareness of the benefits of planned parenthood are effective strategies to improve modern contraceptive practice among Asian women.

Barriers of Modern Contraceptive Practices among Asian Women: A Mini Literature Review

PubMed Central

Najafi-Sharjabad, Fatemeh; Syed Yahya, Sharifah Zainiyah; Rahman, Hejar Abdul; Hanafiah, Muhamad; Abdul Manaf, Rosliza

2013-01-01

Family planning has been cited as essential to the achievement of Millennium Development Goals (MDG). Family planning has a direct impact on women's health and consequence of each pregnancy. The use of modern contraception among Asian women is less than global average. In Asia a majority of unintended pregnancies are due to using traditional contraceptive or no methods which lead to induced unsafe abortion. Cultural attitudes, lack of knowledge of methods and reproduction, socio demographic factors, and health service barriers are the main obstacles to modern contraceptive practice among Asian women. Culturally sensitive family planning program, reforming health system, and reproductive health education through mass media to create awareness of the benefits of planned parenthood are effective strategies to improve modern contraceptive practice among Asian women. PMID:23985120

A Meta-Analysis of Urban Climate Change Adaptation Planning in the U.S.

EPA Science Inventory

The concentration of people, infrastructure, and ecosystem services in urban areas make them prime sites for climate change adaptation. While advances have been made in developing frameworks for adaptation planning and identifying both real and potential barriers to action, empir...

Making High Schools Work through Blended Instruction. A Vision and Plan for the Integration of Academic and Career and Technology Education in Maryland.

ERIC Educational Resources Information Center

Maryland State Dept. of Education, Baltimore.

A team consisting of Maryland State Department of Education (MSDE) staff, local educators, and other representatives developed an action plan to assist in advancing the blending of academic, career, and technology education. The team prepared a vision statement, set strategic directions, analyzed barriers, and developed recommendations and actions…

"But I wasn't told to": lack of education and workplace policy as barriers in the provision of family planning information.

PubMed

Bell, Melissa M

2015-01-01

Access to family planning has been identified as critical to public health. Improving the linkage between medical and social services could result in improved access to care for those most at risk of unintended pregnancy. This study used a survey based on Alfred Bandura's social cognitive theory (1986) to increase the understanding of the barriers social workers confront in the provision of family planning information to clients. Although moral disagreement with family planning presented a barrier for some, workplace policy, participation in family planning trainings, and working in an urban setting were of greater value in understanding barriers.

Barriers on the propagation of renewable energy sources and sustainable solid waste management practices in Greece.

PubMed

Boemi, Sn; Papadopoulos, Am; Karagiannidis, A; Kontogianni, S

2010-11-01

Renewable energy sources (RES), excluding large hydroelectric plants, currently produce 4.21% of total electricity production in Greece. Even when considering the additional production from large hydroelectric plants, which accounts for some 7.8%, the distance to be covered towards the objective of 20% electricity produced from RES by 2010 and respectively towards 20% of total energy production by 2020 is discouraging. The potential, however, does exist; unfortunately so do serious barriers. On the other hand, solid waste management (SWM) is an issue that generates continuously increasing interest due to the extra amounts of solid waste generated; the lack of existing disposal facilities with adequate infrastructure and integrated management plans, also often accompanied by legislative and institutional gaps. However, socio-economic and public awareness problems are still met in the planning and implementation of RES and SWM projects, together with the lack of a complete national cadastre and a spatial development master plan, specifying areas eligible for RES and SWM development. Specific barriers occur for individual RES and the on-going inclusion of waste-derived renewable energy in the examined palette further increases the complexity of the entire issue. The consolidated study of this broad set of barriers was a main task of the present study which was carried out within the frame of a Hellenic-Canadian research project; the main results will be discussed herein.

[Perceived barriers to active commuting to school: reliability and validity of a scale].

PubMed

Molina-García, Javier; Queralt, Ana; Estevan, Isaac; Álvarez, Octavio; Castillo, Isabel

To examine the reliability and validity of a scale to measure perceived barriers to active commuting to school among Spanish young people. The validity of the scale was assessed in a sample of 465 adolescents (14-18 years) using a confirmatory factor analysis and studying its association with self-reported active commuting to school. The reliability of the instrument was evaluated in a sub-sample that completed the scale twice separated by a one-week interval. The results showed that the barriers scale had satisfactory fit indices, and two factors were determined. The first included environment- and safety-related items (α=0.72), while the other concerned planning and psychosocial items (α=0.64). Active commuting to school showed significant correlations with the total score of the barriers scale (rho=-0.27; p <0.001), with the environmental/safety barriers (rho=-0.22; p <0.001), as well as with the planning/psychosocial barriers (rho=-0.29; p <0.001). Test-retest ICCs for the barriers ranged from 0.68 to 0.77. The developed scale has acceptable validity and good reliability to assess barriers to active commuting to school among Spanish young people. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Using Behavioral Science to Design a Peer Comparison Intervention for Postabortion Family Planning in Nepal

PubMed Central

Spring, Hannah; Datta, Saugato; Sapkota, Sabitri

2016-01-01

Despite the provision of free and subsidized family planning services and clients’ demonstrated intentions to delay pregnancies, family planning uptake among women who receive abortion and postabortion services at Sunaulo Parivar Nepal (SPN), one of Nepal’s largest non-governmental sexual and reproductive health (SRH) providers, remains low. Through meetings, interviews, and observations with SPN’s stakeholders, service providers, and clients at its 36 SRH centers, we developed hypotheses about client- and provider-side barriers that may inhibit postabortion family planning (PAFP) uptake. On the provider side, we found that the lack of benchmarks (such as the performance of other facilities) against which providers could compare their own performance and the lack of feedback on the performance were important barriers to PAFP uptake. We designed several variants of three interventions to address these barriers. Through conversations with team members at SPN’s centralized support office and service providers at SPN centers, we prioritized a peer-comparison tool that allows providers at one center to compare their performance with that of other similar centers. We used feedback from the community of providers on the tools’ usability and features to select a variant of the tool that also leverages and reinforces providers’ strong intrinsic motivation to provide quality PAFP services. In this paper, we detail the process of identifying barriers and creating an intervention to overcome those barriers. The intervention’s effectiveness will be tested with a center-level, stepped-wedge randomized control trial in which SPN’s 36 centers will be randomly assigned to receive the intervention at 1-month intervals over a 6-month period. Existing medical record data will be used to monitor family planning uptake. PMID:27446891

Using Behavioral Science to Design a Peer Comparison Intervention for Postabortion Family Planning in Nepal.

PubMed

Spring, Hannah; Datta, Saugato; Sapkota, Sabitri

2016-01-01

Despite the provision of free and subsidized family planning services and clients' demonstrated intentions to delay pregnancies, family planning uptake among women who receive abortion and postabortion services at Sunaulo Parivar Nepal (SPN), one of Nepal's largest non-governmental sexual and reproductive health (SRH) providers, remains low. Through meetings, interviews, and observations with SPN's stakeholders, service providers, and clients at its 36 SRH centers, we developed hypotheses about client- and provider-side barriers that may inhibit postabortion family planning (PAFP) uptake. On the provider side, we found that the lack of benchmarks (such as the performance of other facilities) against which providers could compare their own performance and the lack of feedback on the performance were important barriers to PAFP uptake. We designed several variants of three interventions to address these barriers. Through conversations with team members at SPN's centralized support office and service providers at SPN centers, we prioritized a peer-comparison tool that allows providers at one center to compare their performance with that of other similar centers. We used feedback from the community of providers on the tools' usability and features to select a variant of the tool that also leverages and reinforces providers' strong intrinsic motivation to provide quality PAFP services. In this paper, we detail the process of identifying barriers and creating an intervention to overcome those barriers. The intervention's effectiveness will be tested with a center-level, stepped-wedge randomized control trial in which SPN's 36 centers will be randomly assigned to receive the intervention at 1-month intervals over a 6-month period. Existing medical record data will be used to monitor family planning uptake.

Educational Planning for the Gifted. Overcoming Cultural, Geographic and Socioeconomic Barriers

ERIC Educational Resources Information Center

Baldwin, Alexinia Y., Ed.; And Others

The book presents theoretical considerations and practical recommendations concerned with school planning for gifted children who might not be identified nor have an opportunity to develop their mental capacities because of external influences such as cultural diversity, socioeconomic status, or geographic isolation. Six different approaches to…

Implementing post-trial access plans for HIV prevention research.

PubMed

Paul, Amy; Merritt, Maria W; Sugarman, Jeremy

2018-05-01

Ethics guidance increasingly recognises that researchers and sponsors have obligations to consider provisions for post-trial access (PTA) to interventions that are found to be beneficial in research. Yet, there is little information regarding whether and how such plans can actually be implemented. Understanding practical experiences of developing and implementing these plans is critical to both optimising their implementation and informing conceptual work related to PTA. This viewpoint is informed by experiences with developing and implementing PTA plans for six large-scale multicentre HIV prevention trials supported by the HIV Prevention Trials Network. These experiences suggest that planning and implementing PTA often involve challenges of planning under uncertainty and confronting practical barriers to accessing healthcare systems. Even in relatively favourable circumstances where a tested intervention medication is approved and available in the local healthcare system, system-level barriers can threaten the viability of PTA plans. The aggregate experience across these HIV prevention trials suggests that simply referring participants to local healthcare systems for PTA will not necessarily result in continued access to beneficial interventions for trial participants. Serious commitments to PTA will require additional efforts to learn from future approaches, measuring the success of PTA plans with dedicated follow-up and further developing normative guidance to help research stakeholders navigate the complex practical challenges of realising PTA. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Barriers to the widespread adoption of health data standards: an exploratory qualitative study in tertiary healthcare organizations in Saudi Arabia.

PubMed

Alkraiji, Abdullah; Jackson, Thomas; Murray, Ian

2013-04-01

Although health data standards are perceived to be the essential solution for interoperability barriers within medical IT systems, the level of adoption of those standards still remains frustratingly low. Little is known about the barriers facing their adoption within the healthcare organizations context. In addressing this gap in the literature, based on IT related standards adoption theories such as Diffusion of Innovation Theory and the theories surrounding the Economics of Standards, a qualitative multiple-case study was undertaken in Saudi Arabia to investigate those barriers. The results exposed that few standards were adopted because of four broad reasons, managerial, technical, educational and governmental. While some of the findings can be rooted to those related standards theories, others can be underpinned through the normative literature. Core barriers are the lack of a national regulator and a data exchange plan, and the lack of an adequate policy regarding medical IT systems and information management and national healthcare system; also important are technical barriers and the switching costs to the standards. The outcome of this study can be used in forming effective interventions when planning to use health data standards and, in particular those in developing countries.

Effects of Hurricane Surge Barrier on Hydraulic Environment, Jamaica Bay, New York; Hydraulic Model Investigation

DTIC Science & Technology

1976-09-01

the New York Harbor area and especially the Jamaica Bay complex was used to determine the effects of 13 different hurricane surge barrier plans on...vary directly with the total cross-sectional area of the naviga- tion opening and tidal openings. d. barrier plans B, C-l, C-2, and C-3 would have... plan C-1 with a conservative dye source seaward of the barrier indicated that average dye concentrations will be increased slightly in most areas in

Impediments to media communication of social change in family planning and reproductive health: experiences from East Africa.

PubMed

Kagurusi, Patrick T

2013-09-01

The media has been employed to increase uptake of Family Planning through behaviour change communication (BCC). Understanding the barriers encountered in effectively undertaking this function would increase the strategy's effectiveness. Sixty journalists from East Africa participated in trainings to enhance their BCC skills for Family Planning in which a qualitative study was nested to identify barriers to effective Family Planning BCC in the region's media. The barriers were observed to be insufficient BCC skills, journalists' conflict of interest, interests of media houses, inaccessible sources of family planning information, editorial ideologies and absence of commercially beneficial demand. Coupled with the historical ideologies of the media in the region, the observed barriers have precipitated ineffective family planning BCC in the regions media. Effective BCC for family planning in the regions media requires capacity building among practitioners and alignment of the concept to the media's and consumers' aspirations.

Succession Planning and Management Practice in Washington State Local Public Health Agencies.

PubMed

Wiesman, John M; Babich, Suzanne M; Umble, Karl; Baker, Edward L

2016-01-01

Turnover of top local public health officials is expected to be great, with 23% being 60 years of age or older, and another 42% being 50 to 59 years of age. Yet, we know little about the use of succession planning in public health agencies. Describe succession planning practices in local public health agencies. We conducted a Web-based, cross-sectional survey of succession planning practices and followed the career paths of public health officials for 40 months. The top local public health officials from Washington State's 35 local governmental public health agencies. Twenty-five succession planning best practices. All 35 agencies responded, resulting in a 100% response rate. Our study found evidence of succession planning practices in Washington State local public health agencies: 85% of agencies selected high-performing high potential employees for development, 76% sent them to formal technical and management/leadership training, 70% used cross-functional team projects, and 67% used stretch assignments to develop their employees. Impetuses to implement succession planning were discovering that large percentages of employees were able to retire soon and that national accreditation requires workforce development plans. Barriers to implementing succession planning included other competing demands for time, belief that the agency's workforce was too small for a formal program, and concerns that there would be union barriers. In 2012, 50% of the officials surveyed said that it would be at least possible that they would leave their current jobs within 5 years. Forty months later, 12 (34%) had left their positions. We were encouraged by the level of succession planning in Washington State and recommend creating a greater sense of urgency by focusing on agency retirement profiles and emphasizing the need for workforce development plans for accreditation. Developing the public health leaders of tomorrow is too important to be left to chance.

Health behavior change in advance care planning: an agent-based model.

PubMed

Ernecoff, Natalie C; Keane, Christopher R; Albert, Steven M

2016-02-29

A practical and ethical challenge in advance care planning research is controlling and intervening on human behavior. Additionally, observing dynamic changes in advance care planning (ACP) behavior proves difficult, though tracking changes over time is important for intervention development. Agent-based modeling (ABM) allows researchers to integrate complex behavioral data about advance care planning behaviors and thought processes into a controlled environment that is more easily alterable and observable. Literature to date has not addressed how best to motivate individuals, increase facilitators and reduce barriers associated with ACP. We aimed to build an ABM that applies the Transtheoretical Model of behavior change to ACP as a health behavior and accurately reflects: 1) the rates at which individuals complete the process, 2) how individuals respond to barriers, facilitators, and behavioral variables, and 3) the interactions between these variables. We developed a dynamic ABM of the ACP decision making process based on the stages of change posited by the Transtheoretical Model. We integrated barriers, facilitators, and other behavioral variables that agents encounter as they move through the process. We successfully incorporated ACP barriers, facilitators, and other behavioral variables into our ABM, forming a plausible representation of ACP behavior and decision-making. The resulting distributions across the stages of change replicated those found in the literature, with approximately half of participants in the action-maintenance stage in both the model and the literature. Our ABM is a useful method for representing dynamic social and experiential influences on the ACP decision making process. This model suggests structural interventions, e.g. increasing access to ACP materials in primary care clinics, in addition to improved methods of data collection for behavioral studies, e.g. incorporating longitudinal data to capture behavioral dynamics.

Barriers and Facilitators to Implementing the HEADS-ED: A Rapid Screening Tool for Pediatric Patients in Emergency Departments.

PubMed

MacWilliams, Kate; Curran, Janet; Racek, Jakub; Cloutier, Paula; Cappelli, Mario

2017-12-01

This study sought to identify barriers and facilitators to the implementation of the HEADS-ED, a screening tool appropriate for use in the emergency department (ED) that facilitates standardized assessments, discharge planning, charting, and linking pediatric mental health patients to appropriate community resources. A qualitative theory-based design was used to identify barriers and facilitators to implementing the HEADS-ED tool. Focus groups were conducted with participants recruited from 6 different ED settings across 2 provinces (Ontario and Nova Scotia). The Theoretical Domains Framework was used as a conceptual framework to guide data collection and to identify themes from focus group discussions. The following themes spanning 12 domains were identified as reflective of participants' beliefs about the barriers and facilitators to implementing the HEADS-ED tool: knowledge, skills, beliefs about capabilities, social professional role and identity, optimism, beliefs about consequences, reinforcement, environmental context and resources, social influences, emotion, behavioral regulation and memory, and attention and decision process. The HEADS-ED has the potential to address the need for better discharge planning, complete charting, and standardized assessments for the increasing population of pediatric mental health patients who present to EDs. This study has identified potential barriers and facilitators, which should be considered when developing an implementation plan for adopting the HEADS-ED tool into practice within EDs.

CMC Research at NASA Glenn in 2015: Recent Progress and Plans

NASA Technical Reports Server (NTRS)

Grady, Joseph E.

2015-01-01

As part of NASAs Aeronautical Sciences project, Glenn Research Center has developed advanced fiber and matrix constituents for a 2700F CMC for turbine engine applications. Fiber and matrix development and characterization will be reviewed. Resulting improvements in CMC mechanical properties and durability will be summarized. Plans for 2015 will be described, including development and validation of models predicting effects of the engine environment on durability of SiC/SiC composites with Environmental Barrier Coatings

Learning from the implementation of inter-organisational web-based care planning and coordination.

PubMed

Walker, Rae; Blacker, Vivian; Pandita, Linda; Close, Jacky; Mason, Wendy; Watson, Julie

2013-01-01

In Victoria, despite strong policy support, e-care planning and coordination is poorly developed. The action research project discussed here was developed to overcome organisational and worker-level barriers to change. The project outcomes highlighted the need for work on the building blocks of e-care coordination that enhance workers' knowledge and skills, and provide permission and support for appropriate collaborative system and services coordination practices.

Environmental impact assessment in urban transport planning: Exploring process-related barriers in Spanish practice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Soria-Lara, Julio A., E-mail: j.a.sorialara@uva.nl; Bertolini, Luca, E-mail: l.bertolini@uva.nl; Brömmelstroet, Marco te, E-mail: M.C.G.teBrommelstroet@uva.nl

The effectiveness of EIA for evaluating transport planning projects is increasingly being questioned by practitioners, institutions and scholars. The academic literature has traditionally focused more on solving content-related problems with EIA (i.e. the measurement of environmental effects) than on process-related issues (i.e. the role of EIA in the planning process and the interaction between key actors). Focusing only on technical improvements is not sufficient for rectifying the effectiveness problems of EIA. In order to address this knowledge gap, the paper explores how EIA is experienced in the Spanish planning context and offers in-depth insight into EIA process-related issues in themore » field of urban transport planning. From the multitude of involved actors, the research focuses on exploring the perceptions of the two main professional groups: EIA developers and transport planners. Through a web-based survey we assess the importance of process-related barriers to the effective use of EIA in urban transport planning. The analyses revealed process issues based fundamentally on unstructured stakeholders involvement and an inefficient public participation - Highlights: • Qualitative research on perceptions of EIA participants on EIA processes. • Web-based survey with different participants (EIA-developers; transport planners). • It was seen an inefficient participation of stakeholders during the EIA processes.« less

Psychometrics of an original measure of barriers to providing family planning information: Implications for social service providers.

PubMed

Bell, Melissa M; Newhill, Christina E

2017-07-01

Social service professionals can face challenges in the course of providing family planning information to their clients. This article reports findings from a study that developed an original 27-item measure, the Reproductive Counseling Obstacle Scale (RCOS) designed to measure such obstacles based conceptually on Bandura's social cognitive theory (1986). We examine the reliability and factor structure of the RCOS using a sample of licensed social workers (N = 197). A 20-item revised version of the RCOS was derived using principal component factor analysis. Results indicate that barriers to discussing family planning, as measured by the RCOS, appear to be best represented by a two-factor solution, reflecting self-efficacy/interest and perceived professional obligation/moral concerns. Implications for practice and future research are discussed.

Social justice in pandemic preparedness.

PubMed

DeBruin, Debra; Liaschenko, Joan; Marshall, Mary Faith

2012-04-01

Pandemic influenza planning in the United States violates the demands of social justice in 2 fundamental respects: it embraces the neutrality of procedural justice at the expense of more substantive concern with health disparities, thus perpetuating a predictable and preventable social injustice, and it fails to move beyond lament to practical planning for alleviating barriers to accessing care. A pragmatic social justice approach, addressing both health disparities and access barriers, should inform pandemic preparedness. Achieving social justice goals in pandemic response is challenging, but strategies are available to overcome the obstacles. The public engagement process of one state's pandemic ethics project influenced the development of these strategies.

Social Justice in Pandemic Preparedness

PubMed Central

Liaschenko, Joan; Marshall, Mary Faith

2012-01-01

Pandemic influenza planning in the United States violates the demands of social justice in 2 fundamental respects: it embraces the neutrality of procedural justice at the expense of more substantive concern with health disparities, thus perpetuating a predictable and preventable social injustice, and it fails to move beyond lament to practical planning for alleviating barriers to accessing care. A pragmatic social justice approach, addressing both health disparities and access barriers, should inform pandemic preparedness. Achieving social justice goals in pandemic response is challenging, but strategies are available to overcome the obstacles. The public engagement process of one state's pandemic ethics project influenced the development of these strategies. PMID:22397337

Animal intrusion status report for fiscal year 1989

DOE Office of Scientific and Technical Information (OSTI.GOV)

Landeen, D.S.

1990-08-01

The Protective Barrier and Warning Marker System Development Plan identified tasks that need to be completed to design a final protective barrier to implement in-place disposal of radioactive waste. This report summarizes the animal intrusion tasks that were conducted by Westinghouse Hanford Company in fiscal years 1988 and 1989 with respect to small mammals and water infiltration. 2 refs., 8 figs., 6 tabs.

Overcoming Barriers to Family Planning through Integration: Perspectives of HIV-Positive Men in Nyanza Province, Kenya

PubMed Central

Steinfeld, Rachel L.; Newmann, Sara J.; Onono, Maricianah; Cohen, Craig R.; Bukusi, Elizabeth A.; Grossman, Daniel

2013-01-01

This study explored barriers to and facilitators of using family planning services among HIV-positive men in Nyanza Province, Kenya. From May to June 2010, in-depth interviews were conducted with 30 men receiving care at 15 HIV clinics. The key barriers to the use of family planning included concerns about side effects of contraceptives, lack of knowledge about contraceptive methods, myths and misconceptions including fear of infertility, structural barriers such as staffing shortages at HIV clinics, and a lack of male focus in family planning methods and service delivery. The integration of family planning into HIV clinics including family planning counseling and education was cited as an important strategy to improve family planning receptivity among men. Integrating family planning into HIV services is a promising strategy to facilitate male involvement in family planning. Integration needs to be rigorously evaluated in order to measure its impact on unmet need for contraception among HIV-positive women and their partners and assure that it is implemented in a manner that engages both men and women. PMID:23738057

Knowledge, attitudes, and practice behaviors of oncology advanced practice nurses regarding advanced care planning for patients with cancer.

PubMed

Zhou, Guiyun; Stoltzfus, Jill C; Houldin, Arlene D; Parks, Susan M; Swan, Beth Ann

2010-11-01

To establish initial reliability and validity of a Web-based survey focused on oncology advanced practice nurses' (APNs') knowledge, attitudes, and practice behaviors regarding advanced care planning, and to obtain preliminary understanding of APNs' knowledge, attitudes, and practice behaviors and perceived barriers to advanced care planning. Descriptive, cross-sectional, pilot survey study. The eastern United States. 300 oncology APNs. Guided by the Theory of Planned Behavior, a knowledge, attitudes, and practice behaviors survey was developed and reviewed for content validity. The survey was distributed to 300 APNs via e-mail and sent again to the 89 APNs who responded to the initial survey. Exploratory factor analysis was used to examine the construct validity and test-retest reliability of the survey's attitudinal and practice behavior portions. Respondents' demographics, knowledge, attitudes, practice behaviors, and perceived barriers to advanced care planning practice. Exploratory factor analysis yielded a five-factor solution from the survey's attitudes and practice behavior portions with internal consistency using Cronbach alpha. Respondents achieved an average of 67% correct answers in the 12-item knowledge section and scored positively in attitudes toward advanced care planning. Their practice behavior scores were marginally positive. The most common reported barriers were from patients' and families' as well as physicians' reluctance to discuss advanced care planning. The attitudinal and practice behaviors portions of the survey demonstrated preliminary construct validity and test-retest reliability. Regarding advanced care planning, respondents were moderately knowledgeable, but their advanced care planning practice was not routine. Validly assessing oncology APNs' knowledge, attitudes, and practice behaviors regarding advanced care planning will enable more tailored approaches to improve end-of-life care outcomes.

Connecting the Learning Organization, Strategic Planning, and Public Relations.

ERIC Educational Resources Information Center

Thornton, Bill; Perreault, George

2002-01-01

Examines common perceptions about barriers to effective strategic planning in school districts. Argues that primary barrier to effective use of strategic planning in schools is the failure of educators to fully understand the strategic planning process itself. Discusses the components of a learning organization. Links learning organizations with…

Development and implementation of participant safety plans for international research with stigmatised populations.

PubMed

Sugarman, Jeremy; Barnes, Mark; Rose, Scott; Dumchev, Kostyantyn; Sarasvita, Riza; Viet, Ha Tran; Zeziulin, Oleksandr; Susami, Hepa; Go, Vivian; Hoffman, Irving; Miller, William C

2018-06-22

People who inject drugs with high-risk sharing practices have high rates of HIV transmission and face barriers to HIV care. Interventions to overcome these barriers are needed; however, stigmatisation of drug use and HIV infection leads to safety concerns during the planning and conduct of research on such interventions. In preparing to address concerns about safety and wellbeing of participants in an international research study, HIV Prevention Trials Network 074, we developed participant safety plans (PSPs) at each site to supplement local research ethics committee oversight, community engagement, and usual clinical trial procedures. The PSPs were informed by systematic local legal and policy assessments, and interviews with key stakeholders. After PSP refinement and implementation, we assessed social impacts at each study visit to ensure continued safety. Throughout the study, five participants reported a negative social impact, with three resulting from study participation. Future research with stigmatised populations should consider using and assessing this approach to enhance safety and welfare. Copyright © 2018 Elsevier Ltd. All rights reserved.

Broad Scale Monitoring in the US Forest Service: Institutional Challenges and Collaborative Opportunites for Improving Planning and Decision-Making in an Era of Climate Change

NASA Astrophysics Data System (ADS)

Wurtzebach, Z.

2016-12-01

In 2012, the United States Forest Service promulgated new rules to guide Forest planning efforts in accordance with the National Forest Management Act (NFMA). One important component of the 2012 rule is a requirement for Regionally coordinated cross-boundary "broad scale" monitoring strategies that are designed to inform and facilitate Forest-level adaptive management and planning. This presentation will examine institutional challenges and opportunites for developing effective broad scale monitoring strategies identified in 90 interviews with USFS staff and partner organizations, and collaborative workshops held in Colorado, Wyoming, Arizona, and New Mexico. Internal barriers to development include funding and human resource constraints, organizational culture, problematic incentives and accountability structures, data management issues, and administrative barriers to collaboration. However, we also identify several opportunities for leveraging interagency collaboration, facilitating multi-level coordination, generating efficiencies in data collection and analysis, and improving strategies for reporting and communication to Forest level decision-makers and relevant stakeholders.

Comparison of the perspectives of managers, employees and clients regarding the individual barriers of family planning counseling in healthcare centers of isfahan in 2012.

PubMed

Taheri, Safoura; Ehsanpour, Soheila; Kohan, Shahnaze; Farzi, Saba; Jaafarpour, Molouk; Direkvand-Moghaddam, Ashraf

2014-03-01

Family planning is a lifestyle that is selected voluntarily and is based on the knowledge, attitude and responsible decision making by couples in order to promote the health and welfare of the family and the advancement of the society. In this regard, family planning counseling plays an important role in making informed decisions if used properly and in a responsible way. Detection of individual barriers in family planning counseling based on the viewpoints of managers, employees and clients who are key participants in the healthcare service provision is a major step towards appropriate planning to modify or eliminate such barriers. The present study was conducted with the goal of comparing managers', employees' and clients' viewpoints about individual barriers in family planning counseling in health care centers in Isfahan in 2012. This was a cross-sectional one-step three-group comparative descriptive study conducted on 295 subjects including 59 managers, 110 employees and 126 clients in medical health care centers in Isfahan in 2012. The managers and employees were selected by census sampling, and the clients were recruited through convenient random sampling. The data collection tool was a researcher-designed questionnaire, which was designed in two sections of fertility and personal characteristics, and viewpoint measurement. Descriptive and inferential statistical tests were used to analyze the data. The obtained results showed significant differences between mean scores of viewpoints in three groups of managers, employees and clients concerning individual barriers in family planning counseling. In addition, most of the managers, employees and clients reported individual barriers as an intermediate level barrier in the process of family planning counseling. Results indicate that subjects in three studied groups hold different views regarding the individual barriers in family planning counseling. This difference in the perspectives may be a factor that affects the quality of the provided services. Therefore, it is necessary for the healthcare providers to consider the main concerns of their clients regarding family planning.

CMC Research at NASA Glenn in 2016: Recent Progress and Plans

NASA Technical Reports Server (NTRS)

Grady, Joseph E.

2016-01-01

As part of NASA's Aeronautical Sciences project, Glenn Research Center has developed advanced fiber and matrix constituents for a 2700 degrees Fahrenheit CMC (Ceramic Matrix Composite) for turbine engine applications. Fiber and matrix development and characterization will be reviewed. Resulting improvements in CMC mechanical properties and durability will be summarized. Plans for 2015 will be described, including development and validation of models predicting effects of the engine environment on durability of SiCSiC composites with Environmental Barrier Coatings (EBCs).

Integrated Riparian Area Management on the Tule Lake Allotment, Lassen County

Treesearch

Bill Flournoy; Don Lancaster; Paul Roush

1989-01-01

The Bureau of Land Management, Alturas Resource Area with the cooperation of the Tule Lake Allotment permittees and private landowners has embarked on a riparian enhancement program for the allotment which crosses many traditional boundaries and barriers in land management and land management planning. Currently in the plan development stages the concept provides for a...

Recreational planning: an important component of career counseling for people with disabilities.

PubMed

Devine, Mary Ann; Koch, Lynn C

2003-01-01

Participation in recreational activities is a critical component of the career development process, providing opportunities for individuals to explore their interests and to develop work-related skills. Recreational participation also offers a healthy outlet for dealing with job-related and other life stressors. People with disabilities are often excluded from participation in recreational activities because of a multitude of barriers. This exclusion can seriously impede the career development of these individuals. This article explores the importance of recreational planning as part of the vocational rehabilitation process. The authors define inclusive recreation and discuss the implications of recreational planning in the various phases of rehabilitation.

Deep Space Exploration: Will We Be Ready? Infectious Diseases, Microgravity and Other Forces Affecting Health Pose Challenges for Humans Planning to Explore Space

NASA Technical Reports Server (NTRS)

LaRocco, Mark T.; Pierson, Duane L.

1999-01-01

In contemplating space travel beyond earth orbits, we humans face significant barriers and major challenges. Although researchers involved in several scientific subdisciplines, including space medicine and space life sciences, may provide insights to help overcome those barriers, their efforts are at an early stage of development, leaving open many questions of potentially major consequence.

Applying the plan-do-study-act model to increase the use of kangaroo care.

PubMed

Stikes, Reetta; Barbier, Denise

2013-01-01

To increase the rate of participation in kangaroo care within a level III neonatal intensive care unit. Preterm birth typically results in initial separation of mother and infant which may disrupt the bonding process. Nurses within the neonatal intensive care unit can introduce strategies that will assist parents in overcoming fears and developing relationships with their infants. Kangaroo care is a method of skin-to-skin holding that has been shown to enhance the mother-infant relationship while also improving infant outcomes. However, kangaroo care has been used inconsistently within neonatal intensive care unit settings. The Plan-Do-Study-Act Model was used as a framework for this project. Plan-Do-Study-Act Model uses four cyclical steps for continuous quality improvement. Based upon Plan-Do-Study-Act Model, education was planned, surveys were developed and strategies implemented to overcome barriers. Four months post-implementation, the use of kangaroo care increased by 31%. Staff surveys demonstrated a decrease in the perceived barriers to kangaroo care as well as an increase in kangaroo care. Application of Plan-Do-Study-Act Model was successful in meeting the goal of increasing the use of kangaroo care. The use of the Plan-Do-Study-Act Model framework encourages learning, reflection and validation throughout implementation. Plan-Do-Study-Act Model is a strategy that can promote the effective use of innovative practices in nursing. © 2013 Blackwell Publishing Ltd.

Access to Complex Abortion Care Service and Planning Improved through a Toll-Free Telephone Resource Line

PubMed Central

Norman, Wendy V.; Hestrin, Barbara; Dueck, Royce

2014-01-01

Background. Providing equitable access to the full range of reproductive health services over wide geographic areas presents significant challenges to any health system. We present a review of a service provision model which has provided improved access to abortion care; support for complex issues experienced by women seeking nonjudgmental family planning health services; and a mechanism to collect information on access barriers. The toll-free pregnancy options service (POS) of British Columbia Women's Hospital and Health Centre sought to improve access to services and overcome barriers experienced by women seeking abortion. Methods. We describe the development and implementation of a province-wide toll-free telephone counseling and access facilitation service, including establishment of a provincial network of local abortion service providers in the Canadian province of British Columbia from 1998 to 2010. Results. Over 2000 women annually access service via the POS line, networks of care providers are established and linked to central support, and central program planners receive timely information on new service gaps and access barriers. Conclusion. This novel service has been successful in addressing inequities and access barriers identified as priorities before service establishment. The service provided unanticipated benefits to health care planning and monitoring of provincial health care related service delivery and gaps. This model for low cost health service delivery may realize similar benefits when applied to other health care systems where access and referral barriers exist. PMID:24693291

Barriers to fertility regulation: a review of the literature.

PubMed

Campbell, Martha; Sahin-Hodoglugil, Nuriye Nalan; Potts, Malcolm

2006-06-01

The evidence in the demographic and family planning literature of the range and diversity of the barriers to fertility regulation in many developing countries is reviewed in this article from a consumer perspective. Barriers are defined as the constraining factors standing between women and the realistic availability of the technologies and correct information they need in order to decide whether and when to have a child. The barriers include limited method choice, financial costs, the status of women, medical and legal restrictions, provider bias, and misinformation. The presence or absence of barriers to fertility regulation is likely an important determinant of the pace of fertility decline or its delay in many countries. At the same time, barriers inhibit women's ability to avoid unintended pregnancy. Problems of quantifying barriers limit understanding of their importance. New ways to quantify them and to identify misinformation, which is often concealed in survey data, are needed for future research.

Asthma education: different viewpoints elicited by qualitative and quantitative methods.

PubMed

Damon, Scott A; Tardif, Richard R

2015-04-01

This project began as a qualitative examination of how asthma education provided by health professionals could be improved. Unexpected qualitative findings regarding the use of Asthma Action Plans and the importance of insurance reimbursement for asthma education prompted further quantitative examination. Qualitative individual interviews were conducted with primary care physicians in private practice who routinely provide initial diagnoses of asthma and focus groups were conducted with other clinicians in private primary care practices who routinely provide asthma education. Using the DocStyles quantitative tool two questions regarding Asthma Action Plans and insurance reimbursement were asked of a representative sample of physicians and other clinicians. The utility of Asthma Action Plans was questioned in the 2012 qualitative study. Qualitative findings also raised questions regarding whether reimbursement is the barrier to asthma education for patients performed by medical professionals it is thought to be. 2013 quantitative findings show that the majority of clinicians see Asthma Action Plans as useful. The question of whether reimbursement is a barrier to providing asthma education to patients was not resolved by the quantitative data. The majority of clinicians see Asthma Action Plans as a useful tool for patient education. Clinicians had less clear opinions on whether the lack of defined reimbursement codes acted as a barrier to asthma education. The study also provided useful audience data for design of new asthma educational tools developed by CDC.

Contraceptive Development.

ERIC Educational Resources Information Center

Troen, Philip; And Others

This report provides an overview of research activities and needs in the area of contraceptive development. In a review of the present state, discussions are offered on the effectiveness and drawbacks of oral contraceptives, intrauterine devices, barrier methods, natural family planning, and sterilization. Methods of contraception that are in the…

Proposal for a university-community-hospice partnership to address organizational barriers to cultural competence.

PubMed

Reese, Dona J

2011-02-01

Models of culturally competent hospice services have been developed, but they are not generally being used. This article describes a participatory action research project which is addressing organizational barriers to cultural competence through a university-community-hospice partnership. The intervention plan is to develop a connection with the African American community, increasing community knowledge, and hospice staff cultural competence through a social work student field placement. It is hoped that, if successful, this model will be replicated to address the problem of African American utilization and access to hospice.

Using analytical tools for decision-making and program planning in natural resources: breaking the fear barrier

Treesearch

David L. Peterson; Daniel L. Schmoldt

1999-01-01

The National Park Service and other public agencies are increasing their emphasis on inventory and monitoring (I&M) programs to obtain the information needed to infer changes in resource conditions and trigger management responses.A few individuals on a planning team can develop I&M programs, although a focused workshop is more effective.Workshops are...

Trench Safety–Using a Qualitative Approach to Understand Barriers and Develop Strategies to Improve Trenching Practices

PubMed Central

FLYNN, MICHAEL A.; SAMPSON, JULIE M.

2015-01-01

Despite efforts to ensure workplace safety and health, injuries and fatalities related to trenching and excavation remain alarmingly high in the construction industry. Because properly installed trenching protective systems can potentially reduce the significant number of trenching fatalities, there is clearly a need to identify the barriers to the use of these systems and to develop strategies to ensure these systems are utilized consistently. The current study reports on the results of focus groups with construction workers and safety management personnel to better understand these barriers and to identify solutions. The results suggest several factors, from poor planning to pressures from experienced workers and supervisors, which present barriers to safe trenching practices. Based on the results, it is recommended that safety trainings incorporate unique messages for new workers, experienced workers and management in an effort to motivate each group to work safely as well as provide them with solutions to overcome the identified barriers. PMID:26550006

[Preventing maternal and child malnutrition: the nutrition component of the Mesoamerican Health Initiative 2015].

PubMed

Rivera, Juan A; Martorell, Reynaldo; González, Wendy; Lutter, Chessa; Cossío, Teresa González de; Flores-Ayala, Rafael; Uauy, Ricardo; Delgado, Hernán

2011-01-01

To describe the regional master plan of nutrition to address maternal and child malnutrition in a 5- year period developed by the Nutrition Technical Group. The Nutrition Technical Group developed a situation analysis describing the main nutrition problems, policies and programs in Mesoamerica. The situation analysis and a literature review about effective interventions to address malnutrition were conducted to develop a nutrition master plan. The Nutrition Technical Group held various meetings to develop, discuss and validate the master plan. Theory of change identified problems and barriers, the actions to be developed, the changes and impacts expected. A package of interventions is proposed to reduce undernutrition and micronutrient deficiencies useful under different epidemiological contexts. The nutrition master plan provides a guideline of best practices that can be used for evidence-informed decision making and the development of national policies and programs to reduce malnutrition.

CMC Research at NASA Glenn in 2017: Recent Progress and Plans

NASA Technical Reports Server (NTRS)

Grady, Joseph E.

2017-01-01

As part of NASA's Aeronautics research mission, Glenn Research Center has developed advanced constituents for 2700F CMC turbine engine applications. In this presentation, fiber and matrix development and characterization for SiCSiC composites will be reviewed and resulting improvements in CMC durability and mechanical properties will be summarized. Progress toward the development and validation of models predicting the effects of the engine environment on durability of CMC and Environmental Barrier Coatings will be summarized and plans for research and collaborations in 2017 will be summarized.

Assessing systemic barriers to permanency achievement for children in out-of-home care: development of the child permanency barriers scale.

PubMed

Murphy, April L; Van Zyl, Riaan; Collins-Camargo, Crystal; Sullivan, Dana

2012-01-01

State and local child welfare agencies are engaged in multiple efforts to enact systems change to improve outcomes, particularly in regard to achievement of child permanency. The Child and Family Services Review process, conducted by the Administration Children and Families, requires states to implement program improvement plans designed to improve outcomes for which they are not meeting national standards. However, a tool has not been demonstrated as useful in assessing the barriers to achievement of permanency across the out-of-home service continuum, from recruitment of families to placement stability. This article reports on the development and refinement of such a tool in one Midwestern state. The Child Permanency Barriers Scale has four factors: kinship, placement and matching, adequate services and resources, and communication and collaboration. Implications for use in state-specific and multisystem assessment and system reform are discussed.

Meeting the Late-Career Needs of Faculty Transitioning Through Retirement: One Institution's Approach.

PubMed

Cain, Joanna M; Felice, Marianne E; Ockene, Judith K; Milner, Robert J; Congdon, John L; Tosi, Stephen; Thorndyke, Luanne E

2018-03-01

Medical school faculty are aging, but few academic health centers are adequately prepared with policies, programs, and resources (PPR) to assist late-career faculty. The authors sought to examine cultural barriers to successful retirement and create alignment between individual and institutional needs and tasks through PPR that embrace the contributions of senior faculty while enabling retirement transitions at the University of Massachusetts Medical School, 2013-2017. Faculty 50 or older were surveyed, programs at other institutions and from the literature (multiple fields) were reviewed, and senior faculty and leaders, including retired faculty, were engaged to develop and implement PPR. Cultural barriers were found to be significant, and a multipronged, multiyear strategy to address these barriers, which sequentially added PPR to support faculty, was put in place. A comprehensive framework of sequenced PPR was developed to address the needs and tasks of late-career transitions within three distinct phases: pre-retirement, retirement, and post-retirement. This sequential introduction approach has led to important outcomes for all three of the retirement phases, including reduction of cultural barriers, a policy that has been useful in assessing viability of proposed phased retirement plans, transparent and realistic discussions about financial issues, and consideration of roles that retired faculty can provide. The authors are tracking the issues mentioned in consultations and efficacy of succession planning, and will be resurveying faculty to further refine their work. This framework approach could serve as a template for other academic health centers to address late-career faculty development.

Nurses' views regarding implementing advance care planning for older people: a systematic review and synthesis of qualitative studies.

PubMed

Ke, Li-Shan; Huang, Xiaoyan; O'Connor, Margaret; Lee, Susan

2015-08-01

To explore nurses' views regarding implementing advance care planning for older people. Advance care planning is recommended as a way for older people to discuss their future care with family members and health professionals. Nurses play key roles in the process of advance care planning, including ensuring that patients are informed of their rights and that decisions are known to, and respected by, the health care team. Thus, understanding of nurses' experiences and perspectives regarding implementing advance care planning for older people is a significant topic for review. Qualitative meta-synthesis. Four databases including CINAHL plus, Medline [EBSCOhost], EMBASE, and PsycINFO were searched, and 1844 articles were initially screened. Finally, 18 articles were critically appraised and a thematic synthesis was undertaken. Four themes were identified regarding implementation of advance care planning: perceived disadvantages and advantages of advance directives; nurses' responsibility and roles; facilitators and barriers; and nurses' needs and recommendations. Nurses felt that advance directives provided more advantages than disadvantages. Nurses generally believed that they were well positioned to engage in advance care planning conversations. Nurses perceived barriers relating to older people, families, environment, time, culture, cost, language and knowledge of health care teams with regard to advance care planning. In nurses' needs, education and support were highlighted. This study provides useful knowledge for implementing advance care planning through illustrating nurses' experiences and perspectives. The results showed that nurses were more concerned about barriers in relation to working environment, teamwork, time and knowledge of health care team members than older people's characteristics, when implementing advance care planning. The findings provide nurses and administrators with information to develop related policies and education. Additionally, the appointment of nurses to formal roles related to advance care planning is appropriate and warranted. © 2015 John Wiley & Sons Ltd.

Barriers to Community Participation in Development Planning: Lessons from the Mutengene (Cameroon) Self-Help Water Project.

ERIC Educational Resources Information Center

Njoh, Ambe J.

2002-01-01

A community water supply project in Cameroon illustrates the following constraints on community participation in development: paternalistic authorities, prescriptive role of the state, selective participation, bias toward "hard" issues, inattention to negative results, group conflicts, gatekeeping, pressure for immediate results,…

Development Administration: Obstacles, Theories and Implications for Planning. IIEP Occasional Papers No. 2.

ERIC Educational Resources Information Center

Rodman, Peter W.

In developing countries, public administration is hampered by a number of obstacles foreign to large industrialized nations. Some of these obstacles are shortages of tools and skilled personnel, outmoded organizational structures, political competition, and cultural and attitudinal barriers. The administrative obstacles and their…

Technology Transfer and the Civil Space Program. Volume 2: Workshop proceedings

NASA Technical Reports Server (NTRS)

1992-01-01

The objectives were to (1) provide a top-level review of the Integrated Technology Plan (ITP) and current civil space technology plans, including planning processes and technologies; (2) discuss and assess technology transfer (TT) experiences across a wide range of participants; (3) identify alternate categories/strategies for TT and define the objectives of transfer processes in each case; (4) identify the roles of various government 'stakeholders', aerospace industry, industries at large, and universities in civil space technology research, development, demonstration, and transfer; (5) identify potential barriers and/or opportunities to successful civil space TT; (6) identify specific needs for innovations in policy, programs, and/or procedures to facilitate TT; and (7) develop a plan of attack for the development of a workshop report. Papers from the workshop are presented.

Achieving 80% BSN by 2020: Lessons Learned From Kentucky's Registered Nurses.

PubMed

Warshawsky, Nora E; Brandford, Arica; Barnum, Nancy; Westneat, Susan

2015-09-01

The aim of this study was to understand the educational status and plans of Kentucky's RN workforce in advancing nursing educational levels. The Institute of Medicine called for 80% of nurses to hold a minimum of a BSN by 2020. Nurse leaders from practice, academe, and the community need evidence to guide the development of effective strategies. An electronic survey was administered to Kentucky's RNs. This descriptive analysis was based on 1363 usable responses. Only 40% of Kentucky's RNs held at least a BSN. Another 17% were enrolled in a nursing degree program; half of those enrolled were pursuing a BSN. Of those not enrolled in a degree program, 61.5% reported no plans to return to school. The top barriers were lack of perceived benefit, financial concerns, family obligations, and planned retirement. The top motivating factor was career advancement. The gap between the current reality and the goal is wide. Nurse leaders will need to develop creative strategies that strengthen motivating factors and reduce barriers to accelerate movement toward increasing BSN rates.

Perceived Exercise Self-Efficacy, Benefits and Barriers, and Commitment to a Plan for Exercise among Jordanians with Chronic Illnesses.

PubMed

Darawad, Muhammad W; Khalil, Amani A; Hamdan-Mansour, Ayman M; Nofal, Basema M

2016-11-01

To explore Jordanian chronic illnesses patients' perceived exercise self-efficacy, benefits and barriers, and commitment to exercise planning, and to assess the relationship between those variables. Descriptive cross-sectional design. Data were collected from a convenience sample of 402 outpatient Jordanians with chronic illnesses, using Exercise Self-Efficacy Scale, Exercise Benefits and Barriers Scale, and Commitment to a Plan for Exercise Scale. The average BMI was 28.3, and exercise period 3.2 hours/ week. Participants reported moderate perceived self-efficacy (M= 47.5%, SD= 11.7), commitment to exercise planning (M=2.0/3, SD=0.3), exercise barriers (M=2.4/4, SD=0.3), and benefits (M=2.3/4, SD=0.3). Commitment to exercise planning had a significant correlation with barriers (r=0.11) and benefits (r=0.10). Self-efficacy was not found to correlate with other variables. Even though participants reported higher perceived self-efficacy and commitment to exercise plan than that reported in literature, they were found to be overweight and inactive, which indicates the importance of such study. Exercise education programs are needed taking into considerations patients' individual differences. However, the broad grouping of diseases may not produce a homogenous sample, for which disease categories are recommended in future studies. Patients with chronic illness need more encouragement to engage themselves in exercise practices. Exercise educational program for patients with chronic illnesses should consider patients' reported exercise benefits and barriers. © 2014 Association of Rehabilitation Nurses.

Development and Psychometric Properties of a Survey to Assess Barriers to Implementing Advance Care Planning in Primary Care.

PubMed

Howard, Michelle; Day, Andrew G; Bernard, Carrie; Tan, Amy; You, John; Klein, Doug; Heyland, Daren K

2018-01-01

Valid and reliable measurement of barriers to advance care planning (ACP) in health care settings can inform the design of robust interventions. This article describes the development and psychometric evaluation of an instrument to measure the presence and magnitude of perceived barriers to ACP discussion with patients from the perspective of family physicians. A questionnaire was designed through literature review and expert input, asking family physicians to rate the importance of barriers (0 = not at all a barrier and 6 = an extreme amount) to ACP discussions with patients and administered to 117 physicians. Floor effects and missing data patterns were examined. Item-by-item correlations were examined using Pearson correlation. Exploratory factor analysis was conducted (iterated principle factor analysis with oblique rotation), internal consistency (Cronbach's alpha) overall and within factors was calculated, and construct validity was evaluated by calculating three correlations with related questions that were specified a priori. The questionnaire included 31 questions in three domains relating to the clinician, patient/family and system or external factors. No items were removed due to missing data, floor effects, or high correlation with another item. A solution of three factors accounted for 71% of variance. One item was removed because it did not load strongly on any factor. All other items except one remained in the original domain in the questionnaire. Cronbach's alpha for the three factors ranged from 0.84 to 0.90. Two of three a priori correlations with related questions were statistically significant. This questionnaire to assess barriers to ACP discussion from the perspective of family physicians demonstrates preliminary evidence of reliability and validity. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

The Influence of Drivers and Barriers on Urban Adaptation and Mitigation Plans-An Empirical Analysis of European Cities.

PubMed

Reckien, Diana; Flacke, Johannes; Olazabal, Marta; Heidrich, Oliver

2015-01-01

Cities are recognised as key players in global adaptation and mitigation efforts because the majority of people live in cities. However, in Europe, which is highly urbanized and one of the most advanced regions in terms of environmental policies, there is considerable diversity in the regional distribution, ambition and scope of climate change responses. This paper explores potential factors contributing to such diversity in 200 large and medium-sized cities across 11 European countries. We statistically investigate institutional, socio-economic, environmental and vulnerability characteristics of cities as potential drivers of or barriers to the development of urban climate change plans. Our results show that factors such as membership of climate networks, population size, GDP per capita and adaptive capacity act as drivers of mitigation and adaptation plans. By contrast, factors such as the unemployment rate, warmer summers, proximity to the coast and projected exposure to future climate impacts act as barriers. We see that, overall, it is predominantly large and prosperous cities that engage in climate planning, while vulnerable cities and those at risk of severe climate impacts in the future are less active. Our analysis suggests that climate change planning in European cities is not proactive, i.e. not significantly influenced by anticipated future impacts. Instead, we found that the current adaptive capacity of a city significantly relates to climate planning. Along with the need to further explore these relations, we see a need for more economic and institutional support for smaller and less resourceful cities and those at high risk from climate change impacts in the future.

Barriers and facilitators to implementing cancer survivorship care plans.

PubMed

Dulko, Dorothy; Pace, Claire M; Dittus, Kim L; Sprague, Brian L; Pollack, Lori A; Hawkins, Nikki A; Geller, Berta M

2013-11-01

To evaluate the process of survivorship care plan (SCP) completion and to survey oncology staff and primary care physicians (PCPs) regarding challenges of implementing SCPs. Descriptive pilot study. Two facilities in Vermont, an urban academic medical center and a rural community academic cancer center. 17 oncology clinical staff created SCPs, 39 PCPs completed surveys, and 58 patients (breast or colorectal cancer) participated in a telephone survey. Using Journey Forward tools, SCPs were created and presented to patients. PCPs received the SCP with a survey assessing its usefulness and barriers to delivery. Oncology staff were interviewed to assess perceived challenges and benefits of SCPs. Qualitative and quantitative data were used to identify challenges to the development and implementation process as well as patient perceptions of the SCP visit. SCP, healthcare provider perception of barriers to completion and implementation, and patient perception of SCP visit. Oncology staff cited the time required to obtain information for SCPs as a challenge. Completing SCPs 3-6 months after treatment ended was optimal. All participants felt advanced practice professionals should complete and review SCPs with patients. The most common challenge for PCPs to implement SCP recommendations was insufficient knowledge of cancer survivor issues. Most patients found the care plan visit very useful, particularly within six months of diagnosis. Creation time may be a barrier to widespread SCP implementation. Cancer survivors find SCPs useful, but PCPs feel insufficient knowledge of cancer survivor issues is a barrier to providing best follow-up care. Incorporating SCPs in electronic medical records may facilitate patient identification, appropriate staff scheduling, and timely SCP creation. Oncology nurse practitioners are well positioned to create and deliver SCPs, transitioning patients from oncology care to a PCP in a shared-care model of optimal wellness. Institution support for the time needed for SCP creation and review is imperative for sustaining this initiative. Accessing complete medical records is an obstacle for completing SCPs. A 3-6 month window to develop and deliver SCPs may be ideal. PCPs perceive insufficient knowledge of cancer survivor issues as a barrier to providing appropriate follow-up care.

Self-reported barriers to medication adherence among chronically ill adolescents: a systematic review.

PubMed

Hanghøj, Signe; Boisen, Kirsten A

2014-02-01

To investigate self-reported barriers to medication adherence among chronically ill adolescents, and to investigate whether barriers are unique to specific chronic diseases or more generic across conditions. A systematic search of Web of Science, PubMed, Embase, PsycINFO, and CINAHL from January 2000 to May 2012 was conducted. Articles were included if they examined barriers to medication intake among chronically ill adolescents aged 13-19 years. Articles were excluded if adolescent's views on barriers to adherence were not separated from younger children's or caregiver's views. Data was analyzed using a thematic synthesis approach. Of 3,655 records 28 articles with both quantitative, qualitative, and q-methodology study designs were included in the review. The synthesis led to the following key themes: Relations, adolescent development, health and illness, forgetfulness, organization, medicine complexity, and financial costs. Most reported barriers to adherence were not unique to specific diseases. Some barriers seem to be specific to adolescence; for example, relations to parents and peers and adolescent development. Knowledge and assessment of barriers to medication adherence is important for both policy-makers and clinicians in planning interventions and communicating with adolescents about their treatment. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

User community development for the space transportation system/Skylab

NASA Technical Reports Server (NTRS)

Archer, J. L.; Beauchamp, N. A.

1974-01-01

The New User Function plan for identifying beneficial uses of space is described. Critical issues such as funding, manpower, and protection of user proprietary rights are discussed along with common barriers which impede the development of a user community. Studies for developing methodologies of identifying new users and uses of the space transportation system are included.

Self-Efficacy Beliefs and the Relation between Career Planning and Perception of Barriers

ERIC Educational Resources Information Center

Cardoso, Paulo; Moreira, Joao Manuel

2009-01-01

This study tested the hypothesis that self-efficacy in career roles moderates the relation between perception of career barriers and career planning, in a study with Portuguese students, 488 in Grade 9 and 517 in Grade 12. The results supported the hypothesis only among Grade 9 girls, showing that perception of career barriers leads to less career…

Applying the knowledge to action framework to plan a strategy for implementing breast cancer screening guidelines: an interprofessional perspective.

PubMed

Munce, Sarah; Kastner, Monika; Cramm, Heidi; Lal, Shalini; Deschêne, Sarah-Maude; Auais, Mohammad; Stacey, Dawn; Brouwers, Melissa

2013-09-01

Integrated knowledge translation (IKT) interventions may be one solution to improving the uptake of clinical guidelines. IKT research initiatives are particularly relevant for breast cancer research and initiatives targeting the implementation of clinical guidelines and guideline implementation initiatives, where collaboration with an interdisciplinary team of practitioners, patients, caregivers, and policy makers is needed for producing optimum patient outcomes. The objective of this paper was to describe the process of developing an IKT strategy that could be used by guideline developers to improve the uptake of their new clinical practice guidelines on breast cancer screening. An interprofessional group of students as well as two faculty members met six times over three days at the KT Canada Summer Institute in 2011. The team used all of the phases of the action cycle in the Knowledge to Action Framework as an organizing framework. While the entire framework was used, the step involving assessing barriers to knowledge use was judged to be particularly relevant in anticipating implementation problems and being able to inform the specific KT interventions that would be appropriate to mitigate these challenges and to accomplish goals and outcomes. This activity also underscored the importance of group process and teamwork in IKT. We propose that an a priori assessment of barriers to knowledge use (i.e., level and corresponding barriers), along with the other phases of the Knowledge to Action Framework, is a strategic approach for KT strategy development, implementation, and evaluation planning and could be used in the future planning of KT strategies.

Unpacking the 'information barrier': comparing perspectives on information as a barrier to climate change adaptation in the interior mountain West.

PubMed

Archie, Kelli M; Dilling, Lisa; Milford, Jana B; Pampel, Fred C

2014-01-15

Inadequate information has been repeatedly identified as a barrier to climate change adaptation planning and implementation. However less is known about how information functions as a barrier, and to what degree it prevents adaptation compared to other perceived barriers. In addition, the role of institutional context in mediating the demand for information in the context of adaptation has been less well studied. This paper helps to clarify the role that information plays in adaptation planning for two sectors of public employees working at similar scales, in similar locations, with similar challenges. We conducted surveys and semi-structured interviews to investigate the demand for information in support of adaptation implementation and planning from US federal public lands managers and municipal officials in the US interior West. We found that federal managers and municipal officials both consulted information frequently for decision making, and while both groups indicated that lack of information at relevant scales was a barrier to adaptation planning, this was seen as a much stronger barrier for federal managers than for communities. Uncertainty of information was raised as an issue, but results were mixed on whether or not this acted as a strong barrier. While peer-reviewed publications were seen as the "best available science," and correlated with adaptation planning, they were not accessed directly as frequently as other sources of information, including colleagues, the internet and reports. The strong connection between communities and adjacent federal lands may provide an opportunity for networking that could facilitate the flow of information relevant for adaptation. Copyright © 2013 Elsevier Ltd. All rights reserved.

Managing Environmental Stress: An Evaluation of Environmental Management of the Long Point Sandy Barrier, Lake Erie, Canada.

PubMed

Kreutzwiser; Gabriel

2000-01-01

/ This paper assesses the extent to which key geomorphic components, processes, and stresses have been reflected in the management of a coastal sandy barrier environment. The management policies and practices of selected agencies responsible for Long Point, a World Biosphere Reserve along Lake Erie, Canada, were evaluated for consistency with these principles of environmental management for sandy barriers: maintaining natural stresses essential to sandy barrier development and maintenance;protecting sediment sources, transfers, and storage; recognizing spatial variability and cyclicity of natural stresses, such as barrier overwash events; and accepting and planning for long-term evolutionary changes in the sandy barrier environment. Generally, management policies and practices have not respected the dynamic and sensitive environment of Long Point because of limited mandates of the agencies involved, inconsistent policies, and failure to apply or enforce existing policies. This is particularly evident with local municipalities and less so for the Canadian Wildlife Service, the federal agency responsible for managing National Wildlife Areas at the point. In the developed areas of Long Point, landward sediment transfers and sediment storage in dunes have been impacted by cottage development, shore protection, and maintenance of roads and parking lots. Additionally, agencies responsible for managing Long Point have no jurisdiction over sediment sources as far as 95 km away. Evolutionary change of sandy barriers poses the greatest challenge to environmental managers.

Clinical trials recruitment planning: A proposed framework from the Clinical Trials Transformation Initiative.

PubMed

Huang, Grant D; Bull, Jonca; Johnston McKee, Kelly; Mahon, Elizabeth; Harper, Beth; Roberts, Jamie N

2018-03-01

Patient recruitment is widely recognized as a key determinant of success for clinical trials. Yet a substantial number of trials fail to reach recruitment goals-a situation that has important scientific, financial, ethical, and policy implications. Further, there are important effects on stakeholders who directly contribute to the trial including investigators, sponsors, and study participants. Despite efforts over multiple decades to identify and address barriers, recruitment challenges persist. To advance a more comprehensive approach to trial recruitment, the Clinical Trials Transformation Initiative (CTTI) convened a project team to examine the challenges and to issue actionable, evidence-based recommendations for improving recruitment planning that extend beyond common study-specific strategies. We describe our multi-stakeholder effort to develop a framework that delineates three areas essential to strategic recruitment planning efforts: (1) trial design and protocol development, (2) trial feasibility and site selection, and (3) communication. Our recommendations propose an upstream approach to recruitment planning that has the potential to produce greater impact and reduce downstream barriers. Additionally, we offer tools to help facilitate adoption of the recommendations. We hope that our framework and recommendations will serve as a guide for initial efforts in clinical trial recruitment planning irrespective of disease or intervention focus, provide a common basis for discussions in this area and generate targets for further analysis and continual improvement. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

¿Y ahora qué? Anticipated immigration status barriers and Latina/o high school students' future expectations.

PubMed

McWhirter, Ellen Hawley; Ramos, Karina; Medina, Cynthia

2013-07-01

Latina/o high school students without documentation face a challenging situation when they graduate from high school, with pathways to work and postsecondary education stymied by their immigration status. We examined the effects of anticipated barriers associated with immigration status, age, and sex on the dependent variables of vocational outcome expectations, anticipated external and internal barriers, and postsecondary schooling plans in a sample of 475 Latina/o high school students. Findings include that students anticipating immigration status problems had lower vocational outcome expectations and anticipated more external barriers to pursuing their postsecondary plans. Latina girls and older high school students anticipating immigration status problems were more likely to plan to attend 2-year rather than 4-year colleges, and less likely to plan on postsecondary education, respectively. Implications for practice, policy, and research are discussed. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Electronic health records: what are the most important barriers?

PubMed

Ayatollahi, Haleh; Mirani, Nader; Haghani, Hamid

2014-01-01

The process of design and adoption of electronic health records may face a number of barriers. This study aimed to compare the importance of the main barriers from the experts' point of views in Iran. This survey study was completed in 2011. The potential participants (62 experts) included faculty members who worked in departments of health information technology and individuals who worked in the Ministry of Health in Iran and were in charge of the development and adoption of electronic health records. No sampling method was used in this study. Data were collected using a Likert-scale questionnaire ranging from 1 to 5. The validity of the questionnaire was established using content and face validity methods, and the reliability was calculated using Cronbach's alpha coefficient. The response rate was 51.6 percent. The participants' perspectives showed that the most important barriers in the process of design and adoption of electronic health records were technical barriers (mean = 3.84). Financial and ethical-legal barriers, with the mean value of 3.80 were other important barriers, and individual and organizational barriers, with the mean values of 3.59 and 3.50 were found to be less important than other barriers from the experts' perspectives. Strategic planning for the creation and adoption of electronic health records in the country, creating a team of experts to assess the potential barriers and develop strategies to eliminate them, and allocating financial resources can help to overcome most important barriers to the adoption of electronic health records.

Considerations of technology transfer barriers in the modification of strategic superalloys for aircraft turbine engines

NASA Technical Reports Server (NTRS)

Stephens, J. R.; Tien, J. K.

1983-01-01

A typical innovation-to-commercialization process for the development of a new hot section gas turbine material requires one to two decades with attendant costs in the tens of millions of dollars. This transfer process is examined to determine the potential rate-controlling steps for introduction of future low strategic metal content alloys or processes. Case studies are used to highlight the barriers to commercialization as well as to identify the means by which these barriers can be surmounted. The opportunities for continuing joint government-university-industry partnerships in planning and conducting strategic materials R&D programs are also discussed.

Barriers to Clinical Research in Latin America

PubMed Central

Chomsky-Higgins, Kathryn; Miclau, Theodore A.; Mackechnie, Madeline C.; Aguilar, Dino; Avila, Jorge Rubio; dos Reis, Fernando Baldy; Balmaseda, Roberto; Barquet, Antonio; Ceballos, Alfredo; Contreras, Fernando; Escalante, Igor; Elias, Nelson; Vincenti, Sergio Iriarte; Lozano, Christian; Medina, Fryda; Merchan, Gavino; Segovia, Julio; Guerado, Enrique; Quintero, Jose Eduardo; Morshed, Saam; Bhandari, Mohit; Miclau, Theodore

2017-01-01

Enhancing health research capacity in developing countries is a global health priority. Understanding the orthopedic burden of disease in Latin America will require close partnership between more-developed and less-developed countries. To this end, the Osteosynthesis and Trauma Care Foundation assembled a research consortium of Latin-American orthopedic leaders. Prior to the meeting, we surveyed attendees on perceived barriers to conducting research at their institutions. During the event, working groups discussed these barriers, developed strategies for addressing them, and planned future steps for collaboration. The participants established the need for global relationships that allow colleagues from Latin America to access to training and established investigational infrastructure of North American centers to address research questions relevant to their communities. As a result of the discussion, the International Orthopaedic Multicenter Study (INORMUS) in Fracture Care was initiated. Since then, an expanded international working group, Associación de Cirujanos Traumatológicos en las Americas (ACTUAR), has been created with the purpose of promoting increased global partnership for research capacity development. PMID:28459047

Barriers to Clinical Research in Latin America.

PubMed

Chomsky-Higgins, Kathryn; Miclau, Theodore A; Mackechnie, Madeline C; Aguilar, Dino; Avila, Jorge Rubio; Dos Reis, Fernando Baldy; Balmaseda, Roberto; Barquet, Antonio; Ceballos, Alfredo; Contreras, Fernando; Escalante, Igor; Elias, Nelson; Vincenti, Sergio Iriarte; Lozano, Christian; Medina, Fryda; Merchan, Gavino; Segovia, Julio; Guerado, Enrique; Quintero, Jose Eduardo; Morshed, Saam; Bhandari, Mohit; Miclau, Theodore

2017-01-01

Enhancing health research capacity in developing countries is a global health priority. Understanding the orthopedic burden of disease in Latin America will require close partnership between more-developed and less-developed countries. To this end, the Osteosynthesis and Trauma Care Foundation assembled a research consortium of Latin-American orthopedic leaders. Prior to the meeting, we surveyed attendees on perceived barriers to conducting research at their institutions. During the event, working groups discussed these barriers, developed strategies for addressing them, and planned future steps for collaboration. The participants established the need for global relationships that allow colleagues from Latin America to access to training and established investigational infrastructure of North American centers to address research questions relevant to their communities. As a result of the discussion, the International Orthopaedic Multicenter Study (INORMUS) in Fracture Care was initiated. Since then, an expanded international working group, Associación de Cirujanos Traumatológicos en las Americas (ACTUAR), has been created with the purpose of promoting increased global partnership for research capacity development.

Evaluating New Zealand Early Childhood Education Professional Development: Access, Barriers and Effectiveness

ERIC Educational Resources Information Center

Cherrington, Sue; Wansbrough, Deborah

2010-01-01

"Pathways to the Future: Nga Huarahi Arataki," the ten year strategic plan for early childhood education (ECE) in New Zealand, identified reviewing the delivery of professional development as one strategy for "promoting the effective delivery of 'Te Whariki'"(Ministry of Education, 2002, p. 15) within the overall goal of…

The influence of small mammal burrowing activity on water storage at the Hanford Site

DOE Office of Scientific and Technical Information (OSTI.GOV)

Landeen, D.S.

The amount and rate at which water may penetrate a protective barrier and come into contact with buried radioactive waste is a major concern. Because burrowing animals eventually will reside on the surface of any protective barrier, the effect these burrow systems may have on the loss or retention of water needs to be determined. The first section of this document summarizes the known literature relative to small mammals and the effects that burrowing activities have on water distribution, infiltration, and the overall impact of burrows on the ecosystem. Topics that are summarized include burrow air pressures, airflow, burrow humidity,more » microtopography, mounding, infiltration, climate, soil evaporation, and discussions of large pores relative to water distribution. The second section of this document provides the results of the study that was conducted at the Hanford Site to determine what effect small mammal burrows have on water storage. This Biointrusion task is identified in the Permanent Isolation Surface Barrier Development Plan in support of protective barriers. This particular animal intrusion task is one part of the overall animal intrusion task identified in Animal Intrusion Test Plan.« less

Institutional facilitators and barriers to local public health preparedness planning for vulnerable and at-risk populations.

PubMed

Bevc, Christine A; Simon, Matthew C; Montoya, Tanya A; Horney, Jennifer A

2014-01-01

Numerous institutional facilitators and barriers to preparedness planning exist at the local level for vulnerable and at-risk populations. Findings of this evaluation study contribute to ongoing practice-based efforts to improve response services and address public health preparedness planning and training as they relate to vulnerable and at-risk populations. From January 2012 through June 2013, we conducted a multilevel, mixed-methods evaluation study of the North Carolina Preparedness and Emergency Response Research Center's Vulnerable & At-Risk Populations Resource Guide, an online tool to aid local health departments' (LHDs') preparedness planning efforts. We examined planning practices across multiple local, regional, and state jurisdictions utilizing user data, follow-up surveys, and secondary data. To identify potential incongruities in planning, we compared respondents' reported populations of interest with corresponding census data to determine whether or not there were differences in planning priorities. We used data collected from evaluation surveys to identify key institutional facilitators and barriers associated with planning for at-risk populations, including challenges to conducting assessments and lack of resources. Results identified both barriers within institutional culture and disconnects between planning priorities and evidence-based identification of vulnerable and at-risk populations, including variation in the planning process, partnerships, and perceptions. Our results highlight the important role of LHDs in preparedness planning and the potential implications associated with organizational and bureaucratic impediments to planning implementation. A more in-depth understanding of the relationships among public institutions and the levels of preparedness that contribute to the conditions and processes that generate vulnerability is needed.

Identifying the Factors That Facilitate or Hinder Advance Planning by Persons With Dementia

PubMed Central

Hirschman, Karen B.; Kapo, Jennifer M.; Karlawish, Jason H. T.

2009-01-01

We performed semistructured interviews with 30 family members of patients with advanced dementia to identify the factors that facilitate or hinder advance planning by persons with dementia. All interviews were analyzed using qualitative data analysis techniques. The majority (77%) of family members reported that their relative had some form of written advance directive, and at least half reported previous discussions about health care preferences (57%), living situation or placement issues (50%), and finances or estate planning (60%) with the patient. Family members reported some themes that prompted planning and others that were barriers to planning. Events that most often triggered planning were medical, living situation, or financial issues associated with a friend or family member of the patient (57%). Barriers to planning included both passive and active avoidance. The most common form of passive avoidance was not realizing the importance of planning until it was too late to have the discussion (63%). The most common form of active avoidance was avoiding the discussion (53%). These data suggest potentially remediable strategies to address barriers to advance planning discussions. PMID:18580595

ENGINEERED BARRIER SYSTEM: PHYSICAL AND CHEMICAL ENVIRONMENT

DOE Office of Scientific and Technical Information (OSTI.GOV)

R. Jarek

2005-08-29

The purpose of this model report is to describe the evolution of the physical and chemical environmental conditions within the waste emplacement drifts of the repository, including the drip shield and waste package surfaces. The resulting seepage evaporation and gas abstraction models are used in the total system performance assessment for the license application (TSPA-LA) to assess the performance of the engineered barrier system and the waste form. This report develops and documents a set of abstraction-level models that describe the engineered barrier system physical and chemical environment. Where possible, these models use information directly from other reports as input,more » which promotes integration among process models used for TSPA-LA. Specific tasks and activities of modeling the physical and chemical environment are included in ''Technical Work Plan for: Near-Field Environment and Transport In-Drift Geochemistry Model Report Integration'' (BSC 2005 [DIRS 173782], Section 1.2.2). As described in the technical work plan, the development of this report is coordinated with the development of other engineered barrier system reports. To be consistent with other project documents that address features, events, and processes (FEPs), Table 6.14.1 of the current report includes updates to FEP numbers and FEP subjects for two FEPs identified in the technical work plan (TWP) governing this report (BSC 2005 [DIRS 173782]). FEP 2.1.09.06.0A (Reduction-oxidation potential in EBS), as listed in Table 2 of the TWP (BSC 2005 [DIRS 173782]), has been updated in the current report to FEP 2.1.09.06.0B (Reduction-oxidation potential in Drifts; see Table 6.14-1). FEP 2.1.09.07.0A (Reaction kinetics in EBS), as listed in Table 2 of the TWP (BSC 2005 [DIRS 173782]), has been updated in the current report to FEP 2.1.09.07.0B (Reaction kinetics in Drifts; see Table 6.14-1). These deviations from the TWP are justified because they improve integration with FEPs documents. The updates have no impact on the model developed in this report.« less

Developing a questionnaire to identify perceived barriers for implementing the Dutch physical therapy COPD clinical practice guideline.

PubMed

van der Wees, Philip J; Zagers, Cor A M; de Die, Sara E; Hendriks, Erik J M; Nijhuis-van der Sanden, Maria W G; de Bie, Rob A

2013-05-01

Clinical practice guidelines have been developed to assist healthcare practitioners in clinical decision making. Publication of clinical practice guidelines does not automatically lead to their uptake and barrier identification has been recognized as an important step in implementation planning. This study aimed at developing a questionnaire to identify perceived barriers for implementing the Dutch COPD guideline for physical therapists and its recommended measurement instruments. An overall questionnaire, based on two existing questionnaires, was constructed to identify barriers and facilitators for implementing the COPD guideline. The construct of the questionnaire was assessed in a cross-sectional study among 246 chest physical therapists. Factor analysis was conducted to explore underlying dimensions. Psychometric properties were analyzed using Cronbach's alpha. Barriers and facilitators were assessed using descriptive statistics. Some 139 physical therapists (57%) responded. Factor analysis revealed 4-factor and 5-factor solutions with an explained variance of 36% and 39% respectively. Cronbach's alpha of the overall questionnaire was 0.90, and varied from 0.66 to 0.92 for the different factors. Underlying domains of the 5-factor solution were characterized as: attitude towards using measurement instruments, knowledge and skills of the physical therapist, applicability of the COPD guideline, required investment of time & money, and patient characteristics. Physical therapists showed a positive attitude toward using the COPD guideline. Main barriers for implementation were required time investment and financial constraints. The construct of the questionnaire revealed relevant underlying domains for the identification of barriers and facilitators for implementing the COPD guideline. The questionnaire allowed for tailoring to the target group and may be used across health care professionals as basis for in-depth analysis of barriers to specific recommendations in guidelines. The results of the questionnaire alone do not provide sufficient information to inform the development of an implementation strategy. The infrastructure for developing the guideline can be used for addressing key barriers by the guideline development group, using the questionnaire as well as in-depth analysis such as focus group interviews. Further development of methods for prospective identification of barriers and consequent tailoring of implementation interventions is required.

Developing a questionnaire to identify perceived barriers for implementing the Dutch physical therapy COPD clinical practice guideline

PubMed Central

2013-01-01

Background Clinical practice guidelines have been developed to assist healthcare practitioners in clinical decision making. Publication of clinical practice guidelines does not automatically lead to their uptake and barrier identification has been recognized as an important step in implementation planning. This study aimed at developing a questionnaire to identify perceived barriers for implementing the Dutch COPD guideline for physical therapists and its recommended measurement instruments. Methods An overall questionnaire, based on two existing questionnaires, was constructed to identify barriers and facilitators for implementing the COPD guideline. The construct of the questionnaire was assessed in a cross-sectional study among 246 chest physical therapists. Factor analysis was conducted to explore underlying dimensions. Psychometric properties were analyzed using Cronbach’s alpha. Barriers and facilitators were assessed using descriptive statistics. Results Some 139 physical therapists (57%) responded. Factor analysis revealed 4-factor and 5-factor solutions with an explained variance of 36% and 39% respectively. Cronbach’s alpha of the overall questionnaire was 0.90, and varied from 0.66 to 0.92 for the different factors. Underlying domains of the 5-factor solution were characterized as: attitude towards using measurement instruments, knowledge and skills of the physical therapist, applicability of the COPD guideline, required investment of time & money, and patient characteristics. Physical therapists showed a positive attitude toward using the COPD guideline. Main barriers for implementation were required time investment and financial constraints. Conclusions The construct of the questionnaire revealed relevant underlying domains for the identification of barriers and facilitators for implementing the COPD guideline. The questionnaire allowed for tailoring to the target group and may be used across health care professionals as basis for in-depth analysis of barriers to specific recommendations in guidelines. The results of the questionnaire alone do not provide sufficient information to inform the development of an implementation strategy. The infrastructure for developing the guideline can be used for addressing key barriers by the guideline development group, using the questionnaire as well as in-depth analysis such as focus group interviews. Further development of methods for prospective identification of barriers and consequent tailoring of implementation interventions is required. PMID:23631555

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

Pollution Prevention (P2) has evolved into one of DOE`s sprime strategies to meet environmental, fiscal, and worker safety obligations. P2 program planning, opportunity identification, and implementation tools were developed under the direction of the Waste Minimization Division (EM-334). Forty experts from EM, DP, ER and DOE subcontractors attended this 2-day workshop to formulate the incentives to drive utilization of these tools. Plenary and small working group sessions were held both days. Working Group 1 identified incentives to overcoming barriers in the area of P2 program planning and resource allocation. Working Group 2 identified mechanisms to drive the completion of P2more » assessments and generation of opportunities. Working Group 3 compiled and documented a broad range of potential P2 incentives that address fundamental barriers to implementation of cost effective opportunities.« less

Category mistakes: A barrier to effective environmental management.

PubMed

Wallace, Ken J; Jago, Mark

2017-09-01

How entities, the things that exist, are defined and categorised affects all aspects of environmental management including technical descriptions, quantitative analyses, participatory processes, planning, and decisions. Consequently, ambiguous definitions and wrongly assigning entities to categories, referred to as category mistakes, are barriers to effective management. Confusion caused by treating the term 'biodiversity' variously as the property of an area, the biota of an area, and a preferred end state (a value) - quite different categories of entities - is one example. To overcome such difficulties, we develop and define four entity categories - elements, processes, properties, and values - and two derived categories - states and systems. We argue that adoption of these categories and definitions will significantly improve environmental communication and analysis, and thus strengthen planning and decision-making. Copyright © 2017 Elsevier Ltd. All rights reserved.

Exploring land developer perspectives on conservation subdivision design and environmentally sustainable land development.

PubMed

Göçmen, Z Aslıgül

2014-11-01

Insight into land developers' perspectives on alternative residential developments and the barriers they experience in trying to develop them can be crucial in efforts to change environmentally damaging low-density, large-lot, and automobile-dependent residential patterns. Using a semi-structured interview instrument followed by short surveys, I examined the views of 16 developers in Waukesha County, WI, USA, a county that has experienced significant development pressures and widespread implementation of conservation subdivision design. The land developer investigation focused on conservation subdivision design familiarity and implementation, and identified a number of barriers that developers experienced in implementing the design. While the majority of the developers appeared familiar with the design and had experience developing conservation subdivisions, their motivations for developing them varied, as did their on-site conservation practices. The barriers included the lack of land use regulations supporting the design, economic factors, community opposition, and a lack of knowledge about sustainable residential development practices. Strategies to promote more environmentally sustainable residential land development patterns include providing a more supportive institutional environment, enacting different regulations and guidelines for natural resources protection, and offering education on ecologically sound development and planning practices.

Exploring Land Developer Perspectives on Conservation Subdivision Design and Environmentally Sustainable Land Development

NASA Astrophysics Data System (ADS)

Göçmen, Z. Aslıgül

2014-11-01

Insight into land developers' perspectives on alternative residential developments and the barriers they experience in trying to develop them can be crucial in efforts to change environmentally damaging low-density, large-lot, and automobile-dependent residential patterns. Using a semi-structured interview instrument followed by short surveys, I examined the views of 16 developers in Waukesha County, WI, USA, a county that has experienced significant development pressures and widespread implementation of conservation subdivision design. The land developer investigation focused on conservation subdivision design familiarity and implementation, and identified a number of barriers that developers experienced in implementing the design. While the majority of the developers appeared familiar with the design and had experience developing conservation subdivisions, their motivations for developing them varied, as did their on-site conservation practices. The barriers included the lack of land use regulations supporting the design, economic factors, community opposition, and a lack of knowledge about sustainable residential development practices. Strategies to promote more environmentally sustainable residential land development patterns include providing a more supportive institutional environment, enacting different regulations and guidelines for natural resources protection, and offering education on ecologically sound development and planning practices.

The Influence of Drivers and Barriers on Urban Adaptation and Mitigation Plans—An Empirical Analysis of European Cities

PubMed Central

Reckien, Diana; Flacke, Johannes

2015-01-01

Cities are recognised as key players in global adaptation and mitigation efforts because the majority of people live in cities. However, in Europe, which is highly urbanized and one of the most advanced regions in terms of environmental policies, there is considerable diversity in the regional distribution, ambition and scope of climate change responses. This paper explores potential factors contributing to such diversity in 200 large and medium-sized cities across 11 European countries. We statistically investigate institutional, socio-economic, environmental and vulnerability characteristics of cities as potential drivers of or barriers to the development of urban climate change plans. Our results show that factors such as membership of climate networks, population size, GDP per capita and adaptive capacity act as drivers of mitigation and adaptation plans. By contrast, factors such as the unemployment rate, warmer summers, proximity to the coast and projected exposure to future climate impacts act as barriers. We see that, overall, it is predominantly large and prosperous cities that engage in climate planning, while vulnerable cities and those at risk of severe climate impacts in the future are less active. Our analysis suggests that climate change planning in European cities is not proactive, i.e. not significantly influenced by anticipated future impacts. Instead, we found that the current adaptive capacity of a city significantly relates to climate planning. Along with the need to further explore these relations, we see a need for more economic and institutional support for smaller and less resourceful cities and those at high risk from climate change impacts in the future. PMID:26317420

When the bells toll: engaging healthcare providers in catastrophic disaster response planning.

PubMed

Hanfling, Dan

2013-01-01

Catastrophic disaster planning and response have been impeded by the inability to better coordinate the many components of the emergency response system. Healthcare providers in particular have remained on the periphery of such planning because of a variety of real or perceived barriers. Although hospitals and healthcare systems have worked successfully to develop surge capacity and capability, less successful have been the attempts to inculcate such planning in the private practice medical community. Implementation of a systems approach to catastrophic disaster planning that incorporates healthcare provider participation and engagement as one of the first steps toward such efforts will be of significant importance in ensuring that a comprehensive and successful emergency response will ensue.

Rehabilitation in Madagascar: Challenges in implementing the World Health Organization Disability Action Plan.

PubMed

Khan, Fary; Amatya, Bhasker; Mannan, Hasheem; Burkle, Frederick M; Galea, Mary P

2015-09-01

To provide an update on rehabilitation in Madagascar by using local knowledge to outline the potential barriers and facilitators for implementation of the World Health Organization (WHO) Disability Action Plan (DAP). A 14-day extensive workshop programme (September-October 2014) was held at the University Hospital Antananarivo and Antsirabe, with the Department of Health Madagascar, by rehabilitation staff from Royal Melbourne Hospital, Australia. Attendees were rehabilitation professionals (n=29) from 3 main rehabilitation facilities in Madagascar, who identified various challenges faced in service provision, education and attitudes/approaches to people with disabilities. Their responses and suggested barriers/facilitators were recorded following consensus agreement, using objectives listed in the DAP. The barriers and facilitators outlined by participants in implementing the DAP objectives include: engagement of health professionals and institutions using a multi-sectoral approach, new partnerships, strategic collaboration, provision of technical assistance, future policy directions, and research and development. Other challenges for many basic policies included: access to rehabilitation services, geographical coverage, shortage of skilled work-force, limited info-technology systems; lack of care-models and facility/staff accreditation standards; limited health services infrastructure and "disconnect" between acute and community-based rehabilitation. The DAP summary actions were useful planning tools to improve access, strengthen rehabilitation services and community-based rehabilitation, and collate data for outcome research.

Strategies to prevent and reduce diabetes and obesity in Sacramento, California: the African American Leadership Coalition and University of California, Davis.

PubMed

Ziegahn, Linda; Styne, Dennis; Askia, Joyce; Roberts, Tina; Lewis, Edward T; Edwards, Whitney

2013-11-14

Diabetes is one of the leading causes of illness and death for African Americans and people of African descent throughout the United States and in the city and county of Sacramento, California. The involvement of families and communities in developing prevention strategies can increase the likelihood that behavioral changes will be sustained. Three member organizations of the African American Leadership Coalition (AALC) entered into a partnership with the University of California, Davis (UC Davis) to engage families in developing a process to identify barriers to diabetes and obesity prevention and reduction, exchange strategies, and create action plans for prevention. The intervention comprised 3 phases: 1) coalition formation and training; 2) data collection, analysis, and dissemination of results; and 3) development of family and community action plans. Academic and community partners planned and implemented all project phases together. Sources of information about diabetes and obesity were primarily doctors and the Internet; barriers were related to lack of time needed to prepare healthy meals, high food costs, transportation to fresh markets, motivation around healthy habits, and unsafe environments. Action plans addressed behavioral change and family cohesion. The group discussion format encouraged mutual support and suggestions for better eating and physical exercise habits. This collaborative partnership model can strengthen existing group relationships or promote new affiliations that form the basis for future action coalitions. Participants worked both within and across groups to exchange information, stories of success and challenges, and specific health improvement strategies.

Interprofessional Education and Practice Guide No. 7: Development, implementation, and evaluation of a large-scale required interprofessional education foundational programme.

PubMed

Shrader, Sarah; Hodgkins, Renee; Laverentz, Delois; Zaudke, Jana; Waxman, Michael; Johnston, Kristy; Jernigan, Stephen

2016-09-01

Health profession educators and administrators are interested in how to develop an effective and sustainable interprofessional education (IPE) programme. We describe the approach used at the University of Kansas Medical Centre, Kansas City, United States. This approach is a foundational programme with multiple large-scale, half-day events each year. The programme is threaded with common curricular components that build in complexity over time and assures that each learner is exposed to IPE. In this guide, lessons learned and general principles related to the development of IPE programming are discussed. Important areas that educators should consider include curriculum development, engaging leadership, overcoming scheduling barriers, providing faculty development, piloting the programming, planning for logistical coordination, intentionally pairing IP facilitators, anticipating IP conflict, setting clear expectations for learners, publicising the programme, debriefing with faculty, planning for programme evaluation, and developing a scholarship and dissemination plan.

Applying Community Engagement to Disaster Planning: Developing the Vision and Design for the Los Angeles County Community Disaster Resilience Initiative

PubMed Central

Tang, Jennifer; Lizaola, Elizabeth; Jones, Felica; Brown, Arleen; Stayton, Alix; Williams, Malcolm; Chandra, Anita; Eisenman, David; Fogleman, Stella; Plough, Alonzo

2013-01-01

Community resilience (CR) is a priority for preparedness, but few models exist. A steering council used community-partnered participatory research to support workgroups in developing CR action plans and hosted forums for input to design a pilot demonstration of implementing CR versus enhanced individual preparedness toolkits. Qualitative data describe how stakeholders viewed CR, how toolkits were developed, and demonstration design evolution. Stakeholders viewed community engagement as facilitating partnerships to implement CR programs when appropriately supported by policy and CR resources. Community engagement exercises clarified motivations and informed action plans (e.g., including vulnerable populations). Community input identified barriers (e.g., trust in government) and CR-building strategies. A CR toolkit and demonstration comparing its implementation with individual preparedness were codeveloped. Community-partnered participatory research was a useful framework to plan a CR initiative through knowledge exchange. PMID:23678916

Project Ci-Nergy Towards AN Integrated Energy Urban Planning System from a Data Modelling and System Architecture Perspective

NASA Astrophysics Data System (ADS)

Agugiaro, G.; Robineau, J.-L.; Rodrigues, P.

2017-09-01

Growing urbanisation, its related environmental impacts, and social inequalities in cities are challenges requiring a holistic urban planning perspective that takes into account the different aspects of sustainable development. One crucial point is to reconcile urban planning with environmental targets, which include decreasing energy demand and CO2 emissions, and increasing the share of renewable energy. Within this context, the project CI-NERGY aims to develop urban energy modelling, simulation and optimisation methods and tools to support decision making in urban planning. However, there are several barriers to the implementation of such tools, such as: fragmentation of involved disciplines, different stakeholders, multiplicity of scales in a city and extreme heterogeneity of data regarding all the processes to be addressed. Project CI-NERGY aims, among other goals, at overcoming these barriers, and focuses on two case study cities, Geneva in Switzerland and Vienna in Austria. In particular, project CI-NERGY faces several challenges starting with different cities, heterogeneous data sources and simulation tools, diverse user groups and their individual needs. This paper describes the experiences gathered during the project. After giving a brief overview of the project, the two case study cities, Geneva and Vienna, are briefly presented, and the focus shifts then on overall system architecture of the project, ranging from urban data modelling topics to the implementation of a Service-Oriented Architecture. Some of the challenges faced, the solutions found, as well some plans for future improvements are described and commented.

Focus groups with working parents of school-aged children: what's needed to improve family meals?

PubMed

Fulkerson, Jayne A; Kubik, Martha Y; Rydell, Sarah; Boutelle, Kerri N; Garwick, Ann; Story, Mary; Neumark-Sztainer, Dianne; Dudovitz, Bonnie

2011-01-01

To conduct focus groups to identify parents' perceptions of barriers to family meals and elucidate ideas to guide the development of interventions to overcome barriers. Focus groups were conducted with a convenience sample of 27 working parents in urban community settings. Parents reported enjoying the sharing/bonding at meals, but they reported limited time for meal preparation and frequent multi-tasking at mealtime. They wanted their children's help with meal preparation, but they were concerned about the time and "mess" involved. They were frustrated with the limited range of food items their children would eat. Preferred program ideas included feeding tips/recipes, meal planning/preparation, and changing food offerings. Findings indicate a need for creative programs and professional nutrition guidance to facilitate family engagement in planning and cooking quick, healthful meals; development of skill building; and increasing healthful food consumption. Copyright © 2011 Society for Nutrition Education. Published by Elsevier Inc. All rights reserved.

Water-quality, bed-sediment, and discharge data for the Mississippi River-Gulf Outlet and adjacent waterways, southeastern Louisiana, August 2008 through December 2009

USGS Publications Warehouse

Swarzenski, Christopher M.; Mize, Scott V.; Lovelace, John K.

2012-01-01

The Mississippi River-Gulf Outlet navigation channel (MRGO) was constructed in the early 1960s to provide a safer and shorter route between the Gulf of Mexico and the Port of New Orleans for deep-draft, ocean-going vessels and to promote the economic development of the Port of New Orleans. In 2006, the U.S. Army Corps of Engineers developed a plan to de-authorize the MRGO. The plan called for a rock barrier to be constructed across the MRGO near Bayou La Loutre. In 2008, the U.S. Geological Survey, in cooperation with the Louisiana Coastal Area Science and Technology Program began a study to document the impacts of the rock barrier on water-quality and flow before, during, and after its construction. Water-quality, bed-sediment, and discharge data were collected in the MRGO and adjacent water bodies from August 2008 through December 2009.

Planning for Accessibility.

ERIC Educational Resources Information Center

Spoor, Dana L.

1997-01-01

Argues that barrier-free designs should be incorporated in the first steps of school facility planning to avoid the difficulties in meeting Americans with Disabilities Act (ADA) guidelines during renovations. Explains why not all barriers need be removed to make a facility accessible to everyone. Discusses issues involving ADA guidelines and child…

Contraceptive prevalence, reproductive health and our common future. The C. Donald Christian Memorial Lecture.

PubMed

Diczfalusy, E

1993-05-01

Worldwide, female sterilization is the most common contraceptive method, followed by IUDs and oral contraceptives. As unwanted pregnancy for women in developing countries can mean life or death, which may explain why modern contraceptive methods with low failure rates (e.g., sterilization, IUDs. and hormonal methods) predominate in developing countries. Conventional methods with relatively high failure rates (e.g., natural family planning, barrier methods, and withdrawal) predominate in developed countries. Developing-country governments first supported family planning programs for demographic reasons. They now embrace them because they save the lives of women and children. The four fundamental pillars of reproductive health policy are family planning, maternal care, infant and child care, and control of sexually transmitted diseases (STDs). Indicators of reproductive health include, rates of maternal mortality and morbidity; induced abortion; infertility; perinatal, infant, and child mortality; and STDs (including AIDS). Governments in the poorest countries invest only US$5 per capita for health, compared to US$400 per capita for developed countries. If the poorest countries increased that $5 figure by just $2 per capita, they could immunize all children, eradicate polio, and provide the drugs to cure the most common diseases. Further, if humans were to use resources more reasonably, we could greatly decrease the number of people living in poverty. Three UN population projections show that the population will continue to grow well within the next century. With strong commitment from governments and individuals, we can increase contraceptive use and reduce total fertility rates. Barriers to achieving those goals are few funds allocated to family planning methods and services; politicians; religious and community leaders; culture; low women's status; limited accessibility to information, methods, and quality services; and limited contraceptive choice.

The influence of nurse home visits, including provision of 3 months of contraceptives and contraceptive counseling, on perceived barriers to contraceptive use and contraceptive use self-efficacy.

PubMed

Melnick, Alan L; Rdesinski, Rebecca E; Creach, E Dawn; Choi, Dongseok; Harvey, S Marie

2008-01-01

To identify the influence of a community health nurse (CHN) home visit on perceived barriers to contraceptive access and contraceptive use self-efficacy. We enrolled 103 women into two groups in a randomized trial evaluating the influence of contraceptive dispensing and family planning counseling during home visits on perceived barriers to accessing contraceptives and contraceptive use self-efficacy. Both groups received counseling by a CHN about sexually transmitted disease and pregnancy prevention, and a resource card listing phone numbers of family planning clinics. After randomization, the CHN dispensed three months of hormonal contraception to the intensive intervention group and advised the minimal intervention group to schedule an appointment at a family planning clinic. Data collection at baseline and 12 months included demographic, reproductive and other health-related information as well as quantitative assessments of information on perceived barriers to contraceptive access and contraceptive use self-efficacy. The mean age of participants was 24.7 years. Three-fourths had household incomes under $25,000. We found significant reductions in three perceived barriers to contraceptive access for both groups, as well as significant increases in two measures of contraceptive use self-efficacy at twelve months compared to baseline. Nurse home visits involving family planning counseling might be effective in reducing perceived barriers to contraceptive access and increasing contraceptive use self-efficacy.

The crucial role of the private sector.

PubMed

Barberis, M; Paxman, J M

1986-12-01

Private support for the development of family planning programs continues to grow and now includes industries that provide family planning services, commercial outlets that distribute contraceptives, community groups that help to build demand, private medical practitioners who include contraception as a part of health care, organizations that provide technical and financial assistance to developing country programs, pharmaceutical firms, and foundations that underwrite contraceptive research. Although the mix of private and public programs differs from country to country, these 2 family planning programs complement each other and often work in close partnership. The private sector has the advantages of being able to pioneer innovative programs the public sector is unwilling or unable to pursue, to bring foreign financial and technical assistance to developing countries without political implications, and to achieve financially self-sustaining family planning efforts that are linked to other development efforts. In many countries, the private sector has been instrumental in developing a national family planning program and in eliminating barriers to family planning in countries with restrictive laws and policies. The private sector has been especially important in pioneering grassroots programs that improve the status of women through education, health care, training, and economic opportunity.

Launcher Systems Development Cost: Behavior, Uncertainty, Influences, Barriers and Strategies for Reduction

NASA Technical Reports Server (NTRS)

Shaw, Eric J.

2001-01-01

This paper will report on the activities of the IAA Launcher Systems Economics Working Group in preparations for its Launcher Systems Development Cost Behavior Study. The Study goals include: improve launcher system and other space system parametric cost analysis accuracy; improve launcher system and other space system cost analysis credibility; and provide launcher system and technology development program managers and other decisionmakers with useful information on development cost impacts of their decisions. The Working Group plans to explore at least the following five areas in the Study: define and explain development cost behavior terms and concepts for use in the Study; identify and quantify sources of development cost and cost estimating uncertainty; identify and quantify significant influences on development cost behavior; identify common barriers to development cost understanding and reduction; and recommend practical, realistic strategies to accomplish reductions in launcher system development cost.

Barriers and Facilitators of Mentoring for Trainees and Early Career Investigators in Rheumatology Research: Current State, Identification of Needs, and Road Map to an Inter-Institutional Adult Rheumatology Mentoring Program.

PubMed

Ogdie, Alexis; Sparks, Jeffrey A; Angeles-Han, Sheila T; Bush, Kathleen; Castelino, Flavia V; Golding, Amit; Jiang, Yihui; Kahlenberg, J Michelle; Kim, Alfred H J; Lee, Yvonne C; Machireddy, Kirthi; Ombrello, Michael J; Shah, Ami A; Wallace, Zachary S; Nigrovic, Peter A; Makris, Una E

2018-03-01

To determine perceived barriers and facilitators to effective mentoring for early career rheumatology investigators and to develop a framework for an inter-institutional mentoring program. Focus groups or interviews with rheumatology fellows, junior faculty, and mentors were conducted, audiorecorded, and transcribed. Content analysis was performed using NVivo software. Themes were grouped into categories (e.g., mentor-mentee relationship, barriers, and facilitators of a productive relationship). Rheumatology fellows and early career investigators were also surveyed nationwide to identify specific needs to be addressed through an inter-institutional mentoring program. Twenty-five individuals participated in focus groups or interviews. Attributes of the ideal mentee-mentor relationship included communication, accessibility, regular meetings, shared interests, aligned goals, and mutual respect. The mentee should be proactive, efficient, engaged, committed, focused, accountable, and respectful of the mentor's time. The mentor should support/promote the mentee, shape the mentee's goals and career plan, address day-to-day questions, provide critical feedback, be available, and have team leadership skills. Barriers included difficulty with career path navigation, gaining independence, internal competition, authorship, time demands, funding, and work-life balance. Facilitators of a successful relationship included having a diverse network of mentors filling different roles, mentor-mentee relationship management, and confidence. Among 187 survey respondents, the primary uses of an inter-institutional mentoring program were career development planning and oversight, goal-setting, and networking. In this mixed-methods study, tangible factors for optimizing the mentor-mentee relationship were identified and will inform the development of an adult rheumatology inter-institutional mentoring program. © 2017, American College of Rheumatology.

Barriers to the implementation of self management support in long term lung conditions

PubMed Central

Roberts, NJ; Younis, I; Kidd, L

2012-01-01

Background Self-management improves outcomes in asthma and COPD and is strongly recommended in national and international guidelines; however implementation of the guidelines such as use of written action plans in practice is often poor. Setting A questionnaire survey was undertaken to identify the healthcare professional barriers to implementation of self-management for asthma and COPD in West London. Question Why is self-management education not being undertaken in respiratory conditions? Methods A questionnaire was designed to elicit healthcare professionals' views about barriers to implementation of self-management in asthma and COPD. Results Response rates were 33% (58/175). Results showed strong support for guideline recommendations, however implementation was patchy. Seventy six percent of respondents discussed asthma self-management with patients; however only 47.8% of patients received a written action plan. For COPD patients, 55.1% discussed self-management, with 41% receiving a written action plan. In COPD, there was greater GP involvement and less delegation of self-management. Barriers to implementation included patient factors (compliance, literacy and patient understanding), time constraints and insufficient resources. Those who believed they had witnessed improved health outcomes with self-management (53%, 31/58) were more likely to give written action plans (78%, 24/31, ‘nearly always/sometimes’ gave written action plans), Nearly a third of healthcare professionals reported lacking confidence in constructing written action plans (33% 19/58; GPs 43%, nurses 43%). Conclusion Despite overwhelming evidence self-management support is still not being implemented into routine clinical practice, identified barriers included time constraints, lack of training, lack of belief in patients ability to self-manage and lack of confidence completing self-management plans. Practice implications These issues need to be addressed if self-management support is to be delivered in a meaningful and effective way. PMID:25949665

Municipal officials' perceived barriers to consideration of physical activity in community design decision making.

PubMed

Goins, Karin Valentine; Schneider, Kristin L; Brownson, Ross; Carnoske, Cheryl; Evenson, Kelly R; Eyler, Amy; Heinrich, Katie; Litt, Jill; Lyn, Rodney; Maddock, Jay; Reed, Hannah; Tompkins, Nancy Oʼhara; Lemon, Stephenie C

2013-01-01

Built environment-focused interventions and policies are recommended as sustainable approaches for promoting physical activity. Physical activity has not traditionally been considered in land use and transportation decision making. Effective collaboration with non-public health partners requires knowledge of their perceived barriers to such consideration. This analysis sought to (a) establish prevalence estimates of selected barriers to the consideration of physical activity in community design and layout decisions and (b) describe how barrier reporting by public health officials differs from other municipal officials among a wide range of job functions and departments in a geographically diverse sample. A Web-based survey was conducted among municipal officials in 94 cities and towns with populations of at least 50 000 residents in 8 states. A total of 453 municipal officials from public health, planning, transportation/public works, community and economic development, parks and recreation, city management, and municipal legislatures in 83 cities and towns responded to the survey. Five barriers to consideration of physical activity in community design and layout were assessed. The most common barriers included lack of political will (23.5%), limited staff (20.4%), and lack of collaboration across municipal departments (16.2%). Fewer participants reported opposition from the business community or residents as barriers. Public health department personnel were more likely to report the barriers of limited staff and lack of collaboration across municipal departments than other professionals. They were also more likely to report lack of political will than city managers or mayors and municipal legislators. Barriers to increasing consideration of physical activity in decision making about community design and layout are encouragingly low. Implications for public health practice include the need to strategically increase political will despite public health staffing constraints and perceived lack of collaboration with relevant departments such as planning and public works/transportation.

The Role of Federally Qualified Health Centers in Delivering Family Planning Services to Adolescents.

PubMed

Mead, Katherine H; Beeson, Tishra; Wood, Susan F; Goldberg, Debora Goetz; Shin, Peter; Rosenbaum, Sara

2015-07-01

The purpose of this article was to examine the role of community health centers (CHCs) in providing comprehensive family planning services to adolescents, looking at the range of services offered and factors associated with provision of these services. This study employed a mixed methods approach comprising a national survey of CHCs and six in-depth case studies of health centers to examine the organization and delivery of family planning services. We developed an adolescent family planning index comprising nine family planning services specifically tailored to adolescents. We analyzed the influence of state-level family planning policies, funding for adolescents, and organizational characteristics on the provision of these services in CHCs. The case studies identified barriers to the provision of family planning to adolescent patients. The survey found substantial variation in the provision of family planning services at CHCs, with a mean of 6.33 out of a maximum score of 13 on the family planning adolescent services index. Title X funding and location within a favorable state policy environment were significantly associated with higher scores on the family planning adolescent services index (p value < .001 and .002, respectively). Case studies revealed barriers to adolescent family planning, including lack of funding, lack of knowledge, and limitations on school-based clinical services. CHCs have the opportunity to play a significant role in providing high-quality family planning to low-income, medically underserved adolescents. Additional funding, resources, and a favorable policy climate would further improve CHCs' ability to serve the family planning needs of this special patient population. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Resin transfer molding for advanced composite primary aircraft structures

NASA Technical Reports Server (NTRS)

Markus, Alan; Palmer, Ray

1991-01-01

Resin Transfer Molding (RTM) has been identified by Douglas Aircraft Company (DAC) and industry to be one of the promising processes being developed today which can break the cost barrier of implementing composite primary structures into a commercial aircraft production environment. The RTM process developments and scale-up plans Douglas Aircrart will be conducting under the NASA ACT contract are discussed.

Design and tritium permeation analysis of China HCCB TBM port cell

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jiangfeng, S.; Guoqiang, H.; Zhiyong, H.

2015-03-15

China is planning to develop a helium-cooled ceramic breeder (HCCB) test blanket module (TBM) on ITER to test key blanket technologies. In this paper, the design and tritium permeation analysis of China HCCB TBM port cell are introduced. A theoretical model has been developed to estimate tritium permeation rates and leak rates from the components and pipes which China has scheduled to house in the port cell. It is shown that on normal working conditions, the permeation and leak rate of the systems in the port cell will be no higher than 1.58 Ci/d without the use of tritium permeationmore » barriers, and 0.10 Ci/d with the use of tritium permeation barriers. It also appears that tritium permeation barriers are necessary for high temperature components such as the reduction bed and the heater.« less

Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan

PubMed Central

Petersen, Inge; Fairall, Lara; Bhana, Arvin; Kathree, Tasneem; Selohilwe, One; Brooke-Sumner, Carrie; Faris, Gill; Breuer, Erica; Sibanyoni, Nomvula; Lund, Crick; Patel, Vikram

2016-01-01

Background In South Africa, the escalating prevalence of chronic illness and its high comorbidity with mental disorders bring to the fore the need for integrating mental health into chronic care at district level. Aims To develop a district mental healthcare plan (MHCP) in South Africa that integrates mental healthcare for depression, alcohol use disorders and schizophrenia into chronic care. Method Mixed methods using a situation analysis, qualitative key informant interviews, theory of change workshops and piloting of the plan in one health facility informed the development of the MHCP. Results Collaborative care packages for the three conditions were developed to enable integration at the organisational, facility and community levels, supported by a human resource mix and implementation tools. Potential barriers to the feasibility of implementation at scale were identified. Conclusions The plan leverages resources and systems availed by the emerging chronic care service delivery platform for the integration of mental health. This strengthens the potential for future scale up. PMID:26447176

Paying it forward: Four-year analysis of the Eastern Association for the Surgery of Trauma Mentoring Program.

PubMed

Zakrison, Tanya L; Polk, Travis M; Dixon, Rachel; Ekeh, Akpofure P; Gross, Kirby R; Davis, Kimberly A; Kurek, Stanley J; Stassen, Nicole A; Patel, Mayur B

2017-07-01

Mentorship programs in surgery are used to overcome barriers to clinical and academic productivity, research success, and work-life balance. We sought to determine if the Eastern Association for the Surgery of Trauma (EAST) Mentoring Program has met its goals of fostering academic and personal growth in young acute care surgeons. We conducted a systematic program evaluation of EAST Mentoring Program's first 4 years. Demographic information was collected from EAST records, mentorship program applications, and mentee-mentor career development plans. We reviewed the career development plans for thematic commonalities and results of a structured, online questionnaire distributed since program inception. A mixed methods approach was used to better understand the program goals from both mentee and mentor perspectives, as well as attitudes and barriers regarding the perceived success of this career development program. During 2012 to 2015, 65 mentoring dyads were paired and 60 completed the program. Of 184 surveys distributed, 108 were returned (57% response rate). Respondents were evenly distributed between mentees and mentors (53 vs. 55, p = 0.768). In participant surveys, mentoring relationships were viewed to focus on research (45%), "sticky situations" (e.g., communication, work-life balance) (27%), education (18%), or administrative issues (10%). Mentees were more focused on research and education versus mentors (74% vs. 50%; p = 0.040). Mentees felt that goals were "always" or "usually" met versus mentors (89% vs. 77%; p = 0.096). Two barriers to successful mentorship included time and communication, with most pairs communicating by email. Most respondents (91%) planned to continue the relationship beyond the EAST Mentoring Program and recommended the experience to colleagues. Mentee satisfaction with the EAST Mentoring Program was high. Mentoring is a beneficial tool to promote success among EAST's young members, but differences exist between mentee and mentor perceptions. Revising communication expectations and time commitment to improve career development may help our young acute care surgeons.

78 FR 12715 - Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-25

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Meetings AGENCY: Architectural and Transportation Barriers Compliance Board. ACTION: Notice of meetings. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) plans to hold its regular committee and Board meetings in...

77 FR 74827 - Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-18

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Meetings AGENCY: Architectural and Transportation Barriers Compliance Board. ACTION: Notice of meetings. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) plans to hold its regular committee and Board meetings in...

75 FR 13075 - Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-18

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Meetings AGENCY: Architectural and Transportation Barriers Compliance Board. ACTION: Notice of meetings. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) plans to hold its regular committee and Board meetings in...

77 FR 7126 - Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-10

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Meetings AGENCY: Architectural and Transportation Barriers Compliance Board. ACTION: Notice of meetings. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) plans to hold its regular committee and Board meetings in...

77 FR 51513 - Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-24

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Meetings AGENCY: Architectural and Transportation Barriers Compliance Board. ACTION: Notice of meetings. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) plans to hold its regular committee and Board meetings in...

77 FR 36479 - Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-19

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Meetings AGENCY: Architectural and Transportation Barriers Compliance Board. ACTION: Notice of meetings. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) plans to hold its regular committee and Board meetings in...

76 FR 10557 - Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-25

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Meetings AGENCY: Architectural and Transportation Barriers Compliance Board. ACTION: Notice of meetings. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) plans to hold its regular committee and Board meetings in...

75 FR 66061 - Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-27

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Meetings AGENCY: Architectural and Transportation Barriers Compliance Board. ACTION: Notice of meetings. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) plans to hold its regular committee and Board meetings in...

76 FR 21702 - Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-18

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Meetings AGENCY: Architectural and Transportation Barriers Compliance Board. ACTION: Notice of meetings. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) plans to hold its regular committee and Board meetings in...

76 FR 68127 - Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-03

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Meetings AGENCY: Architectural and Transportation Barriers Compliance Board. ACTION: Notice of meetings. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) plans to hold its regular Board meeting in Washington, DC...

78 FR 38009 - Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-25

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Meetings AGENCY: Architectural and Transportation Barriers Compliance Board. ACTION: Notice of meetings. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) plans to hold its regular committee and Board meetings in...

75 FR 39205 - Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-08

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Meetings AGENCY: Architectural and Transportation Barriers Compliance Board. ACTION: Notice of meetings. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) plans to hold its regular committee and Board meetings in...

76 FR 78611 - Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-19

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Meetings AGENCY: Architectural and Transportation Barriers Compliance Board. ACTION: Notice of meetings. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) plans to hold its regular committee and Board meetings in...

78 FR 52499 - Meetings

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-23

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Meetings AGENCY: Architectural and Transportation Barriers Compliance Board. ACTION: Notice of meetings. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) plans to hold its regular committee and Board meetings in...

24 CFR 598.215 - What are the purpose and content of the strategic plan?

Code of Federal Regulations, 2011 CFR

2011-04-01

..., to advance the creation of livable and vibrant communities through comprehensive approaches that... organizations, the private and nonprofit sectors, centers of learning, and other community institutions and... barriers to human development; and (ii) Resource analysis. An assessment of the resources available to the...

A Social Marketing Approach To Increasing Breast Cancer Screening Rates.

ERIC Educational Resources Information Center

Bryant, Carol A.; Forthofer, Melinda S.; McCormack Brown, Kelli; Alfonso, Moya Lynn; Quinn, Gwen

2000-01-01

Used social marketing to identify factors influencing women's breast cancer screening behaviors. Data from focus groups and interviews with diverse women highlighted women's attitudes, knowledge, and barriers regarding screening. Results were used to develop a comprehensive social marketing plan to motivate irregular users of breast cancer…

E-Learning Experiences and Future

ERIC Educational Resources Information Center

Soomro, Safeeullah, Ed.

2010-01-01

Chapters in this book include: (1) E-Learning Indicators: A Multidimensional Model for Planning Developing and Evaluating E-Learning Software Solutions (Bekim Fetaji and Majlinda Fetaji); (2) Barriers to Effective use of Information Technology in Science Education at Yanbu Kingdom of Saudi Arabia (Abdulkareem Eid S. Alwani and Safeeullah Soomro);…

77 FR 38339 - Dairyland Power Cooperative, La Crosse Boiling Water Reactor Exemption From Certain Security...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-27

... intruders and ensure the integrity of physical barriers or other components and functions of the onsite... decommissioning plan is considered in the post-shutdown decommissioning activities report (PSDAR). The DPC has been conducting dismantlement and decommissioning activities. The DPC is developing an onsite...

78 FR 17674 - Agency Information Collection Activities; Proposed Collection; Public Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

... Office of Women's Health (OWH) and the Department of Health and Human Services (HHS) Coordinating... innovative ways of reducing obesity in lesbian and bisexual women. The planned intervention developed in St... what is currently known about local LB women's community norms, common barriers to health, patterns of...

Chem I Supplement. Chemistry Related to Isolation of High-Level Nuclear Waste.

ERIC Educational Resources Information Center

Hoffman, Darleane C.; Choppin, Gregory R.

1986-01-01

Discusses some of the problems associated with the safe disposal of high-level nuclear wastes. Describes several waste disposal plans developed by various nations. Outlines the multiple-barrier concept of isolation in deep geological questions associated with the implementation of such a method. (TW)

Disengaging from Unattainable Career Goals and Reengaging in More Achievable Ones

ERIC Educational Resources Information Center

Creed, Peter A.; Hood, Michelle

2014-01-01

Participants were 181 university students who completed measures of career development (self-efficacy, perceived barriers, distress, planning, and exploration) and goal adjustment capacity (disengagement and reengagement). We expected (a) that when contemplating unachievable goals, those with a higher capacity to adjust their goals (i.e., to…

Barriers to contraceptive careseeking: the experience of Eritrean asylum-seeking women in Israel.

PubMed

Gebreyesus, Tsega; Gottlieb, Nora; Sultan, Zebib; Ghebrezghiabher, Habtom Mehari; Tol, Wietse; Winch, Peter J; Davidovitch, Nadav; Surkan, Pamela J

2017-12-28

In recent years, there has been a mass migration of Eritreans (many seeking political asylum) into Israel after precarious irregular movement across international borders. This study qualitatively explores the structural barriers to family planning (i.e. contraceptive services) for Eritrean women in Israel that are rooted in their temporary legal status and the patchwork of family planning services. From December 2012 to September 2013, we interviewed 25 key informants (NGO workers, researchers, Eritrean community activists, International NGO representatives and Ministry of Health officials) and 12 Eritrean asylum seekers. We also conducted 8 focus groups with Eritrean asylum seekers. Data were analyzed using both inductive and deductive coding. We identified 7 main barriers to accessing family planning services: (1) distance to health facilities; (2) limited healthcare resources; (3) fragmentation of the healthcare system; (4) cost of contraceptive services; (5) low standard of care in private clinics; (6) discrimination; and (7) language barriers. The political, economic and social marginalization of Eritrean asylum-seeking women in Israel creates structural barriers to family planning services. Their marginalization complicates providers' efforts (NGO and governmental) to provide them with comprehensive healthcare, and hinders their ability to control their sexual and reproductive health. Failure to act on this evidence may perpetuate the pattern of unwanted pregnancies and social and economic disparities in this population.

Group consensus peer review in radiation oncology: commitment to quality.

PubMed

Duggar, W Neil; Bhandari, Rahul; Yang, Chunli Claus; Vijayakumar, Srinivasan

2018-03-27

Peer review, especially prospective peer review, has been supported by professional organizations as an important element in optimal Radiation Oncology practice based on its demonstration of efficacy at detecting and preventing errors prior to patient treatment. Implementation of peer review is not without barriers, but solutions do exist to mitigate or eliminate some of those barriers. Peer review practice at our institution involves three key elements: new patient conference, treatment planning conference, and chart rounds. The treatment planning conference is an adaptation of the group consensus peer review model from radiology which utilizes a group of peers reviewing each treatment plan prior to implementation. The peer group in radiation oncology includes Radiation Oncologists, Physician Residents, Medical Physicists, Dosimetrists, and Therapists. Thus, technical and clinical aspects of each plan are evaluated simultaneously. Though peer review is held in high regard in Radiation Oncology, many barriers commonly exist preventing optimal implementation such as time intensiveness, repetition, and distraction from clinic time with patients. Through the use of automated review tools and commitment by individuals and administration in regards to staffing, scheduling, and responsibilities, these barriers have been mitigated to implement this Group Consensus Peer Review model into a Radiation Oncology Clinic. A Group Consensus Peer Review model has been implemented with strategies to address common barriers to effective and efficient peer review.

Hispanic Community College Students: Acculturation, Family Support, Perceived Educational Barriers, and Vocational Planning

ERIC Educational Resources Information Center

Fiebig, Jennifer Nepper; Braid, Barbara L.; Ross, Patricia A.; Tom, Matthew A.; Prinzo, Cara

2010-01-01

A multiple logistic regression model was used to determine the associations between the role of acculturation, perception of educational barriers, need for family kin support, vocational planning, and expectations for attaining future vocational goals against the demographic variables (gender, age, being the oldest child, the first to attend…

Fragmentation of the Habitat of Wild Ungulates by Anthropogenic Barriers in Mongolia

PubMed Central

Ito, Takehiko Y.; Lhagvasuren, Badamjav; Tsunekawa, Atsushi; Shinoda, Masato; Takatsuki, Seiki; Buuveibaatar, Bayarbaatar; Chimeddorj, Buyanaa

2013-01-01

Habitat loss and habitat fragmentation caused by anthropogenic activities are the main factors that constrain long-distance movement of ungulates. Mongolian gazelles (Procapra gutturosa) and Asiatic wild asses (Equus hemionus) in Mongolia are facing habitat fragmentation and loss. To better understand how their movements respond to potential anthropogenic and natural barriers, we tracked 24 Mongolian gazelles and 12 wild asses near the Ulaanbaatar–Beijing Railroad and the fenced international border between Mongolia and China between 2002 and 2012. None of the tracked gazelles crossed the railroad, even though gazelles were captured on both sides of the tracks at the start of the study. Similarly, we did not observe cross-border movements between Mongolia and China for either species, even though some animals used areas adjacent to the border. The both species used close areas to the anthropogenic barriers more frequently during winter than summer. These results suggest strong impacts by the artificial barriers. The construction of new railroads and roads to permit mining and other resource development therefore creates the threat of further habitat fragmentation, because the planned routes will divide the remaining non-fragmented habitats of the ungulates into smaller pieces. To conserve long-distance movement of the ungulates in this area, it will be necessary to remove or mitigate the barrier effects of the existing and planned roads and railroads and to adopt a landscape-level approach to allow access by ungulates to wide ranges throughout their distribution. PMID:23437291

Implementing system-wide risk stratification approaches: A review of critical success and failure factors.

PubMed

Huckel Schneider, Carmen; Gillespie, James A; Wilson, Andrew

2017-05-01

Risk stratification has become a widely used tool for linking people identified at risk of health deterioration to the most appropriate evidence-based care. This article systematically reviews recent literature to determine key factors that have been identified as critical enablers and/or barriers to successful implementation of risk stratification tools at a system level. A systematic search found 23 articles and four promising protocols for inclusion in the review, covering the use to 20 different risk stratification tools. These articles reported on only a small fraction of the risk stratification tools used in health systems; suggesting that while the development and statistical validation of risk stratification algorithms is widely reported, there has been little published evaluation of how they are implemented in real-world settings. Controlled studies provided some evidence that the use of risk stratification tools in combination with a care management plan offer patient benefits and that the use of a risk stratification tool to determine components of a care management plan may contribute to reductions in hospital readmissions, patient satisfaction and improved patient outcomes. Studies with the strongest focus on implementation used qualitative and case study methods. Among these, the literature converged on four key areas of implementation that were found to be critical for overcoming barriers to success: the engagement of clinicians and safeguarding equity, both of which address barriers of acceptance; the health system context to address administrative, political and system design barriers; and data management and integration to address logistical barriers.

77 FR 74826 - Notice of Intent To Seek OMB Approval To Collect Information: On-Line Architectural Barriers Act...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-18

... ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD Notice of Intent To Seek OMB Approval...: Architectural and Transportation Barriers Compliance Board. ACTION: Notice and request for comments. SUMMARY: The Architectural and Transportation Barriers Compliance Board (Access Board) plans to request...

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives

PubMed Central

Morris, Joanne; Grimmer, Karen; Gilmore, Lisa; Perera, Chandima; Waddington, Gordon; Kyle, Greg; Ashman, Bryan; Murphy, Karen

2014-01-01

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from “a good idea” to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes. PMID:25018637

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives.

PubMed

Morris, Joanne; Grimmer, Karen; Gilmore, Lisa; Perera, Chandima; Waddington, Gordon; Kyle, Greg; Ashman, Bryan; Murphy, Karen

2014-01-01

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from "a good idea" to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes.

Strategies to Prevent and Reduce Diabetes and Obesity in Sacramento, California: The African American Leadership Coalition and University of California, Davis

PubMed Central

Styne, Dennis; Askia, Joyce; Roberts, Tina; Lewis, Edward T.; Edwards, Whitney

2013-01-01

Background Diabetes is one of the leading causes of illness and death for African Americans and people of African descent throughout the United States and in the city and county of Sacramento, California. The involvement of families and communities in developing prevention strategies can increase the likelihood that behavioral changes will be sustained. Context Three member organizations of the African American Leadership Coalition (AALC) entered into a partnership with the University of California, Davis (UC Davis) to engage families in developing a process to identify barriers to diabetes and obesity prevention and reduction, exchange strategies, and create action plans for prevention. Methods The intervention comprised 3 phases: 1) coalition formation and training; 2) data collection, analysis, and dissemination of results; and 3) development of family and community action plans. Academic and community partners planned and implemented all project phases together. Outcomes Sources of information about diabetes and obesity were primarily doctors and the Internet; barriers were related to lack of time needed to prepare healthy meals, high food costs, transportation to fresh markets, motivation around healthy habits, and unsafe environments. Action plans addressed behavioral change and family cohesion. The group discussion format encouraged mutual support and suggestions for better eating and physical exercise habits. Interpretation This collaborative partnership model can strengthen existing group relationships or promote new affiliations that form the basis for future action coalitions. Participants worked both within and across groups to exchange information, stories of success and challenges, and specific health improvement strategies. PMID:24229570

Multiple Intimate Partner Violence Experiences: Knowledge, Access, Utilization and Barriers to Utilization of Resources by Women of the African Diaspora.

PubMed

Sabri, Bushra; Huerta, Julia; Alexander, Kamila A; St Vil, Noelle M; Campbell, Jacquelyn C; Callwood, Gloria B

2015-11-01

This study examined knowledge, access, utilization, and barriers to use of resources among Black women exposed to multiple types of intimate partner violence in Baltimore, Maryland and the U.S. Virgin Islands (USVI). We analyzed quantitative survey data collected by 163 women recruited from primary care, prenatal or family planning clinics in Baltimore and the USVI. In addition we analyzed qualitative data from in-depth interviews with 11 women. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using thematic analysis. A substantial proportion of Black women with multiple types of violence experiences lacked knowledge of, did not have access to, and did not use resources. Barriers to resource use were identified at the individual, relationship, and community levels. There is need for programs to develop awareness, promote access and utilization of resources, and eliminate barriers to resource use among abused Black women.

Barriers to Implementing Person-Centered Recovery Planning in Public Mental Health Organizations in Texas: Results from Nine Focus Groups.

PubMed

Lodge, Amy C; Kaufman, Laura; Stevens Manser, Stacey

2017-05-01

Despite being an established practice in the disabilities service systems, person-centered planning is a relatively new practice in the behavioral health system. As a result, little is known about the barriers that mental health organizations face in implementing person-centered recovery planning (PCRP). To fill this gap, results are presented from a qualitative analysis of nine focus groups at three public mental health organizations in Texas that have been implementing PCRP for at least 2 years. Findings suggest that organizations experienced 12 distinct barriers to PCRP implementation which were categorized into the Consolidated Framework for Implementation Research domains of intervention characteristics, the outer setting, the inner setting, characteristics of individuals, and the implementation process. Half of these 12 barriers fell within the inner setting domain, suggesting that implementation efforts should be flexible and adaptable to organizational culture and context. One-quarter of the barriers fell into the domain of characteristics of individuals involved in the intervention, which further suggests implementation efforts should assess the impact that both staff and consumers have on implementation success.

Barriers to and Facilitators of South Asian Indian-Americans’ Engagement in Advanced Care Planning Behaviors

PubMed Central

Radhakrishnan, Kavita; Saxena, Shubhada; Jillapalli, Regina; Jang, Yuri; Kim, Miyong

2018-01-01

Purpose To identify barriers to and facilitators of older South Asian Indian-Americans’ (SAIAs’) engagement in behaviors associated with advance care planning (ACP). Methods Using a descriptive qualitative design guided by the transcultural nursing assessment model, data were collected in focus groups of community-dwelling older SAIA participants, SAIA family caregivers, and SAIA physicians. A directed approach using predetermined coding categories derived from the Transcultural Nursing Assessment model and aided by NVivo 10 software (Melbourne, Australia) facilitated the qualitative data analysis. Results Eleven focus groups with 36 older SAIAs (61% female, 83% 70+ years old), 10 SAIA family caregivers, and 4 SAIA physicians indicated prior lack of awareness of ACP, good health status, lack of access to linguistically and health literacy–tailored materials, healthcare provider hesitation to initiate discussions on ACP, trust in healthcare providers’ or oldest sons’ decision making, busy family caregiver work routines, and cultural assumptions about filial piety and after-death rituals as major barriers to engaging in ACP. Introducing ACP using personal anecdotes in a neutral, group-based community setting and incentivizing ACP discussions by including long-term care planning were suggested as facilitators to engage in ACP. Clinical Relevance The study’s findings will guide development of culturally sensitive interventions to raise awareness about ACP among SAIAs and encourage SAIA older adults to engage in ACP. PMID:28388828

Barriers to and Facilitators of South Asian Indian-Americans' Engagement in Advanced Care Planning Behaviors.

PubMed

Radhakrishnan, Kavita; Saxena, Shubhada; Jillapalli, Regina; Jang, Yuri; Kim, Miyong

2017-05-01

To identify barriers to and facilitators of older South Asian Indian-Americans' (SAIAs') engagement in behaviors associated with advance care planning (ACP). Using a descriptive qualitative design guided by the transcultural nursing assessment model, data were collected in focus groups of community-dwelling older SAIA participants, SAIA family caregivers, and SAIA physicians. A directed approach using predetermined coding categories derived from the Transcultural Nursing Assessment model and aided by NVivo 10 software (Melbourne, Australia) facilitated the qualitative data analysis. Eleven focus groups with 36 older SAIAs (61% female, 83% 70+ years old), 10 SAIA family caregivers, and 4 SAIA physicians indicated prior lack of awareness of ACP, good health status, lack of access to linguistically and health literacy-tailored materials, healthcare provider hesitation to initiate discussions on ACP, trust in healthcare providers' or oldest sons' decision making, busy family caregiver work routines, and cultural assumptions about filial piety and after-death rituals as major barriers to engaging in ACP. Introducing ACP using personal anecdotes in a neutral, group-based community setting and incentivizing ACP discussions by including long-term care planning were suggested as facilitators to engage in ACP. The study's findings will guide development of culturally sensitive interventions to raise awareness about ACP among SAIAs and encourage SAIA older adults to engage in ACP. © 2017 Sigma Theta Tau International.

Implementing Family Meetings Into a Respiratory Care Unit: A Care and Communication Quality Improvement Project.

PubMed

Loeslie, Vicki; Abcejo, Ma Sunnimpha; Anderson, Claudia; Leibenguth, Emily; Mielke, Cathy; Rabatin, Jeffrey

Substantial evidence in critical care literature identifies a lack of quality and quantity of communication between patients, families, and clinicians while in the intensive care unit. Barriers include time, multiple caregivers, communication skills, culture, language, stress, and optimal meeting space. For patients who are chronically critically ill, the need for a structured method of communication is paramount for discussion of goals of care. The objective of this quality improvement project was to identify barriers to communication, then develop, implement, and evaluate a process for semistructured family meetings in a 9-bed respiratory care unit. Using set dates and times, family meetings were offered to patients and families admitted to the respiratory care unit. Multiple avenues of communication were utilized to facilitate attendance. Utilizing evidence-based family meeting literature, a guide for family meetings was developed. Templates were developed for documentation of the family meeting in the electronic medical record. Multiple communication barriers were identified. Frequency of family meeting occurrence rose from 31% to 88%. Staff satisfaction with meeting frequency, meeting length, and discussion of congruent goals of care between patient/family and health care providers improved. Patient/family satisfaction with consistency of message between team members; understanding of medications, tests, and dismissal plan; and efficacy to address their concerns with the medical team improved. This quality improvement project was implemented to address the communication gap in the care of complex patients who require prolonged hospitalizations. By identifying this need, engaging stakeholders, and developing a family meeting plan to meet to address these needs, communication between all members of the patient's care team has improved.

Perceived Motivating Factors and Barriers for the Completion of Postgraduate Training Among American Pharmacy Students Prior to Beginning Advanced Pharmacy Practice Experiences

PubMed Central

Oyler, Douglas R.; Devlin, John W.; Painter, Jacob T.; Bolesta, Scott; Swanson, Joseph M.; Bailey, Brett J.; Branan, Trisha; Barletta, Jeffrey F.; Dunn, Brianne; Haney, Jason S.; Juang, Paul; Kane-Gill, Sandra L.; Kiser, Tyree H.; Shafeeq, Hira; Skaar, Debra; Smithburger, Pamela; Taylor, Jodi

2017-01-01

Objective. To examine perceived motivating factors and barriers (MFB) to postgraduate training (PGT) pursuit among pharmacy students. Methods. Third-year pharmacy students at 13 schools of pharmacy provided demographics and their plan and perceived MFBs for pursuing PGT. Responses were characterized using descriptive statistics. Kruskal-Wallis equality-of-proportions rank tests determined if differences in perceived MFBs existed between students based on plan to pursue PGT. Results. Among 1218 (69.5%) respondents, 37.1% planned to pursue PGT (32.9% did not, 30% were undecided). Students introduced to PGT prior to beginning pharmacy school more frequently planned to pursue PGT. More students who planned to pursue PGT had hospital work experience. The primary PGT rationale was, “I desire to gain more knowledge and experience.” Student debt was the most commonly cited barrier. Conclusion. Introducing pharmacy students early to PGT options and establishing work experiences in the hospital setting may increase students’ desire to pursue PGT. PMID:28720918

Personal, neighbourhood and urban factors associated with obesity in the United States.

PubMed

Joshu, C E; Boehmer, T K; Brownson, R C; Ewing, R

2008-03-01

Growing evidence suggests the built environment impacts obesity within urban areas; however, little research has investigated these relationships across levels of urbanisation in diverse and representative populations. This study aimed to determine whether personal and neighbourhood barriers differ by the level of urbanisation and the relative importance of personal barriers, neighbourhood barriers and land-use development patterns measured by a county-level sprawl index. Population-based, cross-sectional telephone survey data were collected on 1818 United States adults of diverse ethnicity and income level. Primary analyses were stratified by the level of urbanisation at the county level (large metropolitan, small metropolitan, non-metro, rural). Associations between obesity and neighbourhood and personal barriers were estimated with logistic regression, controlling for demographic variables. Within metropolitan areas, the association between body mass index (BMI) and county-level sprawl was estimated using hierarchical linear modelling, controlling for individual-level neighbourhood and personal barriers and demographic variables and then assessing cross-level interaction. The prevalence of neighbourhood, but not personal, barriers differed widely across levels of urbanisation. Specific neighbourhood (eg traffic, unattended dogs) and personal (eg time, injury) barriers differentially correlated with obesity across strata. The impact of sprawl on BMI (B = -0.005) was consistent with previous findings; standardised coefficients indicate that personal (beta = 0.10) and neighbourhood (beta = 0.05) barriers had a stronger association than sprawl (beta = -0.02). Furthermore, the effect of sprawl on BMI increased by -0.006 with each additional personal barrier. Future intervention planning and policy development should consider that personal barriers and built environment characteristics may interact with each other and influence obesity differently across urbanisation levels.

Development of Evidence-Based Health Policy Documents in Developing Countries: A Case of Iran

PubMed Central

Imani-Nasab, Mohammad Hasan; Seyedin, Hesam; Majdzadeh, Reza; Yazdizadeh, Bahareh; Salehi, Masoud

2014-01-01

Background: Evidence-based policy documents that are well developed by senior civil servants and are timely available can reduce the barriers to evidence utilization by health policy makers. This study examined the barriers and facilitators in developing evidence-based health policy documents from the perspective of their producers in a developing country. Methods: In a qualitative study with a framework analysis approach, we conducted semi-structured interviews using purposive and snowball sampling. A qualitative analysis software (MAXQDA-10) was used to apply the codes and manage the data. This study was theory-based and the results were compared to exploratory studies about the factors influencing evidence-based health policymaking. Results: 18 codes and three main themes of behavioral, normative, and control beliefs were identified. Factors that influence the development of evidence-based policy documents were identified by the participants: behavioral beliefs included quality of policy documents, use of resources, knowledge and innovation, being time-consuming and contextualization; normative beliefs included policy authorities, policymakers, policy administrators, and co-workers; and control beliefs included recruitment policy, performance management, empowerment, management stability, physical environment, access to evidence, policy making process, and effect of other factors. Conclusion: Most of the cited barriers to the development of evidence-based policy were related to control beliefs, i.e. barriers at the organizational and health system levels. This study identified the factors that influence the development of evidence-based policy documents based on the components of the theory of planned behavior. But in exploratory studies on evidence utilization by health policymakers, the identified factors were only related to control behaviors. This suggests that the theoretical approach may be preferable to the exploratory approach in identifying the barriers and facilitators of a behavior. PMID:24762343

Development of evidence-based health policy documents in developing countries: a case of Iran.

PubMed

Imani-Nasab, Mohammad Hasan; Seyedin, Hesam; Majdzadeh, Reza; Yazdizadeh, Bahareh; Salehi, Masoud

2014-02-07

Evidence-based policy documents that are well developed by senior civil servants and are timely available can reduce the barriers to evidence utilization by health policy makers. This study examined the barriers and facilitators in developing evidence-based health policy documents from the perspective of their producers in a developing country. In a qualitative study with a framework analysis approach, we conducted semi-structured interviews using purposive and snowball sampling. A qualitative analysis software (MAXQDA-10) was used to apply the codes and manage the data. This study was theory-based and the results were compared to exploratory studies about the factors influencing evidence-based health policy-making. 18 codes and three main themes of behavioral, normative, and control beliefs were identified. Factors that influence the development of evidence-based policy documents were identified by the participants: behavioral beliefs included quality of policy documents, use of resources, knowledge and innovation, being time-consuming and contextualization; normative beliefs included policy authorities, policymakers, policy administrators, and co-workers; and control beliefs included recruitment policy, performance management, empowerment, management stability, physical environment, access to evidence, policy making process, and effect of other factors. Most of the cited barriers to the development of evidence-based policy were related to control beliefs, i.e. barriers at the organizational and health system levels. This study identified the factors that influence the development of evidence-based policy documents based on the components of the theory of planned behavior. But in exploratory studies on evidence utilization by health policymakers, the identified factors were only related to control behaviors. This suggests that the theoretical approach may be preferable to the exploratory approach in identifying the barriers and facilitators of a behavior.

Theory of Planned Behavior including self-stigma and perceived barriers explain help-seeking behavior for sexual problems in Iranian women suffering from epilepsy.

PubMed

Lin, Chung-Ying; Oveisi, Sonia; Burri, Andrea; Pakpour, Amir H

2017-03-01

To apply the Theory of Planned Behavior (TPB) and the two additional concepts self-stigma and perceived barriers to the help-seeking behavior for sexual problems in women with epilepsy. In this 18-month follow-up study, TPB elements, including attitude, subjective norm, perceived behavioral control, and behavioral intention along with self-stigma and perceived barriers in seeking help for sexual problems were assessed in n=818 women with epilepsy (94.0% aged ≤40years). The basic TPB model (model 1) and the TPB model additionally including self-stigma and perceived barriers (Model 2) were analyzed using structural equation modeling (SEM). Both SEM models showed satisfactory model fits. According to model, attitude, subjective norms, perceived behavioral control, and intention explained 63.1% of the variance in help-seeking behavior. Variance was slightly higher (64.5%) when including self-stigma and perceived barriers (model 2). In addition, the fit indices of the models were better highlighting the importance of self-stigma and perceived barriers in help-seeking behavior for sexual problems. Theory of Planned Behavior is useful in explaining help-seeking behavior for sexual problems in women with epilepsy. Self-stigma and perceived barriers are additional factors that should be considered in future interventions aiming to adopt TPB to improve help-seeking behavior for sexual problems. Copyright © 2017 Elsevier Inc. All rights reserved.

Using the theoretical domains framework to identify barriers and enablers to pediatric asthma management in primary care settings.

PubMed

Yamada, Janet; Potestio, Melissa L; Cave, Andrew J; Sharpe, Heather; Johnson, David W; Patey, Andrea M; Presseau, Justin; Grimshaw, Jeremy M

2017-12-20

This study aimed to apply a theory-based approach to identify barriers and enablers to implementing the Alberta Primary Care Asthma Pediatric Pathway (PCAPP) into clinical practice. Phase 1 included an assessment of assumptions underlying the intervention from the perspectives of the developers. Phase 2 determined the perceived barriers and enablers for: 1) primary care physicians' prescribing practices, 2) allied health care professionals' provision of asthma education to parents, and 3) children and parents' adherence to their treatment plans. Interviews were conducted with 35 individuals who reside in Alberta, Canada. Phase 1 included three developers. Phase 2 included 11 primary care physicians, 10 allied health care professionals, and 11 parents of children with asthma. Phase 2 interviews were based on the 14 domains of the Theoretical Domains Framework (TDF). Transcribed interviews were analyzed using a directed content analysis. Key assumptions by the developers about the intervention, and beliefs by others about the barriers and enablers of the targeted behaviors were identified. Eight TDF domains mapped onto the assumptions of the pathway as described by the intervention developers. Interviews with health care professionals and parents identified nine TDF domains that influenced the targeted behaviors: knowledge, skills, beliefs about capabilities, social/professional role and identity, beliefs about consequences, environmental context and resources, behavioral regulation, social influences, and emotions. Barriers and enablers perceived by health care professionals and parents that influenced asthma management will inform the optimization of the PCAPP prior to its evaluation.

Heard and valued: the development of a model to meaningfully engage marginalized populations in health services planning.

PubMed

Snow, M Elizabeth; Tweedie, Katherine; Pederson, Ann

2018-03-15

Recently, patient engagement has been identified as a promising strategy for supporting healthcare planning. However, the context and structure of universalistic, "one-size-fits-all" approaches often used for patient engagement may not enable diverse patients to participate in decision-making about programs intended to meet their needs. Specifically, standard patient engagement approaches are gender-blind and might not facilitate the engagement of those marginalized by, for example, substance use, low income, experiences of violence, homelessness, and/or mental health challenges-highly gendered health and social experiences. The project's purpose was to develop a heuristic model to assist planners to engage patients who are not traditionally included in healthcare planning. Using a qualitative research approach, we reviewed literature and conducted interviews with patients and healthcare planners regarding engaging marginalized populations in health services planning. From these inputs, we created a model and planning manual to assist healthcare planners to engage marginalized patients in health services planning, which we piloted in two clinical programs undergoing health services design. The findings from the pilots were used to refine the model. The analysis of the interviews and literature identified power and gender as barriers to participation, and generated suggestions to support diverse populations both to attend patient engagement events and to participate meaningfully. Engaging marginalized populations cannot be reduced to a single defined process, but instead needs to be understood as an iterative process of fitting engagement methods to a particular situation. Underlying this process are principles for meaningfully engaging marginalized people in healthcare planning. A one-size-fits-all approach to patient engagement is not appropriate given patients' diverse barriers to meaningful participation in healthcare planning. Instead, planners need a repertoire of skills and strategies to align the purpose of engagement with the capacities and needs of patient participants. Just as services need to meet diverse patients' needs, so too must patient engagement experiences.

Development of community plans to enhance survivorship from colorectal cancer: community-based participatory research in rural communities.

PubMed

Lengerich, Eugene J; Kluhsman, Brenda C; Bencivenga, Marcyann; Allen, Regina; Miele, Mary Beth; Farace, Elana

2007-09-01

In 2002, 10.4% of the 10 million persons alive who have ever been diagnosed with cancer had colorectal cancer (CRC). Barriers, such as distance, terrain, access to care and cultural differences, to CRC survivorship may be especially relevant in rural communities. We tested the hypothesis that teams from rural cancer coalitions and hospitals would develop a Community Plan (CP) to enhance CRC survivorship. We used community-based participatory research and the PRECEDE-PROCEED model to train teams from rural cancer coalitions and hospitals in Pennsylvania and New York. We measured knowledge at three points in time and tested the change with McNemar's test, corrected for multiple comparisons (p < 0.0167). We also conducted a qualitative review of the CP contents. Fourteen (93.3%) of the 15 coalitions or hospitals initially recruited to the study completed a CP. Knowledge in public health, sponsorship of A National Action Plan for Cancer Survivorship, and CRC survivorship and treatment increased. Teams identified perceived barriers and community assets. All teams planned to increase awareness of community assets and almost all planned to enhance treatment-related care and psychosocial care for the CRC survivor; 50% planned to enhance primary care and CRC screening. The study demonstrated the interest and ability of rural organizations to plan to enhance CRC survivorship, including linkage of CRC survivorship to primary care. Rural cancer coalitions and hospitals may be a vehicle to develop local action for A National Action Plan. Access to more comprehensive care for CRC cancer survivors in rural communities appears to be facilitated by the community-based initiative described and investigated in this study. Efforts such as these could be replicated in other rural communities and may impact the care and quality of life of survivors with many types of cancers. While access to health services may be increased through community-based initiatives, we still need to measure the impact of such initiatives on the long term health and well being of cancer survivors in rural locations.

Transformation and Resilience on Urban Coasts

NASA Astrophysics Data System (ADS)

Pelling, M.; Agboola, J.; Birkmann, J.; Grimmond, S. B.; Garschagen, M.; Link, H. D.; Narayanan, P.; Nishi, M.; Ramachandran, R., VI; Solecki, W.; Yamamuro, M.; Welle, T.; Ramachandran, P.; Ajibade, I.

2016-12-01

Large coastal cities are at the forefront of efforts to manage vulnerability and build resilience in the face of multiple, interlinked threats. This paper presents results from the Belmont Forum project Transformation and Resilience on Urban Coasts (TRUC). TRUC aims to shift academic and policy discussion from an assessment of resilience options to an understanding of how cities can transition from one mode of resilience planning to another. In particular TRUC questions the relationship between dominant development trajectories and structures and risk management. Should risk management be deployed to support, adjust or fundamentally change dominant development trajectories and its attendant distributional and procedural justice outcomes? TRUC deployed an interdisciplinary approach bringing together scenario workshops, integrated biophysical and vulnerability modelling, expert and household interviews to open spaces for stakeholders to reflect on existing risk management-development relationships, their determinants, preferences for transition to new states and barriers and opportunities for transition. Results are presented for five global megacities: Kolkata, Lagos, London, New York and Tokyo. Contemporary risk management for these global megacities is found to be rooted in historical events with policy innovation following on from extreme events rather than anticipating future risk. Emergent coastal hazards, most importantly heatwave, are consistently underemphasised in planning and technical capacity. Professionals express a desire to move risk management from a reactive mode aimed at protecting development gains towards a more proactive position and one that can embrace integrated development issues. Barriers to this transition include top-down and centralised planning that makes innovation difficult and slow and variable relations between science and policy communities that make it difficult for high level planners to access novel science opinion.

Sense of place as a determinant of people's attitudes towards the environment: implications for natural resources management and planning in the Great Barrier Reef, Australia.

PubMed

Larson, Silva; De Freitas, Debora M; Hicks, Christina C

2013-03-15

Integrating people's values and perceptions into planning is essential for the successful management of natural resources. However, successful implementation of natural resources management decisions on the ground is a complex task, which requires a comprehensive understanding of a system's social and ecological linkages. This paper investigates the relationship between sense of place and people's attitudes towards their natural environment. Sense of place contributes towards shaping peoples' beliefs, values and commitments. Here, we set out to explore how these theoretical contributions can be operationalized for natural resources management planning in the Great Barrier Reef region of Australia. We hypothesise that the region's diverse range of natural resources, conservation values and management pressures might be reflected in people's attachment to place. To tests this proposition, variables capturing socio-demographics, personal wellbeing and a potential for sense of place were collected via mail-out survey of 372 residents of the region, and tested for relationships using multivariate regression and redundancy orientation analyses. Results indicate that place of residence within the region, involvement in community activities, country of birth and the length of time respondents lived in the region are important determinants of the values assigned to factors related to the natural environment. This type of information is readily available from National Census and thus could be incorporated into the planning of community engagement strategies early in the natural resources management planning process. A better understanding of the characteristics that allow sense of place meanings to develop can facilitate a better understanding of people's perceptions towards environmental and biodiversity issues. We suggest that the insights gained from this study can benefit environmental decision making and planning in the Great Barrier Reef region; and that sense of place is a concept worthy of further investigation elsewhere. Copyright © 2012 Elsevier Ltd. All rights reserved.

Intervention planning for the REDUCE maintenance intervention: a digital intervention to reduce reulceration risk among patients with a history of diabetic foot ulcers

PubMed Central

Sivyer, Katy; Vedhara, Kavita; Yardley, Lucy; Game, Frances; Chalder, Trudie; Richards, Gayle; Drake, Nikki; Gray, Katie; Weinman, John; Bradbury, Katherine

2018-01-01

Objectives To develop a comprehensive intervention plan for the REDUCE maintenance intervention to support people who have had diabetic foot ulcers (DFUs) to sustain behaviours that reduce reulceration risk. Methods Theory-based, evidence-based and person-based approaches to intervention development were used. In phase I of intervention planning, evidence was collated from a scoping review of the literature and qualitative interviews with patients who have had DFUs (n=20). This was used to identify the psychosocial needs and challenges of this population and barriers and facilitators to the intervention’s target behaviours: regular foot checking, rapid self-referral in the event of changes in foot health, graded and regular physical activity and emotional management. In phase II, this evidence was combined with expert consultation to develop the intervention plan. Brief ‘guiding principles’ for shaping intervention development were created. ‘Behavioural analysis’ and ‘logic modelling’ were used to map intervention content onto behaviour change theory to comprehensively describe the intervention and its hypothesised mechanisms. Results Key challenges to the intervention’s target behaviours included patients’ uncertainty regarding when to self-refer, physical limitations affecting foot checking and physical activity and, for some, difficulties managing negative emotions. Important considerations for the intervention design included a need to increase patients’ confidence in making a self-referral and in using the maintenance intervention and a need to acknowledge that some intervention content might be relevant to only some patients (emotional management, physical activity). The behavioural analysis identified the following processes hypothesised to facilitate long-term behaviour maintenance including increasing patients’ skills, self-efficacy, knowledge, positive outcome expectancies, sense of personal control, social support and physical opportunity. Conclusions This research provides a transparent description of the intervention planning for the REDUCE maintenance intervention. It provides insights into potential barriers and facilitators to the target behaviours and potentially useful behaviour change techniques to use in clinical practice. PMID:29779008

Use of human rights to meet the unmet need for family planning.

PubMed

Cottingham, Jane; Germain, Adrienne; Hunt, Paul

2012-07-14

In this report, we describe how human rights can help to shape laws, policies, programmes, and projects in relation to contraceptive information and services. Applying a human rights perspective and recognising the International Conference on Population and Development and Millennium Development Goal commitments to universal access to reproductive health including family planning, we support measurement of unmet need for family planning that encompasses more groups than has been the case until recently. We outline how human rights can be used to identify, reduce, and eliminate barriers to accessing contraception; the ways in which human rights can enhance laws and policies; and governments' legal obligations in relation to contraceptive information and services. We underline the crucial importance of accountability of states and identify some of the priorities for making family planning available that are mandated by human rights. Copyright © 2012 Elsevier Ltd. All rights reserved.

Residual Barriers for Utilization of Maternal and Child Health Services: Community Perceptions From Rural Pakistan

PubMed Central

Memon, Zahid; Zaidi, Shehla; Riaz, Atif

2016-01-01

Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the main barriers reported, while cultural and religious restrictions were lesser reported. For preventive services including antenatal care (ANC), facility deliveries, postnatal care (PNC), childhood immunization and family planning, the main barrier was low awareness. Conversely, formidable distances and poorly functional services were the main reported constraints in the event of maternal complications and acute child illnesses. The study also found that clients residing in areas served by CHWs had better awareness only of ANC and family planning, while other MCH services were overlooked by the health worker program. The paper highlights that traditional policy emphasis on health facility infrastructure expansion is not likely to address poor utilization rates in remote rural areas. Preventive MCH services require concerted attention to building community awareness, task shifting from facility to community for services provision, and re-energization of CHW program. For maternal and child emergencies there is strong community demand to utilize health facilities, but this will require catalytic support for transport networks and functional health care centers. PMID:26925902

Engine technology challenges for a 21st century high speed civil transport

NASA Technical Reports Server (NTRS)

Shaw, Robert J.

1991-01-01

Recent NASA funded studies by Boeing and Douglas suggest an opportunity exists for a 21st Century High Speed Civil Transport (HSCT) to become part of the international air transportation system. However, before this opportunity for high speed travel can be realized, certain environmental and and economic barrier issues must be overcome. These challenges are outlined. Research activities which NASA has planned to address these barrier issues and to provide a technology base to allow U.S. manufacturers to make an informed go/no go decision on developing the HSCT are discussed.

Control of cervical cancer in Peru: Current barriers and challenges for the future.

PubMed

Aguilar, Alfredo; Pinto, Joseph A; Araujo, Jhajaira; Fajardo, Williams; Bravo, Leny; Pinillos, Luis; Vallejos, Carlos

2016-08-01

Cervical cancer is the leading malignant neoplasm in Peruvian women. This malignancy is a public health problem and several efforts were previously performed to develop cancer control plans. Geographical, cultural, structural, infrastructural and procedural barriers can limit the implementation of such strategies. Several previous studies have characterized human papilloma virus (HPV) epidemiology, where prevalence of high-risk HPV in adult females is ~12% and the prevalence in cervical cancer is 90-95%. The predominant barriers for the control of cervical cancer are lack of specialists in remote villages, education/cultural issues, loss of patients in follow-up, lack of access to HPV testing and lack of compliance for HPV vaccination. A good strategy for the prevention and early detection of high-risk HPV, pre-malignant neoplasms and cervical cancer, identified by interventional studies, is the self-sampling test, which assists with overcoming the cultural and geographic barriers. The current cancer control plan, termed 'Plan Esperanza', is performed with massive training of health professionals and social sensitization campaigns leading to filling the gaps regarding education and, in addition, it provides cancer care coverage for poorer individuals. In our experience at Oncosalud-AUNA, with a cohort of ~750,000 affiliates using a pre-paid system with annual screenings for cervical cancer for women, offered free-of-charge, a lower incidence of this malignancy (5.8/100,000) is now observed compared with the national incidence (32.7/100,000). As in other countries, the HPV vaccination can be a cost-utility strategy to reduce the high burdens of cervical cancer in Peru, a rapid and cheap HPV molecular sub-typification is rapidly required.

School and Public Library Relationships: Deja Vu or New Beginnings.

ERIC Educational Resources Information Center

Fitzgibbons, Shirley A.

2001-01-01

Discusses school and public library relationships and maintains that an integrated, coordinated, and systematic planning process at both local and state levels will meet the needs of children and young adults. Topics include developments in the 1990s, barriers to cooperative efforts, examples of cooperative projects, and combined school-public…

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baker, Scott E.; Bruno, Kenneth S.; Butcher, Mark G.

In 2009, we continued to address barriers to fungal fermentation in the primary areas of morphology control, genomics, proteomics, fungal hyperproductivity, biomass-to-products via fungal based consolidated bioprocesses, and filamentous fungal ethanol. “Alternative renewable fuels from fungi” was added as a new subtask. Plans were also made to launch a new advanced strain development subtask in FY2010.

Barriers to the implementation of research perceived by nurses from Osakidetza.

PubMed

Cidoncha-Moreno, M Ángeles; Ruíz de Alegría-Fernandez de Retana, Begoña

To understand the barriers to implementing nursing research findings into practice, as perceived by the nurses working in Osakidetza and to analyze if the workplace factor and time worked affect the perception of these barriers. Cross-sectional study. BARRIERS Scale questionnaire was given to a representative sample of 1,572 Basque Health Service nurses, stratified and randomized, according to scope of work and job responsibility (response rate: 43.76%). According to the research results, the first important barrier was "insufficient time on the job to implement new ideas". Nurses have perceived the organizational factor as the most important barrier in their practice. Nurses in "Special hospital departments" perceived more barriers in the "quality of research" factor than those working in "Primary Care". Years of service showed a slight influence. The nurses stated that external factors related to the organization principally interfered in implementing results into clinical practice. They placed lack of critical reading training second. Working environment and seniority mark differences in the perception of barriers. This study may help to develop strategies for planning training programs to facilitate the use of research in clinical practice, in order to provide quality care. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Barriers of physical assessment skills among nursing students in Arab Peninsula

PubMed Central

Alamri, Majed Sulaiman; Almazan, Joseph U.

2018-01-01

Objective: There is a growing demand for health-care nursing services in several health care institutions. Understanding barriers to physical assessment among nursing students create a more detailed assessment in the development of quality patient’s care in nursing practice. This study examined the barriers to physical assessment skills among nursing students in a government university in Arab Peninsula. Methods: A cross-sectional research survey design of 206 nursing students using a standardized questionnaire was used. The questionnaire is composed of 7 subscales in evaluating the barriers to physical assessment skills between the classroom and clinical setting. Independent Samples t-test was used in comparing the gender mean of the nursing students about the barriers to physical assessment. Paired t-test was also used in determining the differences between perceived barriers to physical assessment in the classroom and clinical setting. Results: Subscale “reliance on others and technology,” ward culture, “lack of influence on patient care” have significant differences between perceived barriers in physical assessment among classroom settings and clinical setting. Conclusion: Although nursing students were oriented and educated about physical assessment in the nursing curriculum, this is not often practiced in clinical settings. The point that is if nursing students are incorrectly performing the patient assessment, then no amount of critical thinking could lead to better clinical decisions. Continuous exposure and enhancing the quality of planning and promotion of the nursing students could develop necessary skills. In addition, increasing self-confidence is vital to assess the patient’s health status effectively and minimize the barriers to performing the physical assessment. PMID:29896073

Access barriers to and unmet needs for home- and community-based services among older Korean Americans.

PubMed

Casado, Banghwa Lee; Lee, Sang E

2012-01-01

This cross-sectional survey study of 146 caregivers of older Korean Americans explored access barriers to and unmet needs for home- and community-based services (HCBS) programs (respite care, adult day care, personal care, home health, housekeeping, and transportation). Most often reported access barriers were lack of awareness and care recipient refusal. Predictors of unmet needs varied depending on the type of service, but included caregiver gender, relationship, education, caregiving duration, Medicaid coverage, English proficiency, caregiver self-efficacy, care recipient functional dependency, cognitive impairment, and caregiving hours. This study highlighted unmet needs for HCBS in Korean American communities, pointing to the pressing need for a collaborative effort to develop plans that modify and expand HCBS programs for older Korean Americans.

Access to Vocational Education. A Planning System for Local Secondary and Post-Secondary Program and Facility Accessibility. Step 1: Identifying Barriers.

ERIC Educational Resources Information Center

Rice, Eric; And Others

This guidebook focuses on the first of five steps included in a planning system for improving local secondary and postsecondary program and facilities accessibility: identifying barriers. The first five sections of the booklet are comprised of self-instructional descriptions of five needs-assessment procedures that can be used to identify…

Longitudinal Relationships between Planned Happenstance Skills and Life Adjustment and the Moderating Role of Career Barriers

ERIC Educational Resources Information Center

Kim, Boyoung; Kim, So Rin; Yang, Na Yeon; Yaung, Huk; Ha, Gyu Young; Yang, Joon Young; Lee, Bora; Lee, Sang Min

2018-01-01

The purpose of the present study was to examine the longitudinal relationships between planned happenstance skills (PHS) and life adjustment and to examine whether this relationship was moderated by the degree of career barriers. The participants were 307 Korean college students going through a school-to-work transition. The results showed that…

Analyzing Barriers to Energy Conservation in Residences and Offices: The Rewire Program at the University of Toronto

ERIC Educational Resources Information Center

Stokes, Leah C.; Mildenberger, Matto; Savan, Beth; Kolenda, Brian

2012-01-01

Conducting a barriers analysis is an important first step when designing proenvironmental behavior change interventions. Yet, detailed information on common barriers to energy conservation campaigns remains unavailable. Using a pair of original surveys, we leverage the theory of planned behavior to report on the most important barriers for…

Creating an enabling environment for WR&R implementation.

PubMed

Stathatou, P-M; Kampragou, E; Grigoropoulou, H; Assimacopoulos, D; Karavitis, C; Gironás, J

2017-09-01

Reclaimed water is receiving growing attention worldwide as an effective solution for alleviating the growing water scarcity in many areas. Despite the various benefits associated with reclaimed water, water recycling and reuse (WR&R) practices are not widely applied around the world. This is mostly due to complex and inadequate local legal and institutional frameworks and socio-economic structures, which pose barriers to wider WR&R implementation. An integrated approach is therefore needed while planning the implementation of WR&R schemes, considering all the potential barriers, and aiming to develop favourable conditions for enhancing reclaimed water use. This paper proposes a comprehensive methodology supporting the development of an enabling environment for WR&R implementation. The political, economic, social, technical, legal and institutional factors that may influence positively (drivers) or negatively (barriers) WR&R implementation in the regional water systems are identified, through the mapping of local stakeholder perceptions. The identified barriers are further analysed, following a Cross-Impact/System analysis, to recognize the most significant barriers inhibiting system transition, and to prioritize the enabling instruments and arrangements that are needed to boost WR&R implementation. The proposed methodology was applied in the Copiapó River Basin in Chile, which faces severe water scarcity. Through the analysis, it was observed that barriers outweigh drivers for the implementation of WR&R schemes in the Copiapó River Basin, while the key barriers which could be useful for policy formulation towards an enabling environment in the area concern the unclear legal framework regarding the ownership of treated wastewater, the lack of environmental policies focusing on pollution control, the limited integration of reclaimed water use in current land use and development policies, the limited public awareness on WR&R, and the limited availability of governmental funding sources for WR&R.

Portable concrete barrier condition and transition plan synthesis.

DOT National Transportation Integrated Search

2012-06-01

Precast (or portable) Concrete Barrier (PCB) is a guardrail system that is intended to contain and redirect a vehicle that has left the travel lane. Barrier connections are typically formed using steel wire or bar to form loops which are joined by a ...

Breaking barriers through collaboration: the example of the Cell Migration Consortium.

PubMed

Horwitz, Alan Rick; Watson, Nikki; Parsons, J Thomas

2002-10-15

Understanding complex integrated biological processes, such as cell migration, requires interdisciplinary approaches. The Cell Migration Consortium, funded by a Large-Scale Collaborative Project Award from the National Institute of General Medical Science, develops and disseminates new technologies, data, reagents, and shared information to a wide audience. The development and operation of this Consortium may provide useful insights for those who plan similarly large-scale, interdisciplinary approaches.

Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study.

PubMed

Ochako, Rhoune; Mbondo, Mwende; Aloo, Stephen; Kaimenyi, Susan; Thompson, Rachel; Temmerman, Marleen; Kays, Megan

2015-02-10

Young women in Kenya experience a higher risk of mistimed and unwanted pregnancy compared to older women. However, contraceptive use among youth remains low. Known barriers to uptake include side effects, access to commodities and partner approval. To inform a youth focussed behaviour change communication campaign, Population Services Kenya developed a qualitative study to better understand these barriers among young women. The study was carried out in Nyanza, Coast, and Central regions. Within these regions, urban or peri-urban districts were purposively selected based on having contraceptive prevalence rate close to the regional average and having a population with low socioeconomic profiles. In depth interviews were conducted with a sample of sexually active women aged 15-24, both users and non-users, that were drawn from randomly selected households. All the respondents in the study were familiar with modern methods of contraception and most could describe their general mechanisms of action. Condoms were not considered as contraception by many users. Contraception was also associated with promiscuity and straying. Fear of side effects and adverse reactions were a major barrier to use. The biggest fear was that a particular method would cause infertility. Many fears were based on myths and misconceptions. Young women learn about both true side effects and myths from their social networks. Findings from this research confirm that awareness and knowledge of contraception do not necessarily translate to use. The main barriers to modern contraceptive uptake among young women are myths and misconceptions. The findings stress the influence of social network approval on the use of family planning, beyond the individual's beliefs. In such settings, family planning programming should engage with the wider community through mass and peer campaign strategies. As an outcome from this study, Population Services Kenya developed a mass media campaign to address key myths and misconceptions among youth.

Identifying perceived barriers to monitoring service quality among substance abuse treatment providers in South Africa

PubMed Central

2014-01-01

Background A performance measurement system is planned for South African substance abuse treatment services. Provider-level barriers to implementing these systems have been identified in the United States, but little is known about the nature of these barriers in South Africa. This study explored the willingness of South African substance abuse treatment providers’ to adopt a performance measurement system and perceived barriers to monitoring service quality that would need to be addressed during system development. Methods Three focus group discussions were held with treatment providers from two of the nine provinces in South Africa. These providers represented the diverse spread of substance abuse treatment services available in the country. The final sample comprised 21 representatives from 12 treatment facilities: eight treatment centres in the Western Cape and four in KwaZulu-Natal. Content analysis was used to extract core themes from these discussions. Results Participants identified barriers to the monitoring of service quality that included outdated modes of collecting data, personnel who were already burdened by paperwork, lack of time to collect data, and limited skills to analyse and interpret data. Participants recommended that developers engage with service providers in a participatory manner to ensure that service providers are invested in the proposed performance measurement system. Conclusion Findings show that substance abuse treatment providers are willing to adopt a performance measurement system and highlight several barriers that need to be addressed during system development in order to enhance the likelihood that this system will be successfully implemented. PMID:24499037

Intervention planning for a digital intervention for self-management of hypertension: a theory-, evidence- and person-based approach.

PubMed

Band, Rebecca; Bradbury, Katherine; Morton, Katherine; May, Carl; Michie, Susan; Mair, Frances S; Murray, Elizabeth; McManus, Richard J; Little, Paul; Yardley, Lucy

2017-02-23

This paper describes the intervention planning process for the Home and Online Management and Evaluation of Blood Pressure (HOME BP), a digital intervention to promote hypertension self-management. It illustrates how a Person-Based Approach can be integrated with theory- and evidence-based approaches. The Person-Based Approach to intervention development emphasises the use of qualitative research to ensure that the intervention is acceptable, persuasive, engaging and easy to implement. Our intervention planning process comprised two parallel, integrated work streams, which combined theory-, evidence- and person-based elements. The first work stream involved collating evidence from a mixed methods feasibility study, a systematic review and a synthesis of qualitative research. This evidence was analysed to identify likely barriers and facilitators to uptake and implementation as well as design features that should be incorporated in the HOME BP intervention. The second work stream used three complementary approaches to theoretical modelling: developing brief guiding principles for intervention design, causal modelling to map behaviour change techniques in the intervention onto the Behaviour Change Wheel and Normalisation Process Theory frameworks, and developing a logic model. The different elements of our integrated approach to intervention planning yielded important, complementary insights into how to design the intervention to maximise acceptability and ease of implementation by both patients and health professionals. From the primary and secondary evidence, we identified key barriers to overcome (such as patient and health professional concerns about side effects of escalating medication) and effective intervention ingredients (such as providing in-person support for making healthy behaviour changes). Our guiding principles highlighted unique design features that could address these issues (such as online reassurance and procedures for managing concerns). Causal modelling ensured that all relevant behavioural determinants had been addressed, and provided a complete description of the intervention. Our logic model linked the hypothesised mechanisms of action of our intervention to existing psychological theory. Our integrated approach to intervention development, combining theory-, evidence- and person-based approaches, increased the clarity, comprehensiveness and confidence of our theoretical modelling and enabled us to ground our intervention in an in-depth understanding of the barriers and facilitators most relevant to this specific intervention and user population.

Supporting culturally and linguistically diverse students during clinical placement: strategies from both sides of the table.

PubMed

O'Reilly, Sharleen L; Milner, Julia

2015-10-15

Increasing proportions of Culturally and Linguistically Diverse (CALD) students within health professional courses at universities creates challenges in delivering inclusive training and education. Clinical placements are a core component of most health care degrees as they allow for applied learning opportunities. A research gap has been identified in regard to understanding challenges and strategies for CALD students in health professional placements. A key stakeholder approach was used to examine barriers and enablers experienced by CALD students in clinical placement. Semi-structured focus groups with healthcare students (n = 13) and clinical placement supervisors (n = 12) were employed. The focus groups were analysed using open coding and thematic analysis. Three main barrier areas were identified: placement planning and preparation; teaching, assessment and feedback; and cultural and language issues. Potential solutions included addressing placement planning and preparation barriers, appropriate student placement preparation, pre-placement identification of higher risk CALD students, and diversity training for supervisors. For the barrier of teaching, assessment & feedback, addressing strategies were to: adapt student caseloads, encourage regular casual supervisor-student conversations, develop supportive placement delivery modes and structures, set expectations early, model the constructive feedback process, use visual aids, and tailor the learning environment to individual student needs. The enablers for cultural & language issues were to: build language and practical approaches for communication, raise awareness of the healthcare system (how it interacts with healthcare professions and how patients access it), and initiate mentoring programs. The findings suggest that teaching and learning strategies should be student-centred, aiming to promote awareness of difference and its impacts then develop appropriate responses by both student and teacher. Universities and partnering agencies, such as clinical training providers, need to provide an inclusive learning environment for students from multiple cultural backgrounds.

Writing for publication: perspectives of graduate nursing students and doctorally prepared faculty.

PubMed

Dowling, Donna A; Savrin, Carol; Graham, Gregory C

2013-07-01

Publication is a common expectation for both faculty and graduate students in schools of nursing. Little is known about the perceptions of students and faculty regarding what supports or interferes with students' success in writing for publication. Perceptions of supports and barriers to writing for publication and the differences in perceptions between graduate nursing students and faculty were examined. A descriptive comparative design was used to sample master's (n = 62), Doctor of Nursing Practice (n = 66), and Doctor of Philosophy (n = 7) students and graduate faculty (n = 35) using two investigator-developed surveys. Students (71.1%) and faculty (57.6%) identified working with faculty and mentors as the greatest support. Students' primary barrier was finding time (64.5%). Faculty identified not knowing how to get started (63.6%) as the students' greatest barrier. Findings support that mentoring and finding sufficient time for writing are priorities for the development of a plan to support students in writing for publication. Copyright 2013, SLACK Incorporated.

NASA's UAS Integration into the NAS: A Report on the Human Systems Integration Phase 1 Simulation Activities

NASA Technical Reports Server (NTRS)

Fern, Lisa; Rorie, R. Conrad; Shively, R. Jay

2014-01-01

In 2011 the National Aeronautics and Space Administration (NASA) began a five-year Project to address the technical barriers related to routine access of Unmanned Aerial Systems (UAS) in the National Airspace System (NAS). Planned in two phases, the goal of the first phase was to lay the foundations for the Project by identifying those barriers and key issues to be addressed to achieve integration. Phase 1 activities were completed two years into the five-year Project. The purpose of this paper is to review activities within the Human Systems Integration (HSI) subproject in Phase 1 toward its two objectives: 1) develop GCS guidelines for routine UAS access to the NAS, and 2) develop a prototype display suite within an existing Ground Control Station (GCS). The first objective directly addresses a critical barrier for UAS integration into the NAS - a lack of GCS design standards or requirements. First, the paper describes the initial development of a prototype GCS display suite and supporting simulation software capabilities. Then, three simulation experiments utilizing this simulation architecture are summarized. The first experiment sought to determine a baseline performance of UAS pilots operating in civil airspace under current instrument flight rules for manned aircraft. The second experiment examined the effect of currently employed UAS contingency procedures on Air Traffic Control (ATC) participants. The third experiment compared three GCS command and control interfaces on UAS pilot response times in compliance with ATC clearances. The authors discuss how the results of these and future simulation and flight-testing activities contribute to the development of GCS guidelines to support the safe integration of UAS into the NAS. Finally, the planned activities for Phase 2, including an integrated human-in-the-loop simulation and two flight tests are briefly described.

The use of programme planning and social marketing models by a state public health agency: a case study.

PubMed

Kohr, J M; Strack, R W; Newton-Ward, M; Cooke, C H

2008-03-01

To investigate the use of planning models and social marketing planning principles within a state's central public health agency as a means for informing improved planning practices. Qualitative semi-structured interviews were conducted with 30 key programme planners in selected division branches, and a quantitative survey was distributed to 63 individuals responsible for programme planning in 12 programme-related branches. Employees who have an appreciation of and support for structured programme planning and social marketing may be considered the 'low hanging fruit' or 'early adopters'. On the other hand, employees that do not support or understand either of the two concepts have other barriers to using social marketing when planning programmes. A framework describing the observed factors involved in programme planning on an individual, interpersonal and organizational level is presented. Understanding the individual and structural barriers and facilitators of structured programme planning and social marketing is critical to increase the planning capacity within public health agencies.

Creating a bridge between data collection and program planning: a technical assistance model to maximize the use of HIV/AIDS surveillance and service utilization data for planning purposes.

PubMed

Logan, Jennifer A; Beatty, Maile; Woliver, Renee; Rubinstein, Eric P; Averbach, Abigail R

2005-12-01

Over time, improvements in HIV/AIDS surveillance and service utilization data have increased their usefulness for planning programs, targeting resources, and otherwise informing HIV/AIDS policy. However, community planning groups, service providers, and health department staff often have difficulty in interpreting and applying the wide array of data now available. We describe the development of the Bridging Model, a technical assistance model for overcoming barriers to the use of data for program planning. Through the use of an iterative feedback loop in the model, HIV/AIDS data products constantly are evolving to better inform the decision-making tasks of their multiple users. Implementation of this model has led to improved data quality and data products and to a greater willingness and ability among stakeholders to use the data for planning purposes.

Barriers Over Time to Full Implementation of Health Information Exchange in the United States

PubMed Central

2014-01-01

Background Although health information exchanges (HIE) have existed since their introduction by President Bush in his 2004 State of the Union Address, and despite monetary incentives earmarked in 2009 by the health information technology for economic and clinical health (HITECH) Act, adoption of HIE has been sparse in the United States. Research has been conducted to explore the concept of HIE and its benefit to patients, but viable business plans for their existence are rare, and so far, no research has been conducted on the dynamic nature of barriers over time. Objective The aim of this study is to map the barriers mentioned in the literature to illustrate the effect, if any, of barriers discussed with respect to the HITECH Act from 2009 to the early months of 2014. Methods We conducted a systematic literature review from CINAHL, PubMed, and Google Scholar. The search criteria primarily focused on studies. Each article was read by at least two of the authors, and a final set was established for evaluation (n=28). Results The 28 articles identified 16 barriers. Cost and efficiency/workflow were identified 15% and 13% of all instances of barriers mentioned in literature, respectively. The years 2010 and 2011 were the most plentiful years when barriers were discussed, with 75% and 69% of all barriers listed, respectively. Conclusions The frequency of barriers mentioned in literature demonstrates the mindfulness of users, developers, and both local and national government. The broad conclusion is that public policy masks the effects of some barriers, while revealing others. However, a deleterious effect can be inferred when the public funds are exhausted. Public policy will need to lever incentives to overcome many of the barriers such as cost and impediments to competition. Process improvement managers need to optimize the efficiency of current practices at the point of care. Developers will need to work with users to ensure tools that use HIE resources work into existing workflows. PMID:25600635

Functional Behavior Assessments and Behavior Intervention Plans in Rural Schools: An Exploration of the Need, Barriers, and Recommendations

ERIC Educational Resources Information Center

Oram, Lindsay; Owens, Sarah; Maras, Melissa

2016-01-01

A wealth of research highlights negative outcomes associated with mental and behavioral health problems in children and adolescents. Prevention-based frameworks have been developed to provide prevention and early intervention in the school setting. Tertiary behavioral supports often include the use of functional behavior assessments (FBAs) and…

Restoring stream habitat connectivity: a proposed method for prioritizing the removal of resident fish passage barriers.

PubMed

O'Hanley, Jesse R; Wright, Jed; Diebel, Matthew; Fedora, Mark A; Soucy, Charles L

2013-08-15

Systematic methods for prioritizing the repair and removal of fish passage barriers, while growing of late, have hitherto focused almost exclusively on meeting the needs of migratory fish species (e.g., anadromous salmonids). An important but as of yet unaddressed issue is the development of new modeling approaches which are applicable to resident fish species habitat restoration programs. In this paper, we develop a budget constrained optimization model for deciding which barriers to repair or remove in order to maximize habitat availability for stream resident fish. Habitat availability at the local stream reach is determined based on the recently proposed C metric, which accounts for the amount, quality, distance and level of connectivity to different stream habitat types. We assess the computational performance of our model using geospatial barrier and stream data collected from the Pine-Popple Watershed, located in northeast Wisconsin (USA). The optimization model is found to be an efficient and practical decision support tool. Optimal solutions, which are useful in informing basin-wide restoration planning efforts, can be generated on average in only a few minutes. Copyright © 2013 Elsevier Ltd. All rights reserved.

National workshop on core competencies for success in the veterinary profession.

PubMed

Lloyd, James W; King, Lonnie J; Klausner, Jeffrey S; Harris, Donna

2003-01-01

A workshop was designed to (1) present results of the Core Competencies for Veterinary Medicine project conducted by Personnel Decisions International (PDI); (2) discuss and analyze the implications of the PDI study results for academia, private practice, and industry; (3) identify actionable items-discuss opportunities and barriers; and (4) develop appropriate recommendations-devise specific actions for implementation as next steps. In total, 25 veterinary colleges were represented at the workshop and a total of 110 attendees participated, a broad cross-section of the veterinary profession (both academic and non-academic). Through an orchestrated combination of general sessions and facilitated, small group discussions, prioritized recommendations for implementation and initial action plans for next steps were developed. Recommendations included publicizing results of the PDI study, reconsidering current admissions policies and processes, evaluating the applicant pool and current recruitment programs, developing structured mentoring programs, enhancing DVM/VMD training programs, coordinating the development of continuing education programs, and overcoming existing barriers to change. Next steps should involve collaborative efforts across all sectors of the veterinary profession to develop plans for implementing the workshop's recommendations. Leadership for follow-up might reasonably come from the Association of American Veterinary Medical Colleges (AAVMC), the American Veterinary Medical Association (AVMA), and the American Animal Hospital Association (AAHA), either individually or collectively, through the National Commission on Veterinary Economic Issues (NCVEI). Partnerships with industry are also possible and should be strongly considered.

76 FR 55107 - Draft Environmental Impact Statement for General Management Plan, Gulf Islands National Seashore...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-06

... reduce the level of infrastructure rebuilt on the barrier islands and allow natural processes to... to enhance visitor education, research, and resource protection opportunities. The seashore would be... barrier islands and coastal environments. Interpretive programs would focus on illustrating how barrier...

Older Adult Participation in Health Promotion Programs: Perspectives of Facility Administrators

ERIC Educational Resources Information Center

Wright, Tim; Hyner, Gerald C.

2011-01-01

Administrators of older adult-centered facilities must identify barriers to the planning and implementation of health promotion programs. In this qualitative research those barriers were identified through in-depth interviews with administrators of older adult-centered facilities. As identified by administrators, the predominant barriers to the…

Training people with HIV disease for involvement in community planning process: Project LEAP. Learning Empowerment Advocacy, Participation.

PubMed

Halloran, J P; Ross, M W; Huffman, L

1996-01-01

Social and political pressure, as well as public health theory, mandate inclusion of PLWHIV in community planning and policy development processes. Barriers to PLWHIV participation may be cognitive, instrumental, and/or affective. The authors report on development, implementation, and initial evaluation of a pilot project testing a psychoeducational intervention to increase organizational participation by people with HIV. Organizational participation by individual increased from a mean of 0.5 organizations at entry to 2.3 at follow-up. Evaluation data indicate that increases in self-esteem, self-confidence, and specific knowledge, along with demystification of organizational operations, networking, and modeling by project staff contributed to the outcome.

Health worker shortages in Zambia: an assessment of government responses.

PubMed

Gow, Jeff; George, Gavin; Mutinta, Given; Mwamba, Sylvia; Ingombe, Lutungu

2011-11-01

A dire health worker shortage in Zambia's national health programs is adversely impacting the quantity and quality of health care and posing a serious barrier to achieving Millennium Development Goals to improve population health. In 2005, Zambia's Ministry of Health developed a 10-year strategic plan for human resources for health to address the crisis through improved training, hiring, and retention. The plan has neither arrested nor reduced the shortage. We review the causes of the shortage, present results from a health worker survey showing that safe work conditions, manageable workloads, and career advancement opportunities matter more to respondents than financial compensation. We comment on the adequacy of government efforts to address the health worker shortage.

Pancreatic cancer survivors' preferences, barriers, and facilitators related to physical activity and diet interventions.

PubMed

Arthur, Anna E; Delk, Ashley; Demark-Wahnefried, Wendy; Christein, John D; Contreras, Carlo; Posey, James A; Vickers, Selwyn; Oster, Robert; Rogers, Laura Q

2016-12-01

To conduct a telephone survey establishing pancreatic cancer survivors' level of interest in, preferences for, and perceived barriers and facilitators to participating in exercise and diet intervention programming. These data will inform the development of such interventions for newly-diagnosed patients. Seventy-one survivors treated for resectable pancreatic adenocarcinoma from October 2011 to August 2014 were identified through an institutional cancer registry and contacted via telephone. A telephone survey was conducted to query survivors' level of interest in, preferences for, and perceived barriers and facilitators to participating in an exercise and dietary intervention program shortly after disease diagnosis. Acceptability of a technology-based visual communication (e.g., Skype™, FaceTime®) intervention was also assessed. Fifty participants completed the survey (response rate 71.8 %). Over two-thirds of participants reported interest in exercise and diet intervention programming. Over half reported comfort with a technology-delivered visual communication intervention. Barriers to participation included older age and physical, personal, and emotional problems. The most common facilitator was program awareness. Outcomes for future research important to participants were supportive care and quality of life. Most pancreatic cancer patients are interested in exercise and diet interventions shortly after diagnosis; however, some barriers to program participation exist. Future research and intervention planning for pancreatic cancer survivors should focus on developing messaging and strategies that provide support for survivorship outcomes, increase survivor awareness, address lack of familiarity with technology, reduce fears about potential barriers, and help survivors overcome these barriers. In so doing, survivorship needs can be better met and quality of life improved in this understudied population.

Overcoming barriers to recruiting ethnic minorities to mental health research: a typology of recruitment strategies.

PubMed

Waheed, Waquas; Hughes-Morley, Adwoa; Woodham, Adrine; Allen, Gill; Bower, Peter

2015-05-02

The ethnic minority population in developed countries is increasing over time. These groups are at higher risk of mental illness and demonstrate lower participation in research. Published evidence suggests that multiple factors like stigma, lack of trust, differences in explanatory models, logistical issues and lack of culturally aware researchers act as barriers to ethnic minority recruitment into mental health research. To reduce inequalities in participation, there is a need to devise innovative and culturally sensitive recruitment strategies. It is important that researchers share their experience of employing these strategies so that ethnic minority participation can be facilitated. We previously published a systematic review of barriers to recruiting ethnic minority participants into mental health research. The nine papers included in our prior review formed the basis for developing a typology of barriers to recruiting ethnic minorities into mental health research. This typology identified 33 barriers, described under five themes. We further extracted data on the strategies used to overcome these recruitment barriers, as described in the included studies. The strategies employed by the authors could be matched to all but two barriers (psychopathology/substance misuse and limited resource availability). There was evidence that multiple strategies were employed, and that these depended upon the population, clinical set-up and resources available. This typology of strategies to overcome barriers to recruiting ethnic minorities provides guidance on achieving higher rates of recruitment. It is important that researchers plan to deploy these strategies well in advance of initiating recruitment. Whilst adopting these strategies, the authors have not been able to quantify the positive impact of these strategies on recruitment. The typology should encourage researchers to employ these strategies in future research, refine them further and quantitatively evaluate their impact.

Multiple Intimate Partner Violence Experiences: Knowledge, Access, Utilization and Barriers to Utilization of Resources by Women of the African Diaspora

PubMed Central

Sabri, Bushra; Huerta, Julia; Alexander, Kamila A.; St.Vil, Noelle M.; Campbell, Jacquelyn C.; Callwood, Gloria B.

2016-01-01

Objective This study examined knowledge, access, utilization, and barriers to use of resources among Black women exposed to multiple types of intimate partner violence in Baltimore, Maryland and the U.S. Virgin Islands (USVI). Methods We analyzed quantitative survey data collected by 163 women recruited from primary care, prenatal or family planning clinics in Baltimore and the USVI. In addition we analyzed qualitative data from in-depth interviews with 11 women. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using thematic analysis. Results A substantial proportion of Black women with multiple types of violence experiences lacked knowledge of, did not have access to, and did not use resources. Barriers to resource use were identified at the individual, relationship, and community levels. Conclusion There is need for programs to develop awareness, promote access and utilization of resources, and eliminate barriers to resource use among abused Black women. PMID:26548679

Designed to deter. Community barriers to physical activity for people with visual or motor impairments.

PubMed

Kirchner, Corinne E; Gerber, Elaine G; Smith, Brooke C

2008-04-01

People with disabilities are more likely to be obese, in poor health, and get less physical activity than the general population. However, research on community factors for physical activity has generally either excluded most people with disabilities, or overlooked relevant factors of community accessibility. This exploratory study investigated environmental factors affecting people with motor impairments and people with visual impairments in urban neighborhoods. Quantitative and qualitative methods were used with a nonrandom sample (n=134) of users of four types of assistive mobility technologies: guide dogs, long canes, and motorized and manual wheelchairs. From July 2005 to August 2006, the sample participated in two telephone surveys. Between the surveys, a stratified random subsample (n =32) engaged in an ethnographic phase of observation and interviews. Most participants in all groups using assistive mobility technologies rated their neighborhoods as accessible, although they also reported many specific barriers. Users of assistive mobility technologies differed in the amount of reported physical activity and on specific barriers. Problems with sidewalk pavement and puddles/poor drainage were the most frequently mentioned environmental barriers, by 90% and 80%, respectively. Users of assistive mobility technologies were more similar on main strategies for dealing with barriers. All groups reported having to plan routes for outings, to alter planned routes, to go more slowly than planned, or to wait for a different time. Despite legislative requirements for accommodation, people with disabilities face barriers to physical activity, both in the built and social environments. Determined people with disabilities were able to overcome barriers, but required additional expenditure of resources to do so. Community design that can include people with disabilities requires detailed understanding of barriers specific both to types of impairments and to different types of assistive mobility technologies.

Emerging roles for biomedical librarians: a survey of current practice, challenges, and changes.

PubMed

Crum, Janet A; Cooper, I Diane

2013-10-01

This study is intended to (1) identify emerging roles for biomedical librarians and determine how common these roles are in a variety of library settings, (2) identify barriers to taking on new roles, and (3) determine how librarians are developing the capacity to take on new roles. A survey was conducted of librarians in biomedical settings. Most biomedical librarians are taking on new roles. The most common roles selected by survey respondents include analysis and enhancement of user experiences, support for social media, support for systematic reviews, clinical informationist, help for faculty or staff with authorship issues, and implementation of researcher profiling and collaboration tools. Respondents in academic settings are more likely to report new roles than hospital librarians are, but some new roles are common in both settings. Respondents use a variety of methods to free up time for new roles, but predominant methods vary between directors and librarians and between academic and hospital respondents. Lack of time is the biggest barrier that librarians face when trying to adopt new roles. New roles are associated with increased collaboration with individuals and/or groups outside the library. This survey documents the widespread incorporation of new roles in biomedical libraries in the United States, as well as the barriers to adopting these roles and the means by which librarians are making time for them. The results of the survey can be used to inform strategic planning, succession planning, library education, and career development for biomedical librarians.

Understanding barriers and facilitators to healthy eating and physical activity from patients either before and after knee arthroplasty.

PubMed

Pellegrini, Christine A; Ledford, Gwendolyn; Chang, Rowland W; Cameron, Kenzie A

2017-05-05

We sought to identify patient-reported barriers and facilitators to healthy eating and physical activity among patients before or after knee arthroplasty. Twenty patients with knee osteoarthritis aged 40-79 years who had knee arthroplasty surgery scheduled or completed within 3 months were interviewed. Interview topics included perceived barriers and facilitators to healthy eating and activity before or after surgery. Interviews were coded and analyzed using constant comparative analysis. Interviews were completed with 11 pre-operative (67.1 ± 7.6 years, 45.5% female, BMI 31.2 ± 6.3) and nine post-operative patients (61.7 ± 11.7 years, 44.4% female, BMI 30.2 ± 4.7 kg/m 2 ). The most commonly identified personal barriers to healthy eating identified were desire for high-fat/high-calorie foods, managing overconsumption and mood. Factors related to planning, portion control and motivation to improve health were identified as healthy eating facilitators. Identified personal barriers for activity included pain, physical limitations and lack of motivation, whereas facilitators included having motivation to improve knee symptoms/outcomes, personal commitment to activity and monitoring activity levels. Identifying specific eating and activity barriers and facilitators, such as mood and motivation to improve outcomes, provides critical insight from the patient perspective, which will aid in developing weight management programs during rehabilitation for knee arthroplasty patients. Implications for rehabilitation This study provides insight into the identified barriers and facilitators to healthy eating and physical activity in knee arthroplasty patients, both before and after surgery. Intrapersonal barriers that may hinder engagement in physical activity and rehabilitation include pain, physical limitations and lack of motivation; factors that may help to improve activity and the rehabilitation process include being motivated to improve knee outcomes, having a personal commitment to activity and tracking activity levels. Barriers that may interfere with healthy eating behaviors and knee arthroplasty rehabilitation include the desire for high-fat/high-calorie foods, overeating and mood; whereas planning and portion control may help to facilitate healthy eating. Understanding barriers and facilitators to healthy eating and physical activity can help guide rehabilitation professionals with their discussions on weight management with patients who had or are contemplating knee arthroplasty.

An Inner Barrier to Career Development: Preconditions of the Impostor Phenomenon and Consequences for Career Development

PubMed Central

Neureiter, Mirjam; Traut-Mattausch, Eva

2016-01-01

The impostor phenomenon (IP) is increasingly recognized as an important psychological construct for career development, yet empirical research on how it functions in this domain is sparse. We investigated in what way impostor feelings are related to the fear of failure, fear of success, self-esteem, and the career-development aspects career planning, career striving, and the motivation to lead. We conducted two studies with independent samples of university students (N = 212) in a laboratory study and working professionals (N = 110) in an online study. In both samples, impostor feelings were fostered by fear of failure, fear of success, and low self-esteem and they decreased career planning, career striving, and the motivation to lead. A path analysis showed that impostor feelings had the most negative effects on career planning and career striving in students and on the motivation to lead in working professionals. The results suggest that the IP is relevant to career development in different ways at different career stages. Practical implications and interventions to reduce the negative effects of impostor feelings on career development are discussed. PMID:26869957

An Inner Barrier to Career Development: Preconditions of the Impostor Phenomenon and Consequences for Career Development.

PubMed

Neureiter, Mirjam; Traut-Mattausch, Eva

2016-01-01

The impostor phenomenon (IP) is increasingly recognized as an important psychological construct for career development, yet empirical research on how it functions in this domain is sparse. We investigated in what way impostor feelings are related to the fear of failure, fear of success, self-esteem, and the career-development aspects career planning, career striving, and the motivation to lead. We conducted two studies with independent samples of university students (N = 212) in a laboratory study and working professionals (N = 110) in an online study. In both samples, impostor feelings were fostered by fear of failure, fear of success, and low self-esteem and they decreased career planning, career striving, and the motivation to lead. A path analysis showed that impostor feelings had the most negative effects on career planning and career striving in students and on the motivation to lead in working professionals. The results suggest that the IP is relevant to career development in different ways at different career stages. Practical implications and interventions to reduce the negative effects of impostor feelings on career development are discussed.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fred D. Brent; Lalit Shah; Earl Berry

The overall objective of this project is the three phase development of an Early Entrance Coproduction Plant (EECP) which uses petroleum coke to produce at least one product from at least two of the following three categories: (1) electric power (or heat), (2) fuels, and (3) chemicals using ChevronTexaco's proprietary gasification technology. The objective of Phase I is to determine the feasibility and define the concept for the EECP located at a specific site; develop a Research, Development, and Testing (RD&T) Plan to mitigate technical risks and barriers; and prepare a Preliminary Project Financing Plan. The objective of Phase IImore » is to implement the work as outlined in the Phase I RD&T Plan to enhance the development and commercial acceptance of coproduction technology. The objective of Phase III is to develop an engineering design package and a financing and testing plan for an EECP located at a specific site. The project's intended result is to provide the necessary technical, economic, and environmental information needed by industry to move the EECP forward to detailed design, construction, and operation. The partners in this project are Texaco Energy Systems LLC or TES (a subsidiary of ChevronTexaco), General Electric (GE), Praxair, and Kellogg Brown & Root (KBR) in addition to the U.S. Department of Energy (DOE). TES is providing gasification technology and Fischer-Tropsch (F-T) technology developed by Rentech, GE is providing combustion turbine technology, Praxair is providing air separation technology, and KBR is providing engineering. Each of the EECP subsystems was assessed for technical risks and barriers. A plan was developed to mitigate the identified risks (Phase II RD&T Plan, October 2000). The potential technical and economic risks to the EECP from Task 2.5 can be mitigated by demonstrating that the end-use products derived from the upgrading of the F-T synthesis total liquid product can meet or exceed current specifications for the manufacture of ethylene and propylene chemicals from F-T naphtha, for the generation of hydrogen from F-T naphtha to power fuel cells, for direct blending of F-T diesels into transportation fuels, for the conversion of F-T heavy product wax to transportation fuels, and the conversion of F-T Heavy product wax to a valuable high melting point food-grade specialty wax product. Product evaluations conducted under Task 2.5 of Phase II successfully mitigated the above technical and economic risks to the EECP with the development of product yields and product qualities for the production of chemicals, transportation fuels, and specialty food-grade waxes from the F-T synthesis products.« less

Toward the design and implementation of stem professional development for middle school teachers: An interdisciplinary approach

NASA Astrophysics Data System (ADS)

Neil-Burke, Merah Bell

The aim of this qualitative study was to determine how professional development might be designed to meet the needs of teachers delivering interdisciplinary STEM instruction in an urban middle school. This study was framed and guided by three bodies of literature: literature in support of the theory of change, adult learning theory, and effective STEM professional development. The study, designed to be collaborative in nature, employed an action research variation of participatory classroom action research, (CAR) to find out how STEM professional development could be designed to meet the needs of teachers delivering interdisciplinary STEM instruction. A sample of five middle school teachers from grades six through eight was interviewed using semi-structured, in-depth interview technique to identify their perceived needs. Observational techniques were utilized to determine how STEM teachers' instructional practices change as a result of exposure to STEM professional development for interdisciplinary instruction. Data from these interviews were used to design the professional development. Planning and implementation of the professional development were accomplished using the CAR model with data being collected in all phases of the CAR cycle for teaching interdisciplinary STEM. The findings suggest that interdisciplinary STEM professional development that is collaborative, along with a curriculum that supports the process of discipline integration, is an effective approach to meeting teachers' needs for the teaching of interdisciplinary STEM instruction. Lastly, the findings imply that certain barriers such as limited time to collaborate, plan, reflect, and practice could impede teachers' ability to use an interdisciplinary approach to classroom instructional practices. However, these barriers may become diminished when teachers, support each other through communication and collaboration. Thus, the essential elements included in the design and implementations of this interdisciplinary STEM professional development are the following: time to plan, to practice, to reflect, and to collaborate with other teachers. These findings reveal the need for support from school administration and curriculum writers.

Successful subject recruitment for a prostate cancer behavioral intervention trial.

PubMed

Heiney, Sue P; Arp Adams, Swann; Drake, Bettina F; Bryant, Lisa H; Bridges, Lynne; Hebert, James R

2010-08-01

Inadequate participant recruitment, which may lead to unrepresentative study samples that threaten a study's validity, is often a major challenge in the conduct of research studies. The purpose of this article is to describe the development and implementation of a recruitment plan and evaluate the different recruitment strategies for a prostate cancer behavioral intervention trial. Our recruitment plan was based on a framework (The Heiney-Adams Recruitment Model) that we developed, which combines relationship building and social marketing. We evaluated the success of our model using several different recruitment sources including: mailed letters, physician referral, and self-referral. Recruitment rates ranged from 67% for a support services department mailing to 100% for physician referral. While our original list of contacted patients was comprised of only 13% African American (AA) men, 22% of our recruited participants were AA. One of the strongest barriers to recruitment was strict patient eligibility. Another significant barrier was the lack of electronic records systems to allow for the identification of large numbers of potential participants. In conclusion, our model incorporating social marketing and relationship building was quite successful in recruiting for a prostate cancer behavioral study, particularly AA participants. In developing strategies, future researchers should attend to issues of staffing, financial resources, physician support, and eligibility criteria in the light of study accrual.

Using Geographical Information Systems (GIS) as an instrument of water resource management: a case study from a GIS-based Water Safety Plan in Germany.

PubMed

Wienand, I; Nolting, U; Kistemann, T

2009-01-01

Following international developments and the new WHO Drinking Water Guidelines (WHO 2004) a process-orientated concept for risk, monitoring and incident management has been developed and implemented in this study. The concept will be reviewed with special consideration for resource protection (first barrier of the multi-barrier system) and in turn, for the Water Safety Plan (WSP) which adequately considers-beyond the current framework of legal requirements-possible new hygienic-microbiologically relevant risks (especially emerging pathogens) for the drinking water supply. The development of a WSP within the framework of risk, monitoring and incident management includes the application of Geographical Information Systems (GIS). In the present study, GIS was used for visualization and spatial analysis in decisive steps in the WSP. The detailed process of GIS-supported implementation included the identification of local participants and their tasks and interactions as an essential part of risk management. A detailed ecological investigation of drinking water conditions in the catchment area was conducted in addition to hazard identification, risk assessment and the monitoring of control measures. The main task of our study was to find out in which steps of the WSP the implementation of GIS could be integrated as a useful, and perhaps even an essential tool.

Physical activity programming in family child care homes: providers' perceptions of practices and barriers.

PubMed

Fees, Bronwyn; Trost, Stewart; Bopp, Melissa; Dzewaltowski, David A

2009-01-01

To examine family child care home (FCCH) providers' perceptions of appropriate physical activity (PA), current practices, and perceived barriers to inclusion of PA within their programs. A trained facilitator lead 4 focus group sessions of FCCH providers. Questions addressed providers' planning for PA, resources and barriers, and perceptions of children's engagement. Family child care homes. 32 FCCH providers (100% female) caring for children 6 weeks to 5 years old in predominantly mixed-age programs. Types of and extent to which PA was offered for children and perceived barriers to PA in this setting. Authors coded and analyzed transcriptions based on a socioecological framework using qualitative data analysis software. Majority of providers reported running and dancing to music as the most common PA, generally in an unstructured context. Frequency varied from none to twice a day. Few providers reported planning intentionally for PA; any plans followed children's interests. Barriers to inclusion of PA included personal, programming, parent, environmental, and financial reasons. Providers requested training on PA, particularly ideas for experiences in mixed-age groups. Type, frequency, consistency, and duration of PA among FCCH homes vary widely. Implications include training on PA and resources tailored to the unique characteristics of family child care homes.

Opportunities and barriers to cardiopulmonary resuscitation training in English secondary schools.

PubMed

Lockey, Andrew S; Barton, Katherine; Yoxall, Heather

2016-10-01

Cardiopulmonary resuscitation rates and survival from out-of-hospital cardiac arrest are poor in the UK compared with areas abroad that deliver mandatory training to all school children. We sought to identify barriers to training and develop a strategy to enable delivery of this training. Qualitative analysis, comprising semistructured interviews and group discussions, covering 14 schools in the metropolitan borough of Calderdale in West Yorkshire. Only three schools out of 14 were delivering training to entire year groups. Barriers include lack of resources, lack of training for teachers and difficulty in initiating a programme. Strategies were developed to overcome these barriers with the result that four additional schools are now teaching a whole year group. There is no single solution and bespoke plans may be needed for each school. The establishment of cardiopulmonary resuscitation training in secondary schools in the UK is achievable. The commonly perceived barriers to establishment of training are all surmountable, but solving them does not necessarily ensure universal coverage. Support from healthcare professionals, in particular public health, is essential to ensure that the training is as widespread as possible. Mandatory inclusion of this training on the school curriculum, as seen in other countries, would result in significantly improved survival rates from out-of-hospital cardiorespiratory arrest. Solutions to improve training have been proposed, which could be used in other parts of Europe where such training is not a mandatory requirement.

GIS-Based Noise Simulation Open Source Software: N-GNOIS

NASA Astrophysics Data System (ADS)

Vijay, Ritesh; Sharma, A.; Kumar, M.; Shende, V.; Chakrabarti, T.; Gupta, Rajesh

2015-12-01

Geographical information system (GIS)-based noise simulation software (N-GNOIS) has been developed to simulate the noise scenario due to point and mobile sources considering the impact of geographical features and meteorological parameters. These have been addressed in the software through attenuation modules of atmosphere, vegetation and barrier. N-GNOIS is a user friendly, platform-independent and open geospatial consortia (OGC) compliant software. It has been developed using open source technology (QGIS) and open source language (Python). N-GNOIS has unique features like cumulative impact of point and mobile sources, building structure and honking due to traffic. Honking is the most common phenomenon in developing countries and is frequently observed on any type of roads. N-GNOIS also helps in designing physical barrier and vegetation cover to check the propagation of noise and acts as a decision making tool for planning and management of noise component in environmental impact assessment (EIA) studies.

Community and health systems barriers and enablers to family planning and contraceptive services provision and use in Kabwe District, Zambia.

PubMed

Silumbwe, Adam; Nkole, Theresa; Munakampe, Margarate Nzala; Milford, Cecilia; Cordero, Joanna Paula; Kriel, Yolandie; Zulu, Joseph Mumba; Steyn, Petrus S

2018-05-31

Unmet need for contraception results in several health challenges such as unintended pregnancies, unwanted births and unsafe abortions. Most interventions have been unable to successfully address this unmet need due to various community and health system level factors. Identifying these inhibiting and enabling factors prior to implementation of interventions forms the basis for planning efforts to increase met needs. This qualitative study was part of the formative phase of a larger research project that aimed to develop an intervention to increase met needs for contraception through community and health system participation. The specific study component reported here explores barriers and enablers to family planning and contraceptive services provision and utilisation at community and health systems levels. Twelve focus group discussions were conducted with community members (n = 114) and two with healthcare providers (n = 19). Ten in-depth interviews were held with key stakeholders. The study was conducted in Kabwe district, Zambia. Interviews/discussions were translated and transcribed verbatim. Data were coded and organised using NVivo 10 (QSR international), and were analysed using thematic analysis. Health systems barriers include long distances to healthcare facilities, stock-outs of preferred methods, lack of policies facilitating contraceptive provision in schools, and undesirable provider attitudes. Community level barriers comprise women's experience with contraceptive side effects, myths, rumours and misconceptions, societal stigma, and negative traditional and religious beliefs. On the other hand, health systems enablers consist of political will from government to expand contraceptive services access, integration of contraceptive services, provision of couples counselling, and availability of personnel to offer basic methods mix. Functional community health system structures, community desire to delay pregnancy, and knowledge of contraceptive services are enablers at a community level. These study findings highlight key community and health systems factors that should be considered by policy, program planners and implementers in the design and implementation of family planning and contraceptive services programmes, to ensure sustained uptake and increased met needs for contraceptive methods and services.

Limit Our Horizons in the Land of Enchantment? The Challenge for Education.

ERIC Educational Resources Information Center

Thomas, Gerald W.

This paper examines the trends in participation in higher education for New Mexico. Statistical data indicated that only 39 percent of the high school graduates in 1973 planned to enter college after graduation. Barriers to advanced education and training are discussed including intellectual barriers, financial barriers, and environmental and…

Testing the relationship between personality characteristics, contextual factors and entrepreneurial intentions in a developing country.

PubMed

Karimi, Saeid; Biemans, Harm J A; Naderi Mahdei, Karim; Lans, Thomas; Chizari, Mohammad; Mulder, Martin

2017-06-01

Drawing upon the theory of planned behaviour (TPB), we developed and tested a conceptual model which integrates both internal personality factors and external contextual factors to determine their associations with motivational factors and entrepreneurial intentions (EIs). We then investigated if the model of EI applies in a developing country, namely Iran. We also set out to identify the most relevant factors for EI within this developing country context. Do distal predictors of EI including personality factors (i.e. need for achievement, risk taking and locus of control) and contextual factors (i.e. perceived barriers and support) significantly relate to EI via proximal predictors including motivational factors (i.e. attitudes towards entrepreneurship and perceived behavioural control [PBC])? Data were collected on 331 students from 7 public universities. The findings support the TPB for EI in Iran. All three motivational factors related to EI, but PBC showed the strongest association, which is different than in developed country contexts. Possible explanations for these differences are discussed. All three personality characteristics indirectly related to EI via the proximal attitudes towards entrepreneurship and PBC. Perceived contextual support and barriers indirectly related to EI via proximal PBC while perceived barriers also directly related to EI. © 2015 International Union of Psychological Science.

Development of an implementation plan for the 6-PACK falls prevention programme as part of a randomised controlled trial: protocol for a series of preimplementation studies.

PubMed

Barker, Anna L; Morello, Renata T; Ayton, Darshini R; Hill, Keith D; Landgren, Fiona S; Brand, Caroline A

2016-12-01

Inhospital falls cause morbidity, staff burden and increased healthcare costs. It is unclear if the persistent problem of inhospital falls is due to the use of ineffective interventions or their suboptimal implementation. The 6-PACK programme appears to reduce fall injuries and a randomised controlled trial (RCT) was undertaken to confirm effects. This paper describes the protocol for the preimplementation studies that aimed to identify moderators of the effective use of the 6-PACK programme to inform the development of an implementation plan to be applied in the RCT. The 6-PACK project included five preimplementation studies: (1) a profile of safety climate; (2) review of current falls prevention practice; (3) epidemiology of inhospital falls; (4) acceptability of the 6-PACK programme; and (5) barriers and enablers to implementation of the 6-PACK programme. The Theoretical Domain Framework that includes 12 behaviour change domains informed the design of these studies that involved 540 staff and 8877 patients from 24 wards from six Australian hospitals. Qualitative and quantitative methods were applied with data collected via: structured bedside observation; daily nurse unit manager verbal report of falls; audit of medical records, incident reporting and hospital administrative data; surveys of ward nurses; focus groups with ward nurses; and key informant interviews with senior staff. Information on contextual, system, intervention, patient and provider level factors is critical to the development of an implementation plan. Information gained from these studies was used to develop a plan applied in the RCT that addressed the barriers and harnessed enablers. The RCT is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000332921. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Anticipated Barriers to Open Schooling System in Nigeria

ERIC Educational Resources Information Center

Wushishi, Aminu Aliyu

2014-01-01

In an attempt to develop plans for making Education for All a reality, four agencies of the United Nations brought together over 150 governments in 1990 to Jomtien, Thailand, and also in 2000 in Dakar, Senegal, with the aim of making education equally accessible to all. Nigeria is one of the countries that signed the Jomtien declaration in 1990,…

Overcoming the Language Barrier. Third European Congress on Information Systems and Networks, Vol. 1.

ERIC Educational Resources Information Center

Commission des Communautes Europeennes (Luxembourg).

The papers presented here have a double objective: to give those responsible for the Action plan for the improvement of information transfer between European languages a good view of existing and developing systems and to make future users of EURONET acquainted with methods and tools that will soon be available. The papers are arranged under six…

Federal Aviation Administration Plan for Research, Engineering & Development, 1998.

DTIC Science & Technology

1998-02-01

release rate. • Improved fracture toughness of non-combustible geopolymer composite fire barriers to enable use as interior and secondary composites ...Fire Resistant, Non-Toxic Interior Panels for Evaluation of Heat Release Rate ♦ Improved Fracture Toughness of Non-Combustible Geopolymer Composite ... composites , atmospheric hazards, crash worthiness, fire safety, and forensics capabilities to support accident investigations. Aviation Security R,E&D

Prediction of attendance at fitness center: a comparison between the theory of planned behavior, the social cognitive theory, and the physical activity maintenance theory

PubMed Central

Jekauc, Darko; Völkle, Manuel; Wagner, Matthias O.; Mess, Filip; Reiner, Miriam; Renner, Britta

2015-01-01

In the processes of physical activity (PA) maintenance specific predictors are effective, which differ from other stages of PA development. Recently, Physical Activity Maintenance Theory (PAMT) was specifically developed for prediction of PA maintenance. The aim of the present study was to evaluate the predictability of the future behavior by the PAMT and compare it with the Theory of Planned Behavior (TPB) and Social Cognitive Theory (SCT). Participation rate in a fitness center was observed for 101 college students (53 female) aged between 19 and 32 years (M = 23.6; SD = 2.9) over 20 weeks using a magnetic card. In order to predict the pattern of participation TPB, SCT and PAMT were used. A latent class zero-inflated Poisson growth curve analysis identified two participation patterns: regular attenders and intermittent exercisers. SCT showed the highest predictive power followed by PAMT and TPB. Impeding aspects as life stress and barriers were the strongest predictors suggesting that overcoming barriers might be an important aspect for working out on a regular basis. Self-efficacy, perceived behavioral control, and social support could also significantly differentiate between the participation patterns. PMID:25717313

From Standards to Standard Practice: A Critical Look at the Perceptions and Process of Integrating the Next Generation Science Standards in the Nation's Schools

NASA Astrophysics Data System (ADS)

Mercadante, Katie Lynn

The Next Generation Science Standards (NGSS) are the culmination of reform efforts spanning more than three decades and are the first major reform movement in science education since Sputnik. When implementing these new standards, teachers are faced with many barriers. NGSS requires critical thinking, cross-curricular learning, and key changes in teaching, learning, and assessment. Implementation nationwide has been slow, due to sweeping changes, and controversial content within the standards. Resistance to implementation occurs in nearly all levels for these reasons. The purpose of this descriptive study was to determine the perceptions of in-service teachers of the NGSS Framework, to identify barriers that inhibit implementation, and to identify commonalities among teachers who have successfully implemented the Framework, as well as assist others who may do the same in the future. Teachers from public, private, and charter schools from across the United States participated in the study. Based upon teacher response, a three-stage action plan and series of necessary recommendations were developed to assist teachers and administrators in K-12 schools to develop plans to implement the NGSS.

Assessing knowledge and application of emergency risk communication principles among public health workers in China.

PubMed

Cope, James R; Frost, Melinda; Richun, Li; Xie, Ruiqian

2014-06-01

Since 2003, the Chinese National Health and Family Planning Commission (formerly the Ministry of Health) has implemented changes to more effectively communicate risk during public health emergencies. In spite of ongoing improvements, provincial and sub-provincial leaders face barriers, such as established modes of operation, lack of training, shortage of trained risk communicators, and limited understanding and willingness of recipients to mitigate risks. We assessed the current status of and barriers to risk communication knowledge and practice among public health practitioners in China. We designed the survey questionnaire to capture information related to the risk communication core capacities required by international health regulations and common risk communication principles. Our findings showed that risk communication training has successfully developed an awareness of risk communication principles and the ability to implement those principles in practice in China. Future efforts should focus on areas such as a dedicated risk communication workforce, requirements that public health agencies develop a risk communication plan, and additional training for public health practitioners and their partners. It is critical that the infectious diseases prevention and control law be amended to grant provincial and local public health agencies more autonomy to release information.

Willingness to participate in accountable care organizations: health care managers' perspective.

PubMed

Wan, Thomas T H; Demachkie Masri, Maysoun; Ortiz, Judith; Lin, Blossom Y J

2014-01-01

This study examines how health care managers responded to the accountable care organization (ACO). The effect of perceived benefits and barriers of the commitment to develop a strategic plan for ACOs and willingness to participate in ACOs is analyzed, using organizational social capital, health information technology uses, health systems integration and size of the health networks, geographic factors, and knowledge about ACOs as predictors. Propensity score matching and analysis are used to adjust the state and regional variations. When the number of perceived benefits is greater than the number of perceived barriers, health care managers are more likely to reveal a stronger commitment to develop a strategic plan for ACO adoption. Health care managers who perceived their organizations as lacking leadership support or commitment, financial incentives, and legal and regulatory support to ACO adoption were less willing to participate in ACOs in the future. Future research should gather more diverse views from a larger sample size of health professionals regarding ACO participation. The perspective of health care managers should be seriously considered in the adoption of an innovative health care delivery system. The transparency on policy formulation should consider multiple views of health care managers.

AACR-FDA-NCI Cancer Biomarkers Collaborative consensus report: advancing the use of biomarkers in cancer drug development.

PubMed

Khleif, Samir N; Doroshow, James H; Hait, William N

2010-07-01

Recent discoveries in cancer biology have greatly increased our understanding of cancer at the molecular and cellular level, but translating this knowledge into safe and effective therapies for cancer patients has proved to be challenging. There is a growing imperative to modernize the drug development process by incorporating new techniques that can predict the safety and effectiveness of new drugs faster, with more certainty, and at lower cost. Biomarkers are central to accelerating the identification and adoption of new therapies, but currently, many barriers impede their use in drug development and clinical practice. In 2007, the AACR-FDA-NCI Cancer Biomarkers Collaborative stepped into the national effort to bring together disparate stakeholders to clearly delineate these barriers, to develop recommendations for integrating biomarkers into the cancer drug development enterprise, and to set in motion the necessary action plans and collaborations to see the promise of biomarkers come to fruition, efficiently delivering quality cancer care to patients.

Physicians' Views on Advance Care Planning and End-of-Life Care Conversations.

PubMed

Fulmer, Terry; Escobedo, Marcus; Berman, Amy; Koren, Mary Jane; Hernández, Sandra; Hult, Angela

2018-05-23

To evaluate physicians' views on advance care planning, goals of care, and end-of-life conversations. Random sample telephone survey. United States. Physicians (primary care specialists; pulmonology, cardiology, oncology subspecialists) actively practicing medicine and regularly seeing patients aged 65 and older (N=736; 81% male, 75% white, 66% aged ≥50. A 37-item telephone survey constructed by a professional polling group with national expert oversight measured attitudes and perceptions of barriers and facilitators to advance care planning. Summative data are presented here. Ninety-nine percent of participants agreed that it is important to have end-of-life conversations, yet only 29% reported that they have formal training for such conversations. Those most likely to have training included younger physicians and those caring for a racially and ethnically diverse population. Patient values and preferences were the strongest motivating factors in having advance care planning conversations, with 92% of participants rating it extremely important. Ninety-five percent of participants reported that they supported a new Medicare fee-for-service benefit reimbursing advance care planning. The biggest barrier mentioned was time availability. Other barriers included not wanting a patient to give up hope and feeling uncomfortable. With more than half of physicians reporting that they feel educationally unprepared, there medical school curricula need to be strengthened to ensure readiness for end-of-life conversations. Clinician barriers need to be addressed to meet the needs of older adults and families. Policies that focus on payment for quality should be evaluated at regular intervals to monitor their effect on advance care planning. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Enablers and barriers in delivery of a cancer exercise program: the Canadian experience

PubMed Central

Mina, D. Santa; Petrella, A.; Currie, K.L.; Bietola, K.; Alibhai, S.M.H.; Trachtenberg, J.; Ritvo, P.; Matthew, A.G.

2015-01-01

Background Exercise is an important therapy to improve well-being after a cancer diagnosis. Accordingly, cancer-exercise programs have been developed to enhance clinical care; however, few programs exist in Canada. Expansion of cancer-exercise programming depends on an understanding of the process of program implementation, as well as enablers and barriers to program success. Gaining knowledge from current professionals in cancer-exercise programs could serve to facilitate the necessary understanding. Methods Key personnel from Canadian cancer-exercise programs (n = 14) participated in semistructured interviews about program development and delivery. Results Content analysis revealed 13 categories and 15 subcategories, which were grouped by three organizing domains: Program Implementation, Program Enablers, and Program Barriers. ■ Program Implementation (5 categories, 8 subcategories) included Program Initiation (clinical care extension, research project expansion, program champion), Funding, Participant Intake (avenues of awareness, health and safety assessment), Active Programming (monitoring patient exercise progress, health care practitioner involvement, program composition), and Discharge and Follow-up Plan.■ Program Enablers (4 categories, 4 subcategories) included Patient Participation (personalized care, supportive network, personal control, awareness of benefits), Partnerships, Advocacy and Support, and Program Characteristics.■ Program Barriers (4 categories, 3 subcategories) included Lack of Funding, Lack of Physician Support, Deterrents to Participation (fear and shame, program location, competing interests), and Disease Progression and Treatment. Conclusions Interview results provided insight into the development and delivery of cancer-exercise programs in Canada and could be used to guide future program development and expansion in Canada. PMID:26715869

Role of health insurance in financing vaccinations for children and adolescents in the United States.

PubMed

Shen, Angela K; Hunsaker, John; Gazmararian, Julie A; Lindley, Megan C; Birkhead, Guthrie S

2009-12-01

The goal was to elicit perspectives of selected health insurance plan medical or quality improvement directors regarding factors related to coverage and reimbursement and perceptions of financing as a barrier to child and adolescent immunization. Medical or quality improvement directors from 20 plans selected by America's Health Insurance Plans were invited to complete an online survey in July 2007. Respondents who agreed to follow-up interviews were invited to participate in telephone interviews conducted by Centers for Disease Control and Prevention staff members in August 2007. Fifteen plans (representing >67 million enrollees) responded to the online survey. All respondents covered all Advisory Committee on Immunization Practices-recommended child and adolescent vaccines in all or most products. Advisory Committee on Immunization Practices recommendations were the most commonly cited criteria for coverage decisions (86.7%) and coverage modifications (100%). Factors affecting reimbursement that were cited most often were manufacturer's vaccine price (80%) and physician feedback (53.3%). In follow-up interviews with 10 self-selected respondents, manufacturer's price (7 of 10 plans) and physician feedback (4 of 10 plans) were identified as the most-important factors affecting reimbursement. Respondents said that reimbursement delays were most commonly attributable to providers' claim submission errors or patient ineligibility. Some respondents thought that vaccine financing was a barrier (4 of 10 plans) or somewhat a barrier (2 of 10 plans) to providing immunizations; others (4 of 10 plans) did not. Although these data suggest that health insurance coverage for recommended vaccines is high, coverage is not universal across all products offered.

Effects of hydrologic modifications on salinity and formation of hypoxia in the Mississippi River-Gulf Outlet and adjacent waterways, southeastern Louisiana, 2008 to 2012

USGS Publications Warehouse

Swarzenski, Christopher M.; Mize, Scott V.

2014-01-01

The Mississippi River-Gulf Outlet (MRGO) was constructed between 1958 and 1968 to provide a safer and shorter route between the Gulf of Mexico and the Port of New Orleans for ocean-going vessels. In 2006, the U.S. Congress directed the U.S. Army Corps of Engineers (USACE) to develop and implement a plan to deauthorize a portion of the MRGO ship channel from its confluence with the Gulf Intracoastal Waterway to the Gulf of Mexico. In 2009, in accordance with plans submitted to Congress, the USACE built a rock barrier across the MRGO near Hopedale, Louisiana. Following Hurricane Katrina, Congress also authorized the USACE to implement the Hurricane Storm Damage Risk Reduction System (HSDRRS) by building structures in the MRGO and adjacent surface waters, to reduce vulnerability of this area to storm surge. The HSDRRS includes the Gulf Intracoastal Waterway-Lake Borgne Surge Barrier and Gate Complex near mile 58 of the deauthorized portion of the MRGO and the Seabrook Gate Complex on the Inner Harbor Navigation Canal (IHNC). By blocking or limiting tidal exchange in the MRGO, these barriers could affect water quality in the MRGO and nearby waters including Lake Pontchartrain, the IHNC, and Lake Borgne. In 2008, the U.S. Geological Survey, in cooperation with the USACE, began a study to document the effects of the construction activities on salinity and dissolved oxygen in these surface waters. Data were collected from August 2008 through October 2012. Completion of the rock barrier in the vicinity of mile 35 in July 2009 reduced hydrologic circulation and separated the MRGO into two distinct salinity regimes, with substantially fresher conditions prevailing upstream from the rock barrier. The rock barrier also contributed to a zone of hypoxia (dissolved oxygen less than 2 milligrams per liter) that formed along the channel bottom during the warmer summer months in each year of this monitoring; the zone was much more developed downstream from the rock barrier. The most extensive hypoxic zone was measured in October 2009 when it extended at least 34 miles in the MRGO, from mile 20 to mile 54. Construction of the surge barrier and flood gates did not affect salinity or dissolved oxygen in any comparable manner. The factors that contributed the most to hypoxia in the MRGO were the reductions in tidal water movement there after completion of the rock barrier combined with the channel depth in the MRGO, in places 10 to 30 feet deeper than surrounding surface water bodies. These factors helped to stratify salinity by reducing vertical mixing in the water column.

Healthy eating for rural low-income toddlers: caregivers' perceptions.

PubMed

Omar, M A; Coleman, G; Hoerr, S

2001-01-01

Caregivers exert a powerful influence on young children's eating habits. This qualitative study used focus groups to assess nutritional needs and barriers in establishing healthy eating habits in toddlers. Three focus groups were conducted with rural, low-income caregivers, 2 with men and 1 with women, in 3 rural Michigan counties. Four major themes emerged: (a) barriers to providing healthy meals, (b) division of responsibility, (c) mealtime behavior, and (d) desired nutrition education. The major barriers identified were work schedules; cost of food; inadequate time to shop, plan, and prepare nutritious meals; or a combination thereof. Caregivers expressed concern for the nutritional well-being of their toddlers. The perceived needs and perceptions of low-income caregivers need to be considered when providing nutrition education. Findings from this study provided the basis for developing a nutrition education intervention for low-income parents of young children.

LANDSAT application of remote sensing to shoreline-form analysis. [Cape Hatteras, Cape Lookout, and Assateague Island

NASA Technical Reports Server (NTRS)

Dolan, R.; Hayden, B.; Heywood, J. (Principal Investigator)

1978-01-01

The author has identified the following significant results. Using Assateague Island, Cape Hatteras, and Cape Lookout, significantly high correlations were found for most of the six barrier island sections that were examined. Relationships were not consistent from island to island. It was concluded that coastal vulnerability to storm damage can not be assessed based on coastal orientation alone. When orientation data were combined with erosion data for individual barrier islands, the relationship could be used as a basis for barrier island classification. A method was developed to obtain large amounts of historical data on surface coastal process from aerial photography, which was called the orthogonal grid address system. Data on shoreline change and overwash penetration gathered on over 400 km of the mid-Atlantic coast, are being used by various federal and state agencies for planning purposes.

Addressing policy barriers to paternal involvement during pregnancy.

PubMed

Alio, Amina P; Bond, M Jermane; Padilla, Yolanda C; Heidelbaugh, Joel J; Lu, Michael; Parker, Willie J

2011-05-01

Efforts to reduce infant mortality in the United States have failed to incorporate paternal involvement. Research suggests that paternal involvement, which has been recognized as contributing to child development and health for many decades, is likely to affect infant mortality through the mother's well-being, primarily her access to resources and support. In spite of that, systemic barriers facing the father and the influence on his involvement in the pregnancy have received little attention. The Commission on Paternal Involvement in Pregnancy Outcomes (CPIPO) has identified the most important social barriers to paternal involvement during pregnancy and outlined a set of key policy priorities aimed at fostering paternal involvement. This article summarizes the key recommendations, including equitable paternity leave, elimination of marriage as a tax and public assistance penalty, integration of fatherhood initiatives in MCH programs, support of low-income fathers through employment training, father inclusion in family planning services, and expansion of birth data collection to include father information.

High value of ecological information for river connectivity restoration

USGS Publications Warehouse

Sethi, Suresh; O'Hanley, Jesse R.; Gerken, Jonathon; Ashline, Joshua; Bradley, Catherine

2017-01-01

ContextEfficient restoration of longitudinal river connectivity relies on barrier mitigation prioritization tools that incorporate stream network spatial structure to maximize ecological benefits given limited resources. Typically, ecological benefits of barrier mitigation are measured using proxies such as the amount of accessible riverine habitat.ObjectivesWe developed an optimization approach for barrier mitigation planning which directly incorporates the ecology of managed taxa, and applied it to an urbanizing salmon-bearing watershed in Alaska.MethodsA novel river connectivity metric that exploits information on the distribution and movement of managed taxon was embedded into a barrier prioritization framework to identify optimal mitigation actions given limited restoration budgets. The value of ecological information on managed taxa was estimated by comparing costs to achieve restoration targets across alternative barrier prioritization approaches.ResultsBarrier mitigation solutions informed by life history information outperformed those using only river connectivity proxies, demonstrating high value of ecological information for watershed restoration. In our study area, information on salmon ecology was typically valued at 0.8–1.2 M USD in costs savings to achieve a given benefit level relative to solutions derived only from stream network information, equating to 16–28% of the restoration budget.ConclusionsInvesting in ecological studies may achieve win–win outcomes of improved understanding of aquatic ecology and greater watershed restoration efficiency.

Pancreatic cancer survivors’ preferences, barriers, and facilitators related to physical activity and diet interventions

PubMed Central

Arthur, Anna E.; Delk, Ashley; Demark-Wahnefried, Wendy; Christein, Johnf D.; Contreras, Carlo; Posey, James A.; Vickers, Selwyn; Oster, Robert; Rogers, Laura Q.

2016-01-01

Purpose To conduct a telephone survey establishing pancreatic cancer survivors’ level of interest in, preferences for and perceived barriers and facilitators to participating in exercise and diet intervention programming. These data will inform the development of such interventions for newly-diagnosed patients. Methods Seventy-one survivors treated for resectable pancreatic adenocarcinoma from October 2011 – August 2014 were identified through an institutional cancer registry and contacted via telephone. A telephone survey was conducted to query survivors’ level of interest in, preferences for, and perceived barriers and facilitators to participating in an exercise and dietary intervention program shortly after disease diagnosis. Acceptability of a technology-based visual communication (e.g. Skype™, FaceTime®) intervention was also assessed. Results Fifty participants completed the survey (response rate 71.8%). Over two-thirds of participants reported interest in exercise and diet intervention programming. Over half reported comfort with a technology-delivered visual communication intervention. Barriers to participation included older age and physical, personal and emotional problems. The most common facilitator was program awareness. Outcomes for future research important to participants were supportive care and quality of life. Conclusions Most pancreatic cancer patients are interested in exercise and diet interventions shortly after diagnosis; however, some barriers to program participation exist. Implications for Cancer Survivors Future research and intervention planning for pancreatic cancer survivors should focus on developing messaging and strategies that provide support for survivorship outcomes, increase survivor awareness, address lack of familiarity with technology, reduce fears about potential barriers and help survivors overcome these barriers. In so doing, survivorship needs can be better met and quality of life improved in this understudied population. PMID:27138993

Breaking Barriers, Building Bridges: Critical Discussion of Social Issues.

ERIC Educational Resources Information Center

Moss, Joy

Noting that picture books can invite students to engage in critical discussion of complex issues of race, class, and gender, this lesson plan helps students to confront the injustice of barriers that separate human beings from one another and to examine the role of prejudice and stereotypes in sustaining these barriers. During the five 45-minute…

A Meta-Analysis of Urban Climate Change Adaptation ...

EPA Pesticide Factsheets

The concentration of people, infrastructure, and ecosystem services in urban areas make them prime sites for climate change adaptation. While advances have been made in developing frameworks for adaptation planning and identifying both real and potential barriers to action, empirical work evaluating urban adaptation planning processes has been relatively piecemeal. Existing assessments of current experience with urban adaptation provide necessarily broad generalizations based on the available peer-reviewed literature. This paper uses a meta-analysis of U.S. cities’ current experience with urban adaptation planning drawing from 54 sources that include peer-reviewed literature, government reports, white papers, and reports published by non-governmental organizations. The analysis specifically evaluates the institutional support structures being developed for urban climate change adaptation. The results demonstrate that adaptation planning is driven by a desire to reduce vulnerability and often catalyzes new collaborations and coordination mechanisms in urban governance. As a result, building capacity for urban climate change adaptation planning requires a focus not only on city governments themselves but also on the complex horizontal and vertical networks that have arisen around such efforts. Existing adaptation planning often lacks attention to equity issues, social vulnerability, and the influence of non-climatic factors on vulnerability. Engaging city govern

Government chief nursing officers' perceptions of barriers to using research on staffing.

PubMed

Baernholdt, M; Lang, N M

2007-03-01

Current global healthcare problems include nursing shortages contributing to low nurse staffing. Low nurse staffing is associated with poor patient and nurse outcomes, but research utilization using these findings especially at the policy level remains slow. To assess high-ranking government nurses' perceptions of barriers to using research on nurse staffing. An electronic information message about the impact of nurse staffing was presented to government chief nursing officers (CNOs) from 110 countries. The CNOs' perceptions of local barriers to utilizing these research findings were then assessed in an electronic survey. The four factors that influence the first two stages of Rogers's five-stage model of diffusion were examined. The factors, characteristics of the adopter, organization, innovation and communication, were measured using an adapted version of the BARRIERS scale. Barriers were present in all four characteristics. The top barrier was lack of reports and studies in one place. Other barriers were lack of cooperation within the organization and lack of awareness of the research findings. Differences according to Gross National Income were also noted. The CNOs and other health policy advisors can use the findings in planning for adequate nurse staffing. Development of electronic newsletters with summaries of pertinent research for CNOs and other policy advisors is needed. Future studies on nurse staffing are warranted. They should focus on other settings and how best to share research findings with policymakers.

Cautious but committed: moving toward adaptive planning and operation strategies for renewable energy's wildlife implications.

PubMed

Köppel, Johann; Dahmen, Marie; Helfrich, Jennifer; Schuster, Eva; Bulling, Lea

2014-10-01

Wildlife planning for renewable energy must cope with the uncertainties of potential wildlife impacts. Unfortunately, the environmental policies which instigate renewable energy and those which protect wildlife are not coherently aligned-creating a green versus green dilemma. Thus, climate mitigation efforts trigger renewable energy development, but then face substantial barriers from biodiversity protection instruments and practices. This article briefly reviews wind energy and wildlife interactions, highlighting the lively debated effects on bats. Today, planning and siting of renewable energy are guided by the precautionary principle in an attempt to carefully address wildlife challenges. However, this planning attitude creates limitations as it struggles to negotiate the aforementioned green versus green dilemma. More adaptive planning and management strategies and practices hold the potential to reconcile these discrepancies to some degree. This adaptive approach is discussed using facets of case studies from policy, planning, siting, and operational stages of wind energy in Germany and the United States, with one case showing adaptive planning in action for solar energy as well. This article attempts to highlight the benefits of more adaptive approaches as well as the possible shortcomings, such as reduced planning security for renewable energy developers. In conclusion, these studies show that adaptive planning and operation strategies can be designed to supplement and enhance the precautionary principle in wildlife planning for green energy.

Cautious but Committed: Moving Toward Adaptive Planning and Operation Strategies for Renewable Energy's Wildlife Implications

NASA Astrophysics Data System (ADS)

Köppel, Johann; Dahmen, Marie; Helfrich, Jennifer; Schuster, Eva; Bulling, Lea

2014-10-01

Wildlife planning for renewable energy must cope with the uncertainties of potential wildlife impacts. Unfortunately, the environmental policies which instigate renewable energy and those which protect wildlife are not coherently aligned—creating a green versus green dilemma. Thus, climate mitigation efforts trigger renewable energy development, but then face substantial barriers from biodiversity protection instruments and practices. This article briefly reviews wind energy and wildlife interactions, highlighting the lively debated effects on bats. Today, planning and siting of renewable energy are guided by the precautionary principle in an attempt to carefully address wildlife challenges. However, this planning attitude creates limitations as it struggles to negotiate the aforementioned green versus green dilemma. More adaptive planning and management strategies and practices hold the potential to reconcile these discrepancies to some degree. This adaptive approach is discussed using facets of case studies from policy, planning, siting, and operational stages of wind energy in Germany and the United States, with one case showing adaptive planning in action for solar energy as well. This article attempts to highlight the benefits of more adaptive approaches as well as the possible shortcomings, such as reduced planning security for renewable energy developers. In conclusion, these studies show that adaptive planning and operation strategies can be designed to supplement and enhance the precautionary principle in wildlife planning for green energy.

Demand and access to mental health services: a qualitative formative study in Nepal

PubMed Central

2014-01-01

Background Nepal is experiencing a significant ‘treatment gap’ in mental health care. People with mental disorders do not always receive appropriate treatment due to a range of structural and individual issues, including stigma and poverty. The PRIME (Programme for Improving Mental Health Care) programme has developed a mental health care plan to address this issue in Nepal and four other low and middle income countries. This study aims to inform the development of this comprehensive care plan by investigating the perceptions of stakeholders at different levels of the care system in the district of Chitwan in southern Nepal: health professionals, lay workers and community members. It focuses specifically on issues of demand and access to care, and aims to identify barriers and potential solutions for reaching people with priority mental disorders. Methods This qualitative study consisted of key informant interviews (33) and focus group discussions (83 participants in 9 groups) at community and health facility levels. Data were analysed using a framework analysis approach. Results As well as pragmatic barriers at the health facility level, mental health stigma and certain cultural norms were found to reduce access and demand for services. Respondents perceived the lack of awareness about mental health problems to be a major problem underlying this, even among those with high levels of education or status. They proposed strategies to improve awareness, such as channelling education through trusted and respected community figures, and responding to the need for openness or privacy in educational programmes, depending on the issue at hand. Adapting to local perceptions of stigmatised treatments emerged as another key strategy to improve demand. Conclusions This study identifies barriers to accessing care in Nepal that reach beyond the health facility and into the social fabric of the community. Stakeholders in PRIME’s integrated care plan advocate strategic awareness raising initiatives to improve the reach of integrated services in this low-income setting. PMID:25084826

Demand and access to mental health services: a qualitative formative study in Nepal.

PubMed

Brenman, Natassia F; Luitel, Nagendra P; Mall, Sumaya; Jordans, Mark J D

2014-08-02

Nepal is experiencing a significant 'treatment gap' in mental health care. People with mental disorders do not always receive appropriate treatment due to a range of structural and individual issues, including stigma and poverty. The PRIME (Programme for Improving Mental Health Care) programme has developed a mental health care plan to address this issue in Nepal and four other low and middle income countries. This study aims to inform the development of this comprehensive care plan by investigating the perceptions of stakeholders at different levels of the care system in the district of Chitwan in southern Nepal: health professionals, lay workers and community members. It focuses specifically on issues of demand and access to care, and aims to identify barriers and potential solutions for reaching people with priority mental disorders. This qualitative study consisted of key informant interviews (33) and focus group discussions (83 participants in 9 groups) at community and health facility levels. Data were analysed using a framework analysis approach. As well as pragmatic barriers at the health facility level, mental health stigma and certain cultural norms were found to reduce access and demand for services. Respondents perceived the lack of awareness about mental health problems to be a major problem underlying this, even among those with high levels of education or status. They proposed strategies to improve awareness, such as channelling education through trusted and respected community figures, and responding to the need for openness or privacy in educational programmes, depending on the issue at hand. Adapting to local perceptions of stigmatised treatments emerged as another key strategy to improve demand. This study identifies barriers to accessing care in Nepal that reach beyond the health facility and into the social fabric of the community. Stakeholders in PRIME's integrated care plan advocate strategic awareness raising initiatives to improve the reach of integrated services in this low-income setting.

Supporting learner-centered technology integration through situated mentoring

NASA Astrophysics Data System (ADS)

Rosenberg, Marian Goode

Situated mentoring was used as a professional development method to help 11 high school science teachers integrate learner-centered technology. The teachers' learner-centered technology beliefs and practices as well as their perception of barriers to learner-centered technology integration were explored before and after participating in the mentoring program. In addition, the participants' thoughts about the effectiveness of various components of the mentoring program were analyzed along with the mentor's observations of their practices. Situated mentoring can be effective for supporting learner-centered technology integration, in particular decreasing the barriers teachers experience. Goal setting, collaborative planning, reflection, and onsite just-in-time support were thought to be the most valuable components of the mentoring program.

Topography-based Flood Planning and Optimization Capability Development Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Judi, David R.; Tasseff, Byron A.; Bent, Russell W.

2014-02-26

Globally, water-related disasters are among the most frequent and costly natural hazards. Flooding inflicts catastrophic damage on critical infrastructure and population, resulting in substantial economic and social costs. NISAC is developing LeveeSim, a suite of nonlinear and network optimization models, to predict optimal barrier placement to protect critical regions and infrastructure during flood events. LeveeSim currently includes a high-performance flood model to simulate overland flow, as well as a network optimization model to predict optimal barrier placement during a flood event. The LeveeSim suite models the effects of flooding in predefined regions. By manipulating a domain’s underlying topography, developers alteredmore » flood propagation to reduce detrimental effects in areas of interest. This numerical altering of a domain’s topography is analogous to building levees, placing sandbags, etc. To induce optimal changes in topography, NISAC used a novel application of an optimization algorithm to minimize flooding effects in regions of interest. To develop LeveeSim, NISAC constructed and coupled hydrodynamic and optimization algorithms. NISAC first implemented its existing flood modeling software to use massively parallel graphics processing units (GPUs), which allowed for the simulation of larger domains and longer timescales. NISAC then implemented a network optimization model to predict optimal barrier placement based on output from flood simulations. As proof of concept, NISAC developed five simple test scenarios, and optimized topographic solutions were compared with intuitive solutions. Finally, as an early validation example, barrier placement was optimized to protect an arbitrary region in a simulation of the historic Taum Sauk dam breach.« less

Barriers to Offering Vasectomy at Publicly Funded Family Planning Organizations in Texas

PubMed Central

White, Kari; Campbell, Anthony; Hopkins, Kristine; Grossman, Daniel; Potter, Joseph E.

2017-01-01

Few publicly funded family planning clinics in the United States offer vasectomy, but little is known about the reasons this method is not more widely available at these sources of care. Between February 2012 and February 2015, three waves of in-depth interviews were conducted with program administrators at 54 family planning organizations in Texas. Participants described their organization’s vasectomy service model and factors that influenced how frequently vasectomy was provided. Interview transcripts were coded and analyzed using a theme-based approach. Service models and barriers to providing vasectomy were compared by organization type (e.g., women’s health center, public health clinic) and receipt of Title X funding. Two thirds of organizations did not offer vasectomy on-site or pay for referrals with family planning funding; nine organizations frequently provided vasectomy. Organizations did not widely offer vasectomy because they could not find providers that would accept the low reimbursement for the procedure or because they lacked funding for men’s reproductive health care. Respondents often did not perceive men’s reproductive health care as a service priority and commented that men, especially Latinos, had limited interest in vasectomy. Although organizations of all types reported barriers, women’s health centers and Title X-funded organizations more frequently offered vasectomy by conducting tailored outreach to men and vasectomy providers. A combination of factors operating at the health systems and provider level influence the availability of vasectomy at publicly funded family planning organizations in Texas. Multilevel approaches that address key barriers to vasectomy provision would help organizations offer comprehensive contraceptive services. PMID:28413942

Barriers to Offering Vasectomy at Publicly Funded Family Planning Organizations in Texas.

PubMed

White, Kari; Campbell, Anthony; Hopkins, Kristine; Grossman, Daniel; Potter, Joseph E

2017-05-01

Few publicly funded family planning clinics in the United States offer vasectomy, but little is known about the reasons this method is not more widely available at these sources of care. Between February 2012 and February 2015, three waves of in-depth interviews were conducted with program administrators at 54 family planning organizations in Texas. Participants described their organization's vasectomy service model and factors that influenced how frequently vasectomy was provided. Interview transcripts were coded and analyzed using a theme-based approach. Service models and barriers to providing vasectomy were compared by organization type (e.g., women's health center, public health clinic) and receipt of Title X funding. Two thirds of organizations did not offer vasectomy on-site or pay for referrals with family planning funding; nine organizations frequently provided vasectomy. Organizations did not widely offer vasectomy because they could not find providers that would accept the low reimbursement for the procedure or because they lacked funding for men's reproductive health care. Respondents often did not perceive men's reproductive health care as a service priority and commented that men, especially Latinos, had limited interest in vasectomy. Although organizations of all types reported barriers, women's health centers and Title X-funded organizations more frequently offered vasectomy by conducting tailored outreach to men and vasectomy providers. A combination of factors operating at the health systems and provider level influence the availability of vasectomy at publicly funded family planning organizations in Texas. Multilevel approaches that address key barriers to vasectomy provision would help organizations offer comprehensive contraceptive services.

Breaking down patient and physician barriers to optimize glycemic control in type 2 diabetes.

PubMed

Ross, Stuart A

2013-09-01

Approximately half of patients with type 2 diabetes (T2D) do not achieve globally recognized blood glucose targets, despite the availability of a wide range of effective glucose-lowering therapies. Failure to maintain good glycemic control increases the risk of diabetes-related complications and long-term health care costs. Patients must be brought under glycemic control to improve treatment outcomes, but existing barriers to optimizing glycemic control must first be overcome, including patient nonadherence to treatment, the failure of physicians to intensify therapy in a timely manner, and inadequacies in the health care system itself. The reasons for such barriers include treatment side effects, complex treatment regimens, needle anxiety, poor patient education, and the absence of an adequate patient care plan; however, newer therapies and devices, combined with comprehensive care plans involving adequate patient education, can help to minimize barriers and improve treatment outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.

Financial barriers to implementing combination vaccines: perspectives from pediatricians and policy makers.

PubMed

Gidengil, Courtney A; Rusinak, Donna; Allred, Norma J; Luff, Donna; Lee, Grace M; Lieu, Tracy A

2009-06-01

To describe the factors that affect the use of new combination vaccines, the authors conducted qualitative interviews with pediatricians (n = 7), state immunization program managers (n = 7), and health insurance plan representatives (n = 6 plans). Respondents from each group identified reduction in pain and potentially increased immunization coverage as key benefits of new combination vaccines. For several pediatricians, low reimbursement for cost of vaccine doses and potential loss of fees for vaccine administration were barriers to using combination vaccines. For most state immunization programs, the higher cost of combination vaccines relative to separate vaccines was an important consideration but not a barrier to adoption. Most insurers were not aware of the financial issues for providers, but some had changed or were willing to change reimbursement to support the use of new combination vaccines. Financial issues for pediatric practices that purchase and provide vaccines for children may be an important barrier to offering combination vaccines.

Preventive Care in Appalachia: Use of the Theory of Planned Behavior to Identify Barriers to Participation in Cholesterol Screenings among West Virginians

ERIC Educational Resources Information Center

Deskins, Shelli; Harris, Carole V.; Bradlyn, Andrew S.; Cottrell, Lesley; Coffman, Jessica W.; Olexa, Julie; Neal, William

2006-01-01

Context: West Virginians are at increased risk for heart disease. Given that the process of atherosclerosis begins in childhood, the Coronary Artery Risk Detection in Appalachian Communities Project was developed to reduce this risk by implementing a cholesterol screening program in the schools. However, participation rates have been less than…

Minding the Gap: The Barriers and Facilitators of Getting Evidence into Policy When Using a Knowledge-Brokering Approach

ERIC Educational Resources Information Center

Reid, Garth; Connolly, John; Halliday, Wendy; Love, Anne-Marie; Higgins, Michael; MacGregor, Anita

2017-01-01

Transferring knowledge into action is challenging. Ward et al. (2009a) developed a framework for bridging this gap. This article describes what helps and hinders getting knowledge into action when using this approach in the field of mental health. Four areas of Scotland were selected which had used resources to inform local planning and…

Development of an Interactive, Web-Delivered System to Increase Provider–Patient Engagement in Smoking Cessation

PubMed Central

Delaughter, Kathryn; Crenshaw, Katie; Sobko, Heather J; Williams, Jessica H; Coley, Heather L; Ray, Midge N; Ford, Daniel E; Allison, Jeroan J; Houston, Thomas K

2011-01-01

Background Patient self-management interventions for smoking cessation are effective but underused. Health care providers do not routinely refer smokers to these interventions. Objective The objective of our study was to uncover barriers and facilitators to the use of an e-referral system that will be evaluated in a community-based randomized trial. The e-referral system will allow providers to refer smokers to an online smoking intervention during routine clinical care. Methods We devised a four-step development and pilot testing process: (1) system conceptualization using Delphi to identify key functionalities that would overcome barriers in provider referrals for smoking cessation, (2) Web system programming using agile software development and best programming practices with usability refinement using think-aloud testing, (3) implementation planning using the nominal group technique for the effective integration of the system into the workflow of practices, and (4) pilot testing to identify practice recruitment and system-use barriers in real-world settings. Results Our Delphi process (step 1) conceptualized three key e-referral functions: (1) Refer Your Smokers, allowing providers to e-refer patients at the point of care by entering their emails directly into the system, (2) practice reports, providing feedback regarding referrals and impact of smoking-cessation counseling, and (3) secure messaging, facilitating provider–patient communication. Usability testing (step 2) suggested the system was easy to use, but implementation planning (step 3) suggested several important approaches to encourage use (eg, proactive email cues to encourage practices to participate). Pilot testing (step 4) in 5 practices had limited success, with only 2 patients referred; we uncovered important recruitment and system-use barriers (eg, lack of study champion, training, and motivation, registration difficulties, and forgetting to refer). Conclusions Implementing a system to be used in a clinical setting is complex, as several issues can affect system use. In our ongoing large randomized trial, preliminary analysis with the first 50 practices using the system for 3 months demonstrated that our rigorous preimplementation evaluation helped us successfully identify and overcome these barriers before the main trial. Trial Clinicaltrials.gov NCT00797628; http://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/61feCfjCy) PMID:22011394

Identifying and overcoming the constraints that prevent the full implementation of decommissioning and remediation programs in uranium mining sites.

PubMed

Franklin, Mariza Ramalho; Fernandes, Horst Monken

2013-05-01

Environmental remediation of radioactive contamination is about achieving appropriate reduction of exposures to ionizing radiation. This goal can be achieved by means of isolation or removal of the contamination source(s) or by breaking the exposure pathways. Ideally, environmental remediation is part of the planning phase of any industrial operation with the potential to cause environmental contamination. This concept is even more important in mining operations due to the significant impacts produced. This approach has not been considered in several operations developed in the past. Therefore many legacy sites face the challenge to implement appropriate remediation plans. One of the first barriers to remediation works is the lack of financial resources as environmental issues used to be taken in the past as marginal costs and were not included in the overall budget of the company. This paper analyses the situation of the former uranium production site of Poços de Caldas in Brazil. It is demonstrated that in addition to the lack of resources, other barriers such as the lack of information on site characteristics, appropriate regulatory framework, funding mechanisms, stakeholder involvement, policy and strategy, technical experience and mechanism for the appropriation of adequate technical expertise will play key roles in preventing the implementation of remediation programs. All these barriers are discussed and some solutions are suggested. It is expected that lessons learned from the Poços de Caldas legacy site may stimulate advancement of more sustainable options in the development of future uranium production centers. Copyright © 2011 Elsevier Ltd. All rights reserved.

Emerging roles for biomedical librarians: a survey of current practice, challenges, and changes

PubMed Central

Crum, Janet A.; Cooper, I. Diane

2013-01-01

Objective: This study is intended to (1) identify emerging roles for biomedical librarians and determine how common these roles are in a variety of library settings, (2) identify barriers to taking on new roles, and (3) determine how librarians are developing the capacity to take on new roles. Methods: A survey was conducted of librarians in biomedical settings. Results: Most biomedical librarians are taking on new roles. The most common roles selected by survey respondents include analysis and enhancement of user experiences, support for social media, support for systematic reviews, clinical informationist, help for faculty or staff with authorship issues, and implementation of researcher profiling and collaboration tools. Respondents in academic settings are more likely to report new roles than hospital librarians are, but some new roles are common in both settings. Respondents use a variety of methods to free up time for new roles, but predominant methods vary between directors and librarians and between academic and hospital respondents. Lack of time is the biggest barrier that librarians face when trying to adopt new roles. New roles are associated with increased collaboration with individuals and/or groups outside the library. Conclusion and Implications: This survey documents the widespread incorporation of new roles in biomedical libraries in the United States, as well as the barriers to adopting these roles and the means by which librarians are making time for them. The results of the survey can be used to inform strategic planning, succession planning, library education, and career development for biomedical librarians. PMID:24163599

Development of a video-based education and process change intervention to improve advance cardiopulmonary resuscitation decision-making.

PubMed

Waldron, Nicholas; Johnson, Claire E; Saul, Peter; Waldron, Heidi; Chong, Jeffrey C; Hill, Anne-Marie; Hayes, Barbara

2016-10-06

Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature. A subsequent iterative consensus process developed two intervention elements: (i) an updated 'Goals of Patient Care' (GOPC) form and process; (ii) an education video and resources for teaching advance CPR decision-making and communication. A multidisciplinary group of health professionals and policy-makers with experience in systems development, education and research provided critical feedback. Three key themes emerged from the focus groups and the literature, which identified a structure for the intervention: (i) knowing what to say; (ii) knowing how to say it; (iii) wanting to say it. The themes informed the development of a video to provide education about advance CPR decision-making framework, improving communication and contextualising relevant clinical issues. Critical feedback assisted in refining the video and further guided development and evolution of a medical GOPC approach to discussing and recording medical treatment and advance care plans. Through an iterative process of consultation and review, video-based education and an expanded GOPC form and approach were developed to address physician and systemic barriers to advance CPR decision-making and documentation. Implementation and evaluation across hospital settings is required to examine utility and determine effect on quality of care.

Developing a workbook to support the contextualisation of global health systems guidance: a case study identifying steps and critical factors for success in this process at WHO.

PubMed

Alvarez, Elizabeth; Lavis, John N; Brouwers, Melissa; Schwartz, Lisa

2018-03-02

Global guidance can help countries strengthen their health systems to deliver effective interventions to their populations. However, to have an impact, guidance needs to be contextualised or adapted to local settings; this process includes consideration of health system arrangements and political system factors. To date, methods to support contextualisation do not exist. In response, a workbook was designed to provide specific methods and strategies to enable the contextualisation of WHO's 'Optimizing health worker roles to improve maternal and newborn health' (OptimizeMNH) guidance at the national or subnational level. The objective of this study was to describe the process of developing the workbook and identify key steps of the development process, barriers that arose and facilitators that helped overcome some of these barriers. A qualitative single case study design was carried out. Interviews, documents and a reflexive journal were used. Constant comparison and an edit-style of organisation were used during data analysis to develop concepts, themes, subthemes and relationships among them. Thirteen interviews were conducted and 52 documents were reviewed. Three main steps were identified in the process of developing the workbook for health systems guidance contextualisation, namely (1) determining the need for and gaining approval to develop the workbook, (2) developing the workbook (taking on the task, creating the structure of the workbook, operationalising its components, undergoing approval processes and editing it), and (3) implementing the workbook both at the WHO level and at the national/subnational level. Five barriers and/or facilitators emerged relevant to each step, namely (1) having well-placed and credible champions, (2) creating and capitalising on opportunities, (3) finding the right language to engage various actors and obtain buy-in, (4) obtaining and maintaining meaningful buy-in, and (5) ensuring access to resources. Understanding the key steps and the critical factors involved in the process of developing the workbook could help in the planning of similar and other tools aimed to support the implementation of WHO guidance. A plan for dissemination and implementation needs to be addressed during the preparation of these tools.

Barriers to shared decision making in mental health care: qualitative study of the Joint Crisis Plan for psychosis.

PubMed

Farrelly, Simone; Lester, Helen; Rose, Diana; Birchwood, Max; Marshall, Max; Waheed, Waquas; Henderson, R Claire; Szmukler, George; Thornicroft, Graham

2016-04-01

Despite increasing calls for shared decision making (SDM), the precise mechanisms for its attainment are unclear. Sharing decisions in mental health care may be especially complex. Fluctuations in service user capacity and significant power differences are particular barriers. We trialled a form of facilitated SDM that aimed to generate patients' treatment preferences in advance of a possible relapse. The 'Joint Crisis Plan' (JCP) intervention was trialled in four mental health trusts in England between 2008 and 2011. This qualitative study used grounded theory methods to analyse focus group and interview data to understand how stakeholders perceived the intervention and the barriers to SDM in the form of a JCP. Fifty service users with psychotic disorders and 45 clinicians participated in focus groups or interviews between February 2010 and November 2011. Results suggested four barriers to clinician engagement in the JCP: (i) ambivalence about care planning; (ii) perceptions that they were 'already doing SDM'; (iii) concerns regarding the clinical 'appropriateness of service users' choices'; and (iv) limited 'availability of service users' choices'. Service users reported barriers to SDM in routine practice, most of which were addressed by the JCP process. Barriers identified by clinicians led to their lack of constructive engagement in the process, undermining the service users' experience. Future work requires interventions targeted at the engagement of clinicians addressing their concerns about SDM. Particular strategies include organizational investment in implementation of service users' choices and directly training clinicians in SDM communication processes. © 2015 John Wiley & Sons Ltd.

Patient-centered knowledge sharing in healthcare organizations: Identifying the external barriers.

PubMed

Zhou, Lihong

2017-12-01

This paper reports on a research study, which aims to identify, qualify, and theorize the external barriers that prevent and hinder the exercises and activities of patient-centered knowledge sharing (KS) in healthcare organizations. The project adopted a qualitative secondary analysis approach as the overarching methodology to guide the analysis of data collected in a previously completed research study. Specifically, 46 semi-structured interview data were included and analyzed using a thematic analysis approach. The secondary analysis showed that healthcare KS is strongly influenced and hindered by five external barriers: social belief and preference, cultural values, healthcare education structure, political decisions, and economic environment and constraints. Moreover, the research findings suggest that these external barriers cannot be overlooked in KS implementation and operation in healthcare organizations and should be carefully assessed beginning in the early stages of KS design and strategic planning. Based on the secondary analysis, this paper proposes a conceptual model, which will contribute to the development of hypotheses in the future for building a generalized knowledge. The case study used is Chinese healthcare, but the KS problems studied can be shared across international borders.

Atlas V Launch Incorporated NASA Glenn Thermal Barrier

NASA Technical Reports Server (NTRS)

Dunlap, Patrick H., Jr.; Steinetz, Bruce M.

2004-01-01

In the Spring of 2002, Aerojet experienced a major failure during a qualification test of the solid rocket motor that they were developing for the Atlas V Enhanced Expendable Launch Vehicle. In that test, hot combustion gas reached the O-rings in the nozzle-to-case joint and caused a structural failure that resulted in loss of the nozzle and aft dome sections of the motor. To improve the design of this joint, Aerojet decided to incorporate three braided carbon-fiber thermal barriers developed at the NASA Glenn Research Center. The thermal barriers were used to block the searing-hot 5500 F pressurized gases from reaching the temperature-sensitive O-rings that seal the joint. Glenn originally developed the thermal barriers for the nozzle joints of the space shuttle solid rocket motors, and Aerojet decided to use them on the basis of the results of several successful ground tests of the thermal barriers in the shuttle rockets. Aerojet undertook an aggressive schedule to redesign the rocket nozzle-to-case joint with the thermal barriers and to qualify it in time for a launch planned for the middle of 2003. They performed two successful qualification tests (Oct. and Dec. 2002) in which the Glenn thermal barriers effectively protected the O-rings. These qualification tests saved hundreds of thousands of dollars in development costs and put the Lockheed-Martin/Aerojet team back on schedule. On July 17, 2003, the first flight of an Atlas V boosted with solid rocket motors successfully launched a commercial satellite into orbit from Cape Canaveral Air Force Station. Aero-jet's two 67-ft solid rocket boosters performed flawlessly, with each providing thrust in excess of 250,000 lbf. Both motors incorporated three Glenn-developed thermal barriers in their nozzle-to-case joints. The Cablevision satellite launched on this mission will be used to provide direct-to-home satellite television programming for the U.S. market starting in late 2003. The Atlas V is a product of the military's Enhanced Expendable Launch Vehicle program designed to provide assured military access to space. It can lift payloads up to 19,100 lb to geosynchronous transfer orbit and was designed to meet Department of Defense, commercial, and NASA needs. The Atlas V and Delta IV are two launch systems being considered by NASA to launch the Orbital Space Plane/Crew Exploration Vehicle. The launch and rocket costs of this mission are valued at $250 million. Successful application of the Glenn thermal barrier to the Atlas V program was an enormous breakthrough for the program's technical and schedule success.

Formative research and stakeholder participation in intervention development.

PubMed

Vastine, Amy; Gittelsohn, Joel; Ethelbah, Becky; Anliker, Jean; Caballero, Benjamin

2005-01-01

To present a model for using formative research and stakeholder participation to develop a community-based dietary intervention targeting American Indians. Formative research included interviews, assessment of food- purchasing frequency and preparation methods, and dietary recalls. Stakeholders contributed to intervention development through formative research, a program planning workshop, group feedback, and implementation training. Foods high in fat and sugar are commonly consumed. Barriers to healthy eating include low availability, perceived high cost, and poor flavor. Stakeholder participation contributed to the development of a culturally appropriate intervention. This approach resulted in project acceptance, stakeholder collaboration, and a culturally appropriate program.

Consumers' perceptions of preconception health.

PubMed

Squiers, Linda; Mitchell, Elizabeth W; Levis, Denise M; Lynch, Molly; Dolina, Suzanne; Margolis, Marjorie; Scales, Monica; Kish-Doto, Julia

2013-01-01

To inform the development of a preconception health (PCH) social marketing plan, we conducted qualitative research with prospective consumers. We present formative findings based on the four Ps of social marketing: product, price, promotion, and place. We conducted focus groups with 10 groups of women in Atlanta, Georgia, in fall 2010. We classified women aged 18 to 44 into five groups based on their pregnancy plans, and then further segmented the groups based on socioeconomic status for a total of 10 groups. The focus group guide was designed to elicit participants' responses about the product, price, promotion, and placement of PCH. We used NVivo 9 software to analyze focus group data. Women planning a pregnancy in the future had different perspectives on PCH as a product than women not planning a pregnancy. Barriers to PCH included lack of social support, addiction, and lack of awareness about PCH. Participants preferred to think of PCH behaviors as "promoting" a healthy baby rather than preventing an unhealthy birth outcome. Many women in the focus groups preferred to hear PCH messages from a health care provider, among other channels. The results from this research will inform the development of a social marketing plan for PCH and the development of concepts that will be tested with consumers to determine their viability for use in a national campaign.

Challenges and Opportunities for Mainstreaming Climate Change Adaptation into WaSH Development Planning in Ghana

PubMed Central

2017-01-01

Climate change threatens water, sanitation and hygiene (WaSH) facilities and services, as these are intimately linked to the water cycle and are vulnerable to changes in the quantity and quality of available water resources. Floods and droughts, which pollute and reduce water delivery respectively, have now become a perennial issue to deal with in the northern regions of Ghana. This study aimed to assess the degree to which climate change adaptation measures are mainstreamed into the water, sanitation and hygiene (WaSH) development planning process in Ghana. Stakeholders from government and non-government agencies were interviewed to gain perspectives on the threat of climate change, the inclusion of climate change in WaSH planning and the barriers preventing mainstreaming. Despite awareness of climate change, adaptation measures have not been considered, and the immediate WaSH needs remain the priority. Overall, stakeholders felt the adaptive capacity of the Municipality was low and that mainstreaming has not yet occurred. Despite the lack of progress, there are great opportunities for mainstreaming climate change adaptation into planning through increasing awareness and capacity, legislative and institutional changes and the development of participatory systems to provide early warning systems and disaster risk analyses that will inform future planning. PMID:28698518

Challenges and Opportunities for Mainstreaming Climate Change Adaptation into WaSH Development Planning in Ghana.

PubMed

Alhassan, Salley; Hadwen, Wade L

2017-07-10

Climate change threatens water, sanitation and hygiene (WaSH) facilities and services, as these are intimately linked to the water cycle and are vulnerable to changes in the quantity and quality of available water resources. Floods and droughts, which pollute and reduce water delivery respectively, have now become a perennial issue to deal with in the northern regions of Ghana. This study aimed to assess the degree to which climate change adaptation measures are mainstreamed into the water, sanitation and hygiene (WaSH) development planning process in Ghana. Stakeholders from government and non-government agencies were interviewed to gain perspectives on the threat of climate change, the inclusion of climate change in WaSH planning and the barriers preventing mainstreaming. Despite awareness of climate change, adaptation measures have not been considered, and the immediate WaSH needs remain the priority. Overall, stakeholders felt the adaptive capacity of the Municipality was low and that mainstreaming has not yet occurred. Despite the lack of progress, there are great opportunities for mainstreaming climate change adaptation into planning through increasing awareness and capacity, legislative and institutional changes and the development of participatory systems to provide early warning systems and disaster risk analyses that will inform future planning.

Developing team leadership to facilitate guideline utilization: planning and evaluating a 3-month intervention strategy.

PubMed

Gifford, Wendy; Davies, Barbara; Tourangeau, Ann; Lefebre, Nancy

2011-01-01

Research describes leadership as important to guideline use. Yet interventions to develop current and future leaders for this purpose are not well understood. To describe the planning and evaluation of a leadership intervention to facilitate nurses' use of guideline recommendations for diabetic foot ulcers in home health care. Planning the intervention involved a synthesis of theory and research (qualitative interviews and chart audits). One workshop and three follow-up teleconferences were delivered at two sites to nurse managers and clinical leaders (n=15) responsible for 180 staff nurses. Evaluation involved workshop surveys and interviews. Highest rated intervention components (four-point scale) were: identification of target indicators (mean 3.7), and development of a team leadership action plan (mean 3.5). Pre-workshop barriers assessment rated lowest (mean 2.9). Three months later participants indicated their leadership performance had changed as a result of the intervention, being more engaged with staff and clear about implementation goals. Creating a team leadership action plan to operationalize leadership behaviours can help in delivery of evidence-informed care. Access to clinical data and understanding team leadership knowledge and skills prior to formal training will assist nursing management in tailoring intervention strategies to identify needs and gaps. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

Rewards and advancements for clinical pharmacists.

PubMed

Goodwin, S Diane; Kane-Gill, Sandra L; Ng, Tien M H; Melroy, Joel T; Hess, Mary M; Tallian, Kimberly; Trujillo, Toby C; Vermeulen, Lee C

2010-01-01

The American College of Clinical Pharmacy charged the Clinical Practice Affairs Committee to review and update the College's 1995 White Paper, "Rewards and Advancements for Clinical Pharmacy Practitioners." Because of the limited data on the present state of rewards and advancements for clinical pharmacists, an online survey of "front-line" clinical pharmacists and pharmacy managers was conducted (1126 total respondents, 14% response rate). The resulting White Paper discusses motivators and existing systems of rewards and advancements for clinical pharmacists, as well as perceived barriers to implementation of these systems. Clinical pharmacists reported work-life balance, a challenging position, and opportunities for professional advancement as the most important factors for career success. At the time of the survey, financial rewards appeared not to be a major motivator for clinical pharmacists. Managers underestimated the importance that clinical pharmacists place on work-life balance and favorable work schedules. Although almost two thirds of the clinical pharmacists surveyed had not developed a professional development plan, 84% indicated an interest in career planning. Both clinical pharmacists and managers rated the lack of a clear reward and advancement structure as the most important barrier to effective systems of rewards and advancements. Pharmacy managers and administrators are encouraged to develop effective systems of rewards and advancements for clinical pharmacists that positively impact patient care and the institution's mission; these systems will benefit the clinical pharmacist, the health care institution, and the patient.

Development of a synoptic MRI report for primary rectal cancer.

PubMed

Spiegle, Gillian; Leon-Carlyle, Marisa; Schmocker, Selina; Fruitman, Mark; Milot, Laurent; Gagliardi, Anna R; Smith, Andy J; McLeod, Robin S; Kennedy, Erin D

2009-12-02

Although magnetic resonance imaging (MRI) is an important imaging modality for pre-operative staging and surgical planning of rectal cancer, to date there has been little investigation on the completeness and overall quality of MRI reports. This is important because optimal patient care depends on the quality of the MRI report and clear communication of these reports to treating physicians. Previous work has shown that the use of synoptic pathology reports improves the quality of pathology reports and communication between physicians. The aims of this project are to develop a synoptic MRI report for rectal cancer and determine the enablers and barriers toward the implementation of a synoptic MRI report for rectal cancer in the clinical setting. A three-step Delphi process with an expert panel will extract the key criteria for the MRI report to guide pre-operative chemoradiation and surgical planning following a review of the literature, and a synoptic template will be developed. Furthermore, standardized qualitative research methods will be used to conduct interviews with radiologists to determine the enablers and barriers to the implementation and sustainability of the synoptic MRI report in the clinic setting. Synoptic MRI reports for rectal cancer are currently not used in North America and may improve the overall quality of MRI report and communication between physicians. This may, in turn, lead to improved patient care and outcomes for rectal cancer patients.

Successful subject recruitment for a prostate cancer behavioral intervention trial

PubMed Central

Heiney, Sue P; Adams, Swann Arp; Drake, Bettina F; Bryant, Lisa H; Bridges, Lynne; Hebert, James R

2010-01-01

Background Inadequate participant recruitment, which may lead to unrepresentative study samples that threaten a study’s validity, is often a major challenge in the conduct of research studies. Purpose The purpose of this article is to describe the development and implementation of a recruitment plan and evaluate the different recruitment strategies for a prostate cancer behavioral intervention trial. Methods Our recruitment plan was based on a framework (The Heiney–Adams Recruitment Model) that we developed, which combines relationship building and social marketing. We evaluated the success of our model using several different recruitment sources including: mailed letters, physician referral, and self-referral. Results Recruitment rates ranged from 67% for a support services department mailing to 100% for physician referral. While our original list of contacted patients was comprised of only 13% African American (AA) men, 22% of our recruited participants were AA. Limitations One of the strongest barriers to recruitment was strict patient eligibility. Another significant barrier was the lack of electronic records systems to allow for the identification of large numbers of potential participants. Conclusions In conclusion, our model incorporating social marketing and relationship building was quite successful in recruiting for a prostate cancer behavioral study, particularly AA participants. In developing strategies, future researchers should attend to issues of staffing, financial resources, physician support, and eligibility criteria in the light of study accrual. PMID:20571136

Barriers to use of information and computer technology by Australia's nurses: a national survey.

PubMed

Eley, Robert; Fallon, Tony; Soar, Jeffrey; Buikstra, Elizabeth; Hegney, Desley

2009-04-01

To support policy planning for health, the barriers to the use of health information and computer technology (ICT) by nurses in Australia were determined. Australia, in line with many countries, aims to achieve a better quality of care and health outcomes through effective and innovative use of health information. Nurses form the largest component of the health workforce. Successful adoption of ICT by nurses will be a requirement for success. No national study has been undertaken to determine the barriers to adoption. A self-administered postal survey was conducted. A questionnaire was distributed to 10,000 members of the Australian Nursing Federation. Twenty possible barriers to the use of health ICT uptake were offered and responses were given on a five point Likert scale. Work demands, access to computers and lack of support were the principal barriers faced by nurses to their adoption of the technology in the workplace. Factors that were considered to present few barriers included age and lack of interest. While age was not considered by the respondents to be a barrier, their age was positively correlated with several barriers, including knowledge and confidence in the use of computers. Results indicate that to use the information and computer technologies being brought into health care fully, barriers that prevent the principal users from embracing those technologies must be addressed. Factors such as the age of the nurse and their level of job must be considered when developing strategies to overcome barriers. The findings of the present study provide essential information not only for national government and state health departments but also for local administrators and managers to enable clinical nurses to meet present and future job requirements.

Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women's perceptions in two rural districts in Uganda.

PubMed

Kabagenyi, Allen; Jennings, Larissa; Reid, Alice; Nalwadda, Gorette; Ntozi, James; Atuyambe, Lynn

2014-03-05

Spousal communication can improve family planning use and continuation. Yet, in countries with high fertility rates and unmet need, men have often been regarded as unsupportive of their partner's use of family planning methods. This study examines men and women's perceptions regarding obstacles to men's support and uptake of modern contraceptives. A qualitative study using 18 focus group discussions (FGDs) with purposively selected men aged 15-54 and women aged 15-49 as well as eight key informant interviews (KIIs) with government and community leaders was conducted in 2012 in Bugiri and Mpigi Districts, Uganda. Open-ended question guides were used to explore men and women's perceptions regarding barriers to men's involvement in reproductive health. All FGDs and KIIs were recorded, translated, and transcribed verbatim. Transcripts were coded and analyzed thematically using ATLAS.ti. Five themes were identified as rationale for men's limited involvement: (i) perceived side effects of female contraceptive methods which disrupt sexual activity, (ii) limited choices of available male contraceptives, including fear and concerns relating to vasectomy, (iii) perceptions that reproductive health was a woman's domain due to gender norms and traditional family planning communication geared towards women, (iv) preference for large family sizes which are uninhibited by prolonged birth spacing; and (v) concerns that women's use of contraceptives will lead to extramarital sexual relations. In general, knowledge of effective contraceptive methods was high. However, lack of time and overall limited awareness regarding the specific role of men in reproductive health was also thought to deter men's meaningful involvement in issues related to fertility regulation. Decision-making on contraceptive use is the shared responsibility of men and women. Effective development and implementation of male-involvement family planning initiatives should address barriers to men's supportive participation in reproductive health, including addressing men's negative beliefs regarding contraceptive services.

Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women’s perceptions in two rural districts in Uganda

PubMed Central

2014-01-01

Background Spousal communication can improve family planning use and continuation. Yet, in countries with high fertility rates and unmet need, men have often been regarded as unsupportive of their partner’s use of family planning methods. This study examines men and women’s perceptions regarding obstacles to men’s support and uptake of modern contraceptives. Methods A qualitative study using 18 focus group discussions (FGDs) with purposively selected men aged 15–54 and women aged 15–49 as well as eight key informant interviews (KIIs) with government and community leaders was conducted in 2012 in Bugiri and Mpigi Districts, Uganda. Open-ended question guides were used to explore men and women’s perceptions regarding barriers to men’s involvement in reproductive health. All FGDs and KIIs were recorded, translated, and transcribed verbatim. Transcripts were coded and analyzed thematically using ATLAS.ti. Results Five themes were identified as rationale for men’s limited involvement: (i) perceived side effects of female contraceptive methods which disrupt sexual activity, (ii) limited choices of available male contraceptives, including fear and concerns relating to vasectomy, (iii) perceptions that reproductive health was a woman’s domain due to gender norms and traditional family planning communication geared towards women, (iv) preference for large family sizes which are uninhibited by prolonged birth spacing; and (v) concerns that women’s use of contraceptives will lead to extramarital sexual relations. In general, knowledge of effective contraceptive methods was high. However, lack of time and overall limited awareness regarding the specific role of men in reproductive health was also thought to deter men’s meaningful involvement in issues related to fertility regulation. Conclusion Decision-making on contraceptive use is the shared responsibility of men and women. Effective development and implementation of male-involvement family planning initiatives should address barriers to men’s supportive participation in reproductive health, including addressing men's negative beliefs regarding contraceptive services. PMID:24597502

Models of health behaviour predict intention to use long-acting reversible contraception

PubMed Central

Roderique-Davies, Gareth; McKnight, Christine; John, Bev; Faulkner, Susan; Lancastle, Deborah

2016-01-01

The aim of this study was to investigate women’s intention to use long-acting reversible contraception using two established models of health behaviour: the theory of planned behaviour and the health belief model. A questionnaire was completed by a convenience sample of 128 women attending a community sexual health clinic. The independent variables were constructs of theory of planned behaviour (attitude, subjective norm and perceived behavioural control) and health belief model (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, health motivation and cues to action). The dependent variable was intention to use long-acting reversible contraception. The theory of planned behaviour and the health belief model accounted for 75% of the variance in intention to use. Perceived behavioural control, perceived barriers and health motivation predict the use of long-acting reversible contraception. Public health information for women considering using long-acting reversible contraception should be based around addressing the perceived barriers and promoting long-acting reversible contraception as a reliable contraceptive method. PMID:27864572

Barriers and enablers to implementing clinical treatment protocols for fever, hyperglycaemia, and swallowing dysfunction in the Quality in Acute Stroke Care (QASC) Project--a mixed methods study.

PubMed

Dale, Simeon; Levi, Christopher; Ward, Jeanette; Grimshaw, Jeremy M; Jammali-Blasi, Asmara; D'Este, Catherine; Griffiths, Rhonda; Quinn, Clare; Evans, Malcolm; Cadilhac, Dominique; Cheung, N Wah; Middleton, Sandy

2015-02-01

The Quality in Acute Stroke Care (QASC) trial evaluated systematic implementation of clinical treatment protocols to manage fever, sugar, and swallow (FeSS protocols) in acute stroke care. This cluster-randomised controlled trial was conducted in 19 stroke units in Australia. To describe perceived barriers and enablers preimplementation to the introduction of the FeSS protocols and, postimplementation, to determine which of these barriers eventuated as actual barriers. Preimplementation: Workshops were held at the intervention stroke units (n = 10). The first workshop involved senior clinicians who identified perceived barriers and enablers to implementation of the protocols, the second workshop involved bedside clinicians. Postimplementation, an online survey with stroke champions from intervention sites was conducted. A total of 111 clinicians attended the preimplementation workshops, identifying 22 barriers covering four main themes: (a) need for new policies, (b) limited workforce (capacity), (c) lack of equipment, and (d) education and logistics of training staff. Preimplementation enablers identified were: support by clinical champions, medical staff, nursing management and allied health staff; easy adaptation of current protocols, care-plans, and local policies; and presence of specialist stroke unit staff. Postimplementation, only five of the 22 barriers identified preimplementation were reported as actual barriers to adoption of the FeSS protocols, namely, no previous use of insulin infusions; hyperglycaemic protocols could not be commenced without written orders; medical staff reluctance to use the ASSIST swallowing screening tool; poor level of engagement of medical staff; and doctors' unawareness of the trial. The process of identifying barriers and enablers preimplementation allowed staff to take ownership and to address barriers and plan for change. As only five of the 22 barriers identified preimplementation were reported to be actual barriers at completion of the trial, this suggests that barriers are often overcome whilst some are only ever perceived rather than actual barriers. © 2015 Sigma Theta Tau International.

A streamlined sustainability assessment tool for improved decision making in the urban water industry.

PubMed

Schulz, Matthias; Short, Michael D; Peters, Gregory M

2012-01-01

Water supply is a key consideration in sustainable urban planning. Ideally, detailed quantitative sustainability assessments are undertaken during the planning stage to inform the decision-making process. In reality, however, the significant time and cost associated with undertaking such detailed environmental and economic assessments is often cited as a barrier to wider implementation of these key decision support tools, particularly for decisions made at the local or regional government level. In an attempt to overcome this barrier of complexity, 4 water service providers in Melbourne, Australia, funded the development of a publicly available streamlined Environmental Sustainability Assessment Tool, which is aimed at a wide range of decision makers to assist them in broadening the type and number of water servicing options that can be considered for greenfield or backlog developments. The Environmental Sustainability Assessment Tool consists of a simple user interface and draws on life cycle inventory data to allow for rapid estimation of the environmental and economic performance of different water servicing scenarios. Scenario options can then be further prioritized by means of an interactive multicriteria analysis. The intent of this article is to identify the key issues to be considered in a streamlined sustainability assessment tool for the urban water industry, and to demonstrate the feasibility of generating accurate life cycle assessments and life cycle costings, using such a tool. We use a real-life case study example consisting of 3 separate scenarios for a planned urban development to show that this kind of tool can emulate life cycle assessments and life cycle costings outcomes obtained through more detailed studies. This simplified approach is aimed at supporting "sustainability thinking" early in the decision-making process, thereby encouraging more sustainable water and sewerage infrastructure solutions. Copyright © 2011 SETAC.

Texas Solar Collaboration DOE Rooftop Solar Challenge City of Houston Project Summary

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ronk, Jennifer

2013-02-14

The City of Houston is committed to achieving a sustainable solar infrastructure. In 2008, Houston was named a United States Department of Energy (DOE) Solar America City. As a Solar America City, Houston teamed with the Houston Advanced Research Center (HARC), Sandia National Laboratory (Sandia), industry, and academia, to implement the Solar Houston Initiative and prepare the Solar Houston Plan. The Solar Houston initiative was focused on identifying and overcoming barriers associated with establishing a solar infrastructure that is incorporated into the City of Houston’s overall energy plan. A broad group of Houston area stakeholders, facilitated by HARC, came togethermore » to develop a comprehensive solar plan that went beyond technology to address barriers and establish demonstrations, public outreach, education programs and other activities. The plan included proposed scopes of work in four program areas: policies, solar integration, public outreach, and education. Through the support of the DOE SunShot Rooftop Solar Challenge (RSC) grant to the Texas Collaboration (San Antonio, Austin, and Hosuton), Houston has been able to implement several of the recommendations of the Solar Houston Plan. Specific recommendations that this project was able to support include; Working with the other Texas Solar America Cities (San Antonio and Austin), to harmonize permitting and inspection processes to simplify for installers and lower soft costs of installation; Participating in state level solar policy groups such as the Texas Renewable Energy Industries Association (TRIEA); Continued coordination with the local transmission and distribution utility (CenterPoint) and retail electric providers (REP); Identification of opportunities to improve permitting and interconnection; Providing training on PV systems to City inspectors; Educating the public by continuing outreach, training, and workshops, particularly using the the Green Building Resources Center; Evaluating methods of addressing financial barriers to residential solar; Maintaining www.solarhoustontx.org; and Continuing meetings with stakeholders to get ongoing feedback from the solar community on their needs. The following sections provide a brief summary of the activities completed under each of the nine tasks specifically related to the RSC grant. Reports and other backup information are included in the appendices.« less

A case report in health information exchange for inter-organizational patient transfers.

PubMed

Richardson, J E; Malhotra, S; Kaushal, R

2014-01-01

To provide a case report of barriers and promoters to implementing a health information exchange (HIE) tool that supports patient transfers between hospitals and skilled nursing facilities. A multi-disciplinary team conducted semi-structured telephone and in-person interviews in a purposive sample of HIE organizational informants and providers in New York City who implemented HIE to share patient transfer information. The researchers conducted grounded theory analysis to identify themes of barriers and promoters and took steps to improve the trustworthiness of the results including vetting from a knowledgeable study participant. Between May and October 2011, researchers recruited 18 participants: informaticians, healthcare administrators, software engineers, and providers from a skilled nursing facility. Subjects perceived the HIE tool's development a success in that it brought together stakeholders who had traditionally not partnered for informatics work, and that they could successfully share patient transfer information between a hospital and a skilled nursing facility. Perceived barriers included lack of hospital stakeholder buy-in and misalignment with clinical workflows that inhibited use of HIE-based patient transfer data. Participants described barriers and promoters in themes related to organizational, technical, and user-oriented issues. The investigation revealed that stakeholders could develop and implement health information technology that technically enables clinicians in both hospitals and skilled nursing facilities to exchange real-time information in support of patient transfers. User level barriers, particularly in the emergency department, should give pause to developers and implementers who plan to use HIE in support of patient transfers. Participants' experiences demonstrate how stakeholders may succeed in developing and piloting an electronic transfer form that relies on HIE to aggregate, communicate, and display relevant patient transfer data across health care organizations. Their experiences also provide insights for others seeking to develop HIE applications to improve patient transfers between emergency departments and skilled nursing facilities.

[Development and implementation of an outpatient clinic at an initial reception centre for asylum seekers in the German federal state of Baden-Wuerttemberg].

PubMed

Nikendei, Christoph; Huhn, Daniel; Adler, Guido; von Rose, Peta Becker; Eckstein, Torsten M; Fuchs, Birgit; Gewalt, Sandra C; Greiner, Bernhard; Günther, Thomas; Herzog, Wolfgang; Junghanss, Thomas; Krczal, Thomas; Lorenzen, Detlef; Lutz, Thomas; Manigault, Meryl A; Reinhart, Nico; Rodenberg, Michiko; Schelletter, Iris; Szecsenyi, Joachim; Steen, Rainer; Straßner, Cornelia; Thomsen, Mirjam; Wahedi, Katharina; Bozorgmehr, Kayvan

2017-10-01

In 2015, more than 890,000 asylum seekers were registered in Germany. The provision of medical and psychosocial care for asylum seekers is facing numerous obstacles. Access to health care is mostly insufficient, particularly in initial reception centres. The present article describes the development and implementation of an interdisciplinary outpatient clinic for asylum seekers at the main registration authority in the state of Baden-Wuerttemberg operated by physicians of the University Hospital of Heidelberg and the local Medical Association in Heidelberg. A steering committee was appointed to plan and implement the interdisciplinary outpatient clinic. Semi-structured interviews with nine steering committee members were conducted to elucidate perceived barriers during the planning and implementation phase. The steering committee's strong personal commitment and the health authorities' impartial management were cited as the main contributing factors to the success of the implementation process. Significant barriers were seen in the funding of personnel, equipment, and language mediation as well as in legal liability and billing-related aspects. Results are discussed with a focus on financing, administrative and legal framework as well as language mediation, documentation and further matters that are essential to ensure high-quality care. Copyright © 2017. Published by Elsevier GmbH.

Government bodies and their influence on the 2009 H1N1 health sector pandemic response in remote and isolated First Nation communities of sub-Arctic Ontario, Canada.

PubMed

Charania, N A; Tsuji, L J S

2011-01-01

First Nation communities were highly impacted by the 2009 H1N1 influenza pandemic. Multiple government bodies (ie federal, provincial, and First Nations) in Canada share responsibility for the health sector pandemic response in remote and isolated First Nation communities and this may have resulted in a fragmented pandemic response. This study aimed to discover if and how the dichotomy (or trichotomy) of involved government bodies led to barriers faced and opportunities for improvement during the health sector response to the 2009 H1N1 pandemic in three remote and isolated sub-arctic First Nation communities of northern Ontario, Canada. A qualitative community-based participatory approach was employed. Semi-directed interviews were conducted with adult key informants (n=13) using purposive sampling of participants representing the two (or three) government bodies of each study community. Data were manually transcribed and coded using deductive and inductive thematic analysis to reveal positive aspects, barriers faced, and opportunities for improvement along with the similarities and differences regarding the pandemic responses of each government body. Primary barriers faced by participants included receiving contradicting governmental guidelines and direction from many sources. In addition, there was a lack of human resources, information sharing, and specific details included in community-level pandemic plans. Recommended areas of improvement include developing a complementary communication plan, increasing human resources, and updating community-level pandemic plans. Participants reported many issues that may be attributable to the dichotomy (or trichotomy) of government bodies responsible for healthcare delivery during a pandemic. Increasing formal communication and collaboration between responsible government bodies will assist in clarifying roles and responsibilities and improve the pandemic response in Canada's remote and isolated First Nation communities.

Development and psychometric properties of a questionnaire to assess barriers to feeding critically ill patients

PubMed Central

2013-01-01

Background To successfully implement the recommendations of critical care nutrition guidelines, one potential approach is to identify barriers to providing optimal enteral nutrition (EN) in the intensive care unit (ICU), and then address these barriers systematically. Therefore, the purpose of this study was to develop a questionnaire to assess barriers to enterally feeding critically ill patients and to conduct preliminary validity testing of the new instrument. Methods The content of the questionnaire was guided by a published conceptual framework, literature review, and consultation with experts. The questionnaire was pre-tested on a convenience sample of 32 critical care practitioners, and then field tested with 186 critical care providers working at 5 hospitals in North America. The revised questionnaire was pilot tested at another ICU (n = 43). Finally, the questionnaire was distributed to a random sample of ICU nurses twice, two weeks apart, to determine test retest reliability (n = 17). Descriptive statistics, exploratory factor analysis, Cronbach alpha, intraclass correlations (ICC), and kappa coefficients were conducted to assess validity and reliability. Results We developed a questionnaire with 26 potential barriers to delivery of EN asking respondents to rate their importance as barriers in their ICU. Face and content validity of the questionnaire was established through literature review and expert input. The factor analysis indicated a five-factor solution and accounted for 72% of the variance in barriers: guideline recommendations and implementation strategies, delivery of EN to the patient, critical care provider attitudes and behavior, dietitian support, and ICU resources. Overall, the indices of internal reliability for the derived factor subscales and the overall instrument were acceptable (subscale Cronbach alphas range 0.84 – 0.89). However, the test retest reliability was variable and below acceptable thresholds for the majority of items (ICC’s range −0.13 to 0.70). The within group agreement, an indices reflecting the reliability of aggregating individual responses to the ICU level was also variable (ICC’s range 0.0 to 0.82). Conclusions We developed a questionnaire to identify barriers to enteral feeding in critically ill patients. Additional studies are planned to further revise and evaluate the reliability and validity of the instrument. PMID:24305039

Bird on the wire: Landscape planning considering costs and benefits for bird populations coexisting with power lines.

PubMed

D'Amico, Marcello; Catry, Inês; Martins, Ricardo C; Ascensão, Fernando; Barrientos, Rafael; Moreira, Francisco

2018-02-24

Power-line grids are increasingly expanding worldwide, as well as their negative impacts on avifauna, namely the direct mortality through collision and electrocution, the reduction of breeding performance, and the barrier effect. On the other hand, some bird species can apparently benefit from the presence of power lines, for example perching for hunting purposes or nesting on electricity towers. In this perspective essay, we reviewed the scientific literature on both costs and benefits for avifauna coexisting with power lines. Overall, we detected a generalized lack of studies focusing on these costs or benefits at a population level. We suggest that a switch in research approach to a larger spatio-temporal scale would greatly improve our knowledge about the actual effects of power lines on bird populations. This research approach would facilitate suitable landscape planning encompassing both mitigation of costs and promotion of benefits for bird populations coexisting with power lines. For example, the strategic route planning of electricity infrastructures would limit collision risk or barrier effects for threatened bird populations. Concurrently, this strategic route planning would promote the range expansion of threatened populations of other bird species, by providing nesting structures in treeless but potentially suitable landscapes. We suggest establishing a collaborative dialogue among the scientific community, governments, and electricity companies, with the aim to produce a win-win scenario in which both biodiversity conservation and infrastructure development are integrated in a common strategy.

Interprofessional collaboration regarding patients' care plans in primary care: a focus group study into influential factors.

PubMed

van Dongen, Jerôme Jean Jacques; Lenzen, Stephanie Anna; van Bokhoven, Marloes Amantia; Daniëls, Ramon; van der Weijden, Trudy; Beurskens, Anna

2016-05-28

The number of people with multiple chronic conditions demanding primary care services is increasing. To deal with the complex health care demands of these people, professionals from different disciplines collaborate. This study aims to explore influential factors regarding interprofessional collaboration related to care plan development in primary care. A qualitative study, including four semi-structured focus group interviews (n = 4). In total, a heterogeneous group of experts (n = 16) and health care professionals (n = 15) participated. Participants discussed viewpoints, barriers, and facilitators regarding interprofessional collaboration related to care plan development. The data were analysed by means of inductive content analysis. The findings show a variety of factors influencing the interprofessional collaboration in developing a care plan. Factors can be divided into 5 key categories: (1) patient-related factors: active role, self-management, goals and wishes, membership of the team; (2) professional-related factors: individual competences, domain thinking, motivation; (3) interpersonal factors: language differences, knowing each other, trust and respect, and motivation; (4) organisational factors: structure, composition, time, shared vision, leadership and administrative support; and (5) external factors: education, culture, hierarchy, domain thinking, law and regulations, finance, technology and ICT. Improving interprofessional collaboration regarding care plan development calls for an integral approach including patient- and professional related factors, interpersonal, organisational, and external factors. Further, the leader of the team seems to play a key role in watching the patient perspective, organising and coordinating interprofessional collaborations, and guiding the team through developments. The results of this study can be used as input for developing tools and interventions targeted at executing and improving interprofessional collaboration related to care plan development.

Barriers to Leisure-Time Physical Activities in Individuals with Spinal Cord Injury.

PubMed

Hwang, Eric J; Groves, Mary D; Sanchez, Jacqueline N; Hudson, Cassandra E; Jao, Rachel G; Kroll, Meghan E

2016-07-01

This study investigated the personal, environmental, and activity barriers to leisure-time physical activities (LTPAs) among individuals with spinal cord injury (SCI). A survey instrument was administered to 85 participants with SCI. Personal barriers to LTPAs included issues involving motivation, pain, scheduling, and financial resources. Environmental barriers marked the issues regarding availability and accessibility to specialized programs, activities, and professional services. Activity barriers included limitations in equipment, training, and personal skills required by the selected activities. Significant negative correlations were found between these barriers and the levels of physical activity and satisfaction with physical activity. While working with clients with SCI, occupational therapists should identify those LTPA barriers and possible solutions in order to establish individualized action plans for enhancing participation in LTPAs.

Hispanic Older Adult’s Perceptions of Personal, Contextual and Technology-Related Barriers for Using Assistive Technology Devices

PubMed Central

Orellano-Colón, Elsa M.; Mann, William C.; Rivero, Marta; Torres, Mayra; Jutai, Jeff; Santiago, Angélica; Varas, Nelson

2016-01-01

Assistive technologies (AT) are tools that enhance the independence, safety, and quality of life of older people with functional limitations. While AT may extend independence in ageing, there are racial and ethnic disparities in late-life AT use, with lower rates reported among Hispanic older populations. The aim of this study was to identify barriers experienced by Hispanic community-living older adults for using AT. Sixty Hispanic older adults (70 years and older) with functional limitations participated in this study. A descriptive qualitative research design was used guided by the principles of the Human Activity Assistive Technology Model to gain in-depth understanding of participants’ perspectives regarding barriers to using AT devices. Individual in-depth semi-structure interviews were conducted, using the Assistive Technology Devices Cards (ATDC) assessment as a prompt to facilitate participants’ qualitative responses. Data analysis included descriptive statistics and rigorous thematic content analysis. Lack of AT awareness and information, cost of AT, limited coverage of AT by heath care plans, and perceived complexity of AT were the predominant barriers experienced by the participants. A multi-level approach is required for a better understanding of the barriers for using AT devices. The personal, contextual, and activity-based barriers found in this study can be used to develop culturally sensitive AT interventions to reduce existent disparities in independent living disabilities among older Hispanics. PMID:27294762

PubMed Central

AHADI, H.; JOMEHRI, F.; RAHGOZAR, M.

2013-01-01

Summary Objectives. Despite advances in screening and treatment during past several Decades, cervical cancer remains a major health problem for Iranian women. Recent researches have focused on factors related to development of health behavior in an effort to design effective early interventions. The current study aimed to investigate the role of attachment styles on cervix cancer screening barriers among women of BandarAbbas-Iran. Methods. In an analytic-cross sectional study, 681 women aged 21-65 referring to health centers were selected randomly and after completing written informed consents were investigated by Revised Adult Attachment Scale (RAAS) (Collins and Read), Pap smear screening barriers and demographic data questionnaire. The data were analyzed by Pearson correlation coefficient, linear regressions and chi-square test. Results. The results showed significant association between attachment styles and screening barriers. There was a negative significant relation between secure attachment style and screening barriers and there was a positive significant association between insecure attachment style (anxiety and avoidant) and screening barriers. The regression analysis indicated that insecure attachment style (avoidant) were predictors of barriers to the Pap smear screening test in this regard. There was a significant association between age and residential area and participation in Pap smear test. Conclusions. Insecure attachment style is associated with hazardous risk behaviors and these results can be useful for health service providers in preventive planning of screening and identification of people susceptible to risk and the design of the intervention. PMID:24779284

Interprofessional Education for Whom? — Challenges and Lessons Learned from Its Implementation in Developed Countries and Their Application to Developing Countries: A Systematic Review

PubMed Central

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

2014-01-01

Background Evidence is available on the potential efficacy of interprofessional education (IPE) to foster interprofessional cooperation, improve professional satisfaction, and improve patient care. While the intention of the World Health Organization (WHO) is to implement IPE in all countries, evidence comes from developed countries about its efficiency, challenges, and barriers to planning and implementing IPE. We therefore conducted this review to examine challenges of implementing IPE to suggest possible pathways to overcome the anticipated challenges in developing countries. Methods We searched for literatures on IPE in PubMed/MEDLINE, CINAHL, PsycINFO, and ERIC databases. We examined challenges or barriers and initiatives to overcome them so as to suggest methods to solve the anticipated challenges in developing countries. We could not conduct a meta-analysis because of the qualitative nature of the research question and the data; instead we conducted a meta-narrative of evidence. Results A total of 40 out of 2,146 articles were eligible for analyses in the current review. Only two articles were available from developing countries. Despite the known benefits of IPE, a total of ten challenges or barriers were common based on the retrieved evidence. They included curriculum, leadership, resources, stereotypes and attitudes, variety of students, IPE concept, teaching, enthusiasm, professional jargons, and accreditation. Out of ten, three had already been reported in developing countries: IPE curriculum, resource limitations, and stereotypes. Conclusion This study found ten important challenges on implementing IPE. They are curriculum, leadership, resources, stereotypes, students' diversity, IPE concept, teaching, enthusiasm, professional jargons, and accreditation. Although only three of them are already experienced in developing countries, the remaining seven are potentially important for developing countries, too. By knowing these challenges and barriers in advance, those who implement IPE programs in developing countries will be much more prepared, and can enhance the program's potential success. PMID:24809509

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

PubMed

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

2014-01-01

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

Why and for Whom May Coping Planning Have Adverse Effects? A Moderated Mediation Analysis.

PubMed

Inauen, Jennifer; Stocker, Andrea; Scholz, Urte

2018-05-09

Coping planning, the formation of plans to overcome behavioral barriers is assumed to promote health behavior maintenance, but the literature on this is inconsistent. In this study, we aimed to investigate the mechanisms of a coping planning intervention that adversely affected maintained safe water consumption. We also explored perceived behavioral difficulty as a potential moderator of coping planning interventions. In the second phase of a cluster-randomised trial, households (N = 177 analyzed) were randomly allocated to a coping planning intervention or a comparison group (repetition of interventions from first intervention phase). Safe water consumption, the mechanisms of coping planning, and perceived difficulty were measured pre-post. The data were analyzed using mediation and moderated mediation analysis. Changes in behavioral intention mediated the intervention effects on behavioral maintenance (b = -0.36, 95% CI [-0.91, -0.03]). Changes in perceived coping planning (b = 0.08, 95% CI [-0.12, 0.34]), and maintenance self-efficacy (b = -0.13, 95% CI [-0.45, 0.01]) did not mediate the effects. Prior perceived difficulty moderated the coping planning intervention effects on maintenance via intention. Coping planning may decrease motivation for health behavior maintenance for persons who experienced few barriers prior to the planning intervention. © 2018 The International Association of Applied Psychology.

Caregiver and Health Care Provider Perspectives on Cloud-Based Shared Care Plans for Children With Medical Complexity.

PubMed

Desai, Arti D; Jacob-Files, Elizabeth A; Wignall, Julia; Wang, Grace; Pratt, Wanda; Mangione-Smith, Rita; Britto, Maria T

2018-06-05

Shared care plans play an essential role in coordinating care across health care providers and settings for children with medical complexity (CMC). However, existing care plans often lack shared ownership, are out-of-date, and lack universal accessibility. In this study, we aimed to establish requirements for shared care plans to meet the information needs of caregivers and providers and to mitigate current information barriers when caring for CMC. We followed a user-centered design methodology and conducted in-depth semistructured interviews with caregivers and providers of CMC who receive care at a tertiary care children's hospital. We applied inductive, thematic analysis to identify salient themes. Analysis occurred concurrently with data collection; therefore, the interview guide was iteratively revised as new questions and themes emerged. Interviews were conducted with 17 caregivers and 22 providers. On the basis of participant perspectives, we identified 4 requirements for shared care plans that would help meet information needs and mitigate current information barriers when caring for CMC. These requirements included the following: (1) supporting the accessibility of care plans from multiple locations (eg, cloud-based) and from multiple devices, with alert and search features; (2) ensuring the organization is tailored to the specific user; (3) including collaborative functionality such as real-time, multiuser content management and secure messaging; and (4) storing care plans on a secure platform with caregiver-controlled permission settings. Although further studies are needed to understand the optimal design and implementation strategies, shared care plans that meet these specified requirements could mitigate perceived information barriers and improve care for CMC. Copyright © 2018 by the American Academy of Pediatrics.

Global health training in ophthalmology residency programs.

PubMed

Coombs, Peter G; Feldman, Brad H; Lauer, Andreas K; Paul Chan, Robison V; Sun, Grace

2015-01-01

To assess current global health education and international electives in ophthalmology residency programs and barriers to global health implementation in ophthalmology resident education. A web-based survey regarding participation in global health and international electives was emailed to residency program directors at 116 accredited ophthalmology residency programs via an Association of University Professors in Ophthalmology (AUPO) residency program director listserv. Fifty-nine (51%) ophthalmology residency program directors responded. Thirty-seven program directors (63%) said global health was important to medical students when evaluating residency programs. Thirty-two program directors (55%) reported developing international electives. Reported barriers to resident participation in international electives were: 1) insufficient financial support, 2) inadequate resident coverage at home, and 3) lack of ACGME approval for international electives. Program directors requested more information about resident international electives, funding, and global ophthalmology educational resources. They requested ACGME recognition of international electives to facilitate resident participation. More than half (54%) of program directors supported international electives for residents. This survey demonstrates that program directors believe global health is an important consideration when medical students evaluate training programs. Despite perceived barriers to incorporating global health opportunities into residency training, program directors are interested in development of global health resources and plan to further develop global health opportunities. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Getting Home on Time: Predicting Timely Permanence for Young Children.

ERIC Educational Resources Information Center

Potter, Cathryn C.; Klein-Rothschild, Susan

2002-01-01

Studied the multivariate predictors of timely permanence for children served by Colorado's Expedited Permanency Planning (EPP) Project. Used qualitative interviews with child welfare and court personnel to identify critical barriers to and supports for effective permanency planning focusing on the areas of: (1) concurrent planning practice and…

What is killing? People's knowledge about coronary heart disease, attitude towards prevention and main risk reduction barriers in Ismailia, Egypt (descriptive cross-sectional study).

PubMed

Seef, Sameh; Jeppsson, Anders; Stafström, Martin

2013-01-01

Cardiovascular diseases are a public health concern everywhere, especially ischemic or coronary heart diseases (CHD) which are on top of causes list of mortality and morbidity in both genders globally. From which nearly 80% can be because of modifiable risks. In Egypt, there is a lack of studies on the knowledge of people about coronary heart diseases and its modifiable risks. So, this research reported here we designed to measure the dimensions of peoples knowledge about CHD and their attitude towards prevention, and to identify the main risk reduction barriers. By using comprehensive cross-sectional, descriptive research design, all adult individuals attending the family health clinic at Suez Canal University Hospital were eligible for inclusion with total number 125 participants. An interview questionnaire designed and used to collect data. The study revealed that (10.4%) of participants had a history of CHD, and (7.2%) had a family history of CHD. 79.2% Had a satisfactory total knowledge about CHD, and (94.4%) had a positive total attitude towards prevention. Risk reduction barriers as a medical setting barriers were (24%), patient related barriers were (22.4%). Community-societal barriers were almost the same as knowledge barriers which were around (16%). At last the systemic-organizational barriers were (9.6%). The findings settled that, total knowledge about CHD was satisfactory but lower than the level total of attitude. More effort the health system needs to improve the settings and engage patients in their plans and breaking related barriers, with development of health education programs based on needs assessment. Further studies we recommend to explore the reasons and follow up the changes.

Introducing birth plans in Mexico: an exploratory study in a hospital serving low-income Mexicans.

PubMed

Yam, Eileen A; Grossman, Amy A; Goldman, Lisa A; García, Sandra G

2007-03-01

Increased medicalization of childbirth in Mexico has not always translated into more satisfactory childbirth experiences for women. In developed countries, pregnant women often prepare written birth plans, outlining how they would like their childbirth experiences to proceed. The notion of expressing childbirth desires with a birth plan is novel in the developing world. We conducted an exploratory study to assess the feasibility and acceptability of introducing birth plans in a hospital serving low-socioeconomic status Mexicans and to document women's and health practitioners' perspectives on the advantages and barriers in implementing a birth plan program. We invited 9 pregnant women to prepare birth plans during their antenatal care visits. The women also participated in interviews before and after childbirth. We also conducted in-depth interviews with 4 women who had given birth in the past year, and with 2 nurses, 2 social workers, and 1 physician to learn about their perspectives on the benefits and challenges of implementing a birth plan program. All 9 women who completed a birth plan found the experience highly satisfying, despite the fact that in some cases, their childbirths did not proceed as they had specified in their plans. Interviewed practitioners believed that birth plans could improve the childbirth experience for women and health care practitioners, but facilities often lacked space and financial incentives for birth plan programs. Our findings suggest that birth plans are acceptable and feasible in this study population. Facility administrators would need to commit to provide the physical space and financial incentives necessary to ensure successful implementation.

Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare.

PubMed

Weller, Jennifer; Boyd, Matt; Cumin, David

2014-03-01

Modern healthcare is delivered by multidisciplinary, distributed healthcare teams who rely on effective teamwork and communication to ensure effective and safe patient care. However, we know that there is an unacceptable rate of unintended patient harm, and much of this is attributed to failures in communication between health professionals. The extensive literature on teams has identified shared mental models, mutual respect and trust and closed-loop communication as the underpinning conditions required for effective teams. However, a number of challenges exist in the healthcare environment. We explore these in a framework of educational, psychological and organisational challenges to the development of effective healthcare teams. Educational interventions can promote a better understanding of the principles of teamwork, help staff understand each other's roles and perspectives, and help develop specific communication strategies, but may not be sufficient on their own. Psychological barriers, such as professional silos and hierarchies, and organisational barriers such as geographically distributed teams, can increase the chance of communication failures with the potential for patient harm. We propose a seven-step plan to overcome the barriers to effective team communication that incorporates education, psychological and organisational strategies. Recent evidence suggests that improvement in teamwork in healthcare can lead to significant gains in patient safety, measured against efficiency of care, complication rate and mortality. Interventions to improve teamwork in healthcare may be the next major advance in patient outcomes.

Newly-graduated midwives transcending barriers: a grounded theory study.

PubMed

Barry, Michele J; Hauck, Yvonne L; O'Donoghue, Thomas; Clarke, Simon

2013-12-01

Midwifery has developed its own philosophy to formalise its unique identity as a profession. Newly-graduated midwives are taught, and ideally embrace, this philosophy during their education. However, embarking in their career within a predominantly institutionalised and the medically focused health-care model may challenge this application. The research question guiding this study was as follows: 'How do newly graduated midwives deal with applying the philosophy of midwifery in their first six months of practice?' The aim was to generate a grounded theory around this social process. This Western Australian grounded theory study is conceptualised within the social theory of symbolic interactionism. Data were collected by means of in-depth, semi-structured interviews with 11 recent midwifery graduates. Participant and interviewer's journals provided supplementary data. The 'constant comparison' approach was used for data analysis. The substantive theory of transcending barriers was generated. Three stages in transcending barriers were identified: Addressing personal attributes, Understanding the 'bigger picture', and finally, 'Evaluating, planning and acting' to provide woman-centred care. An overview of these three stages provides the focus of this article. The theory of transcending barriers provides a new perspective on how newly-graduated midwives deal with applying the philosophy of midwifery in their first six months of practice. A number of implications for pre and post registration midwifery education and policy development are suggested, as well as recommendations for future research. Copyright © 2013 Elsevier Ltd. All rights reserved.

Architectural Barriers to the Physically Disabled.

ERIC Educational Resources Information Center

Kirkland, Sue-Anne

Presented is evidence on the increasing need to plan for the accommodation of the physically handicapped in the design and construction of present and future public buildings and transportation facilities in Canada. Terms such as "architectural barriers" and "disability" are defined. Statistics on disability incidence in Canada…

Strengthening Cultural Competence in Prenatal Care With a Virtual Community: Building Capacity Through Collaboration.

PubMed

Weideman, Yvonne L; Young, Lisa; Lockhart, Joan Such; Grund, Faye J; Fridline, Mark M; Panas, Marie

2016-01-01

The purpose of this project was to design, implement, and evaluate a virtual simulation experience (VSE) facilitating student access to diverse cultures and strengthening their ability to provide culturally congruent care. Faculty from two universities collaborated in designing a pre/postnatal VSE with African American and Amish patients. Students viewed patient assessments, interacted with patients, worked in teams to develop culturally appropriate care plans, and engaged in debriefing. Outcomes measurements included Jeffreys' Transcultural Self-Efficacy Test (TSET), researcher developed care plans, and program evaluation. Over 80% (N=141) of the invited students consented. Significant increases occurred in overall and subscale post-TSET scores (P<.001). Care plan mean scores were ≥8.82 out of 10 points per category. Students recognized the need to be nonjudgmental in patient care. This study suggests that VSEs are effective in transcending geographic barriers, gaining access to diverse cultures, and strengthening students' cultural competence. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluation of the Effectiveness of Stormwater Decision Support Tools for Infrastructure Selection and the Barriers to Implementation

NASA Astrophysics Data System (ADS)

Spahr, K.; Hogue, T. S.

2016-12-01

Selecting the most appropriate green, gray, and / or hybrid system for stormwater treatment and conveyance can prove challenging to decision markers across all scales, from site managers to large municipalities. To help streamline the selection process, a multi-disciplinary team of academics and professionals is developing an industry standard for selecting and evaluating the most appropriate stormwater management technology for different regions. To make the tool more robust and comprehensive, life-cycle cost assessment and optimization modules will be included to evaluate non-monetized and ecosystem benefits of selected technologies. Initial work includes surveying advisory board members based in cities that use existing decision support tools in their infrastructure planning process. These surveys will qualify the decisions currently being made and identify challenges within the current planning process across a range of hydroclimatic regions and city size. Analysis of social and other non-technical barriers to adoption of the existing tools is also being performed, with identification of regional differences and institutional challenges. Surveys will also gage the regional appropriateness of certain stormwater technologies based off experiences in implementing stormwater treatment and conveyance plans. In additional to compiling qualitative data on existing decision support tools, a technical review of components of the decision support tool used will be performed. Gaps in each tool's analysis, like the lack of certain critical functionalities, will be identified and ease of use will be evaluated. Conclusions drawn from both the qualitative and quantitative analyses will be used to inform the development of the new decision support tool and its eventual dissemination.

Iowa Climate Change Adaptation and Resilience Report

EPA Pesticide Factsheets

The findings of a pilot project to work with stakeholders and governments in Iowa to identify barriers to and incentives for considering regional effects of climate change in hazard mitigation planning and other community planning processes.

Advance care planning for nursing home residents with dementia: Influence of 'we DECide' on policy and practice.

PubMed

Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

2017-01-01

(1) To pilot 'we DECide' in terms of influence on advance care planning policy and practice in nursing home dementia care units. (2) To investigate barriers and facilitators for implementing 'we DECide'. This was a pre-test-post-test study in 18 nursing homes. Measurements included: compliance with best practice of advance care planning policy (ACP-audit); advance care planning practice (ACP criteria: degree to which advance care planning was discussed, and OPTION scale: degree of involvement of residents and families in conversations). Advance care planning policy was significantly more compliant with best practice after 'we DECide'; policy in the control group was not. Advance care planning was not discussed more frequently, nor were residents and families involved to a higher degree in conversations after 'we DECide'. Barriers to realizing advance care planning included staff's limited responsibilities; facilitators included support by management staff, and involvement of the whole organization. 'We DECide' had a positive influence on advance care planning policy. Daily practice, however, did not change. Future studies should pay more attention to long-term implementation strategies. Long-term implementation of advance care planning requires involvement of the whole organization and a continuing support system for health care professionals. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Collaborative Pediatric Bone Tumor Program to Improve Access to Specialized Care: An Initiative by the Lebanese Children’s Oncology Group

PubMed Central

Merabi, Zeina; Abboud, Miguel R.; Muwakkit, Samar; Noun, Peter; Gemayel, Gladys; Bechara, Elie; Khalifeh, Hassan; Farah, Roula; Kabbara, Nabil; El-Khoury, Tarek; Al-Yousef, Rasha; Haidar, Rachid; Saghieh, Said; Eid, Toufic; Akel, Samir; Khoury, Nabil; Bayram, Layal; Krasin, Matthew J.; Jeha, Sima; El-Solh, Hassan

2017-01-01

Background Children with malignant bone tumors have average 5-year survival rates of 60% to 70% with current multimodality therapy. Local control modalities aimed at preserving function greatly influence the quality of life of long-term survivors. In developing countries, the limited availability of multidisciplinary care and limited expertise in specialized surgery and pediatric radiation therapy, as well as financial cost, all form barriers to achieving optimal outcomes in this population. Methods We describe the establishment of a collaborative pediatric bone tumor program among a group of pediatric oncologists in Lebanon and Syria. This program provides access to specialized local control at a tertiary children’s cancer center to pediatric patients with newly diagnosed bone tumors at participating sites. Central review of pathology, staging, and treatment planning is performed in a multidisciplinary tumor board setting. Patients receive chemotherapy at their respective centers on a unified treatment plan. Surgery and/or radiation therapy are performed centrally by specialized staff at the children’s cancer center. Cost barriers were resolved through a program development initiative led by St Jude Children’s Research Hospital. Once program feasibility was achieved, the Children’s Cancer Center of Lebanon Foundation, via fundraising efforts, provided continuation of program-directed funding. Results Findings over a 3-year period showed the feasibility of this project, with timely local control and protocol adherence at eight collaborating centers. We report success in providing standard-of-care multidisciplinary therapy to this patient population with complex needs and financially challenging surgical procedures. Conclusion This initiative can serve as a model, noting that facilitating access to specialized multidisciplinary care, resolution of financial barriers, and close administrative coordination all greatly contributed to the success of the program. PMID:28717738

Analysis of interactions among the barriers to JIT production: interpretive structural modelling approach

NASA Astrophysics Data System (ADS)

Jadhav, J. R.; Mantha, S. S.; Rane, S. B.

2015-09-01

`Survival of the fittest' is the reality in modern global competition. Organizations around the globe are adopting or willing to embrace just-in-time (JIT) production to reinforce the competitiveness. Even though JIT is the most powerful inventory management methodologies it is not free from barriers. Barriers derail the implementation of JIT production system. One of the most significant tasks of top management is to identify and understand the relationship between the barriers to JIT production for alleviating its bad effects. The aims of this paper are to study the barriers hampering the implementation of successful JIT production and analysing the interactions among the barriers using interpretive structural modelling technique. Twelve barriers have been identified after reviewing literature. This paper offers a roadmap for preparing an action plan to tackle the barriers in successful implementation of JIT production.

Perceived benefits and barriers of physical activity: A social marketing formative study.

PubMed

Rundle-Thiele, Sharyn; Kubacki, Krzysztof; Gruneklee, Naomi

2016-01-01

The aim of this study was to gain formative research insights that can be used to design social marketing campaigns. One thousand four hundred fifty-nine people participated in an online survey. Factor analysis was undertaken to establish perceived benefits and barriers, and indexes were created for barriers, benefits, and healthy living knowledge. Four attitude groups were formed and analysis of variance was undertaken to explore group differences. Consumers with high perceived barriers report less physical activity than consumers with low perceived barriers to exercise. The current study provides evidence to suggest that exchange theory can offer important insights to inform social marketing intervention planning.

RadShield: semiautomated shielding design using a floor plan driven graphical user interface

PubMed Central

Wu, Dee H.; Yang, Kai; Rutel, Isaac B.

2016-01-01

The purpose of this study was to introduce and describe the development of RadShield, a Java‐based graphical user interface (GUI), which provides a base design that uniquely performs thorough, spatially distributed calculations at many points and reports the maximum air‐kerma rate and barrier thickness for each barrier pursuant to NCRP Report 147 methodology. Semiautomated shielding design calculations are validated by two approaches: a geometry‐based approach and a manual approach. A series of geometry‐based equations were derived giving the maximum air‐kerma rate magnitude and location through a first derivative root finding approach. The second approach consisted of comparing RadShield results with those found by manual shielding design by an American Board of Radiology (ABR)‐certified medical physicist for two clinical room situations: two adjacent catheterization labs, and a radiographic and fluoroscopic (R&F) exam room. RadShield's efficacy in finding the maximum air‐kerma rate was compared against the geometry‐based approach and the overall shielding recommendations by RadShield were compared against the medical physicist's shielding results. Percentage errors between the geometry‐based approach and RadShield's approach in finding the magnitude and location of the maximum air‐kerma rate was within 0.00124% and 14 mm. RadShield's barrier thickness calculations were found to be within 0.156 mm lead (Pb) and 0.150 mm lead (Pb) for the adjacent catheterization labs and R&F room examples, respectively. However, within the R&F room example, differences in locating the most sensitive calculation point on the floor plan for one of the barriers was not considered in the medical physicist's calculation and was revealed by the RadShield calculations. RadShield is shown to accurately find the maximum values of air‐kerma rate and barrier thickness using NCRP Report 147 methodology. Visual inspection alone of the 2D X‐ray exam distribution by a medical physicist may not be sufficient to accurately select the point of maximum air‐kerma rate or barrier thickness. PACS number(s): 87.55.N, 87.52.‐g, 87.59.Bh, 87.57.‐s PMID:27685128

RadShield: semiautomated shielding design using a floor plan driven graphical user interface.

PubMed

DeLorenzo, Matthew C; Wu, Dee H; Yang, Kai; Rutel, Isaac B

2016-09-08

The purpose of this study was to introduce and describe the development of RadShield, a Java-based graphical user interface (GUI), which provides a base design that uniquely performs thorough, spatially distributed calculations at many points and reports the maximum air-kerma rate and barrier thickness for each barrier pursuant to NCRP Report 147 methodology. Semiautomated shielding design calculations are validated by two approaches: a geometry-based approach and a manual approach. A series of geometry-based equations were derived giv-ing the maximum air-kerma rate magnitude and location through a first derivative root finding approach. The second approach consisted of comparing RadShield results with those found by manual shielding design by an American Board of Radiology (ABR)-certified medical physicist for two clinical room situations: two adjacent catheterization labs, and a radiographic and fluoroscopic (R&F) exam room. RadShield's efficacy in finding the maximum air-kerma rate was compared against the geometry-based approach and the overall shielding recommendations by RadShield were compared against the medical physicist's shielding results. Percentage errors between the geometry-based approach and RadShield's approach in finding the magnitude and location of the maximum air-kerma rate was within 0.00124% and 14 mm. RadShield's barrier thickness calculations were found to be within 0.156 mm lead (Pb) and 0.150 mm lead (Pb) for the adjacent catheteriza-tion labs and R&F room examples, respectively. However, within the R&F room example, differences in locating the most sensitive calculation point on the floor plan for one of the barriers was not considered in the medical physicist's calculation and was revealed by the RadShield calculations. RadShield is shown to accurately find the maximum values of air-kerma rate and barrier thickness using NCRP Report 147 methodology. Visual inspection alone of the 2D X-ray exam distribution by a medical physicist may not be sufficient to accurately select the point of maximum air-kerma rate or barrier thickness. © 2016 The Authors.

Fusion cross sections for reactions involving medium and heavy nucleus-nucleus systems

NASA Astrophysics Data System (ADS)

Atta, Debasis; Basu, D. N.

2014-12-01

Existing data on near-barrier fusion excitation functions of medium and heavy nucleus-nucleus systems have been analyzed by using a simple diffused-barrier formula derived assuming the Gaussian shape of the barrier-height distributions. The fusion cross section is obtained by folding the Gaussian barrier distribution with the classical expression for the fusion cross section for a fixed barrier. The energy dependence of the fusion cross section, thus obtained, provides good description to the existing data on near-barrier fusion and capture excitation functions for medium and heavy nucleus-nucleus systems. The theoretical values for the parameters of the barrier distribution are estimated which can be used for fusion or capture cross-section predictions that are especially important for planning experiments for synthesizing new superheavy elements.

Commitment to Change and Challenges to Implementing Changes After Workplace-Based Assessment Rater Training.

PubMed

Kogan, Jennifer R; Conforti, Lisa N; Yamazaki, Kenji; Iobst, William; Holmboe, Eric S

2017-03-01

Faculty development for clinical faculty who assess trainees is necessary to improve assessment quality and impor tant for competency-based education. Little is known about what faculty plan to do differently after training. This study explored the changes faculty intended to make after workplace-based assessment rater training, their ability to implement change, predictors of change, and barriers encountered. In 2012, 45 outpatient internal medicine faculty preceptors (who supervised residents) from 26 institutions participated in rater training. They completed a commitment to change form listing up to five commitments and ranked (on a 1-5 scale) their motivation for and anticipated difficulty implementing each change. Three months later, participants were interviewed about their ability to implement change and barriers encountered. The authors used logistic regression to examine predictors of change. Of 191 total commitments, the most common commitments focused on what faculty would change about their own teaching (57%) and increasing direct observation (31%). Of the 183 commitments for which follow-up data were available, 39% were fully implemented, 40% were partially implemented, and 20% were not implemented. Lack of time/competing priorities was the most commonly cited barrier. Higher initial motivation (odds ratio [OR] 2.02; 95% confidence interval [CI] 1.14, 3.57) predicted change. As anticipated difficulty increased, implementation became less likely (OR 0.67; 95% CI 0.49, 0.93). While higher baseline motivation predicted change, multiple system-level barriers undermined ability to implement change. Rater-training faculty development programs should address how faculty motivation and organizational barriers interact and influence ability to change.

Do knowledge translation (KT) plans help to structure KT practices?

PubMed

Tchameni Ngamo, Salomon; Souffez, Karine; Lord, Catherine; Dagenais, Christian

2016-06-17

A knowledge translation (KT) planning template is a roadmap laying out the core elements to be considered when structuring the implementation of KT activities by researchers and practitioners. Since 2010, the Institut national de santé publique du Québec (INSPQ; Québec Public Health Institute) has provided tools and guidance to in-house project teams to help them develop KT plans. This study sought to identify the dimensions included in those plans and which ones were integrated and how. The results will be of interest to funding agencies and scientific organizations that provide frameworks for KT planning. The operationalization of KT planning dimensions was assessed in a mixed methods case study of 14 projects developed at the INSPQ between 2010 and 2013. All plans were assessed (rated) using an analytical tool developed for this study and data from interviews with the planning coordinators. The analytical tool and interview guide were based on eight core KT dimensions identified in the literature. Analysis of the plans and interviews revealed that the dimensions best integrated into the KT plans were 'analysis of the context (barriers and facilitators) and of users' needs', 'knowledge to be translated', 'KT partners', 'KT strategies' and, to a lesser extent, 'overall KT approach'. The least well integrated dimensions were 'knowledge about knowledge users', 'KT process evaluation' and 'resources'. While the planning coordinators asserted that a plan did not need to include all the dimensions to ensure its quality and success, nevertheless the dimensions that received less attention might have been better incorporated if they had been supported with more instruments related to those dimensions and sustained methodological guidance. Overall, KT planning templates appear to be an appreciated mechanism for supporting KT reflexive practices. Based on this study and our experience, we recommend using KT plans cautiously when assessing project efficacy and funding.

Integrating environment into land-use planning through strategic environmental assessment in China: Towards legal frameworks and operational procedures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tao Tang; Tan Zhu; He Xu

China currently put forwards 'striving to build an environmentally friendly society' as one of the most important development goals. The land administration authorities are facing the challenge of effectively incorporating environment considerations into their planning system. This paper aims to investigate why and how Strategic Environmental Assessment (SEA) is enacted as an effective tool to integrate the environment into land-use planning during the construction process of an environmentally friendly society in China, and identify factors that influence the integration. It presents characteristics of the land-use planning system, and reviews the progress and current state of SEA in China. Results showmore » that SEA provides many benefits in promoting environmental considerations into the land-use planning process. The legal frameworks and operational procedures, in the context of land-use master planning SEA, are summarized and an assessment made of their effectiveness. Some barriers are highlighted through examination of the latest case studies, and several recommendations are presented to overcome these obstacles.« less

Barriers and facilitators to family planning access in Canada.

PubMed

Hulme, Jennifer; Dunn, Sheila; Guilbert, Edith; Soon, Judith; Norman, Wendy

2015-02-01

Contraceptives are underutilized in Canada, and nearly one in three Canadian women will have an abortion in her lifetime. To help delineate a national family planning research agenda, the authors interviewed healthcare providers and organizational stakeholders to explore their perspective on barriers to contraception across regions of Canada. Semi-structured interviews were conducted based on validated frameworks for assessing family planning access and quality. The authors purposefully selected 14 key stakeholders from government agencies, professional organizations and non-governmental organizations for in-person interviews. Fifty-eight healthcare providers and representatives of stakeholder organizations in reproductive health who self-selected through an online survey were also interviewed. Transcripts were analyzed for repeated and saturated themes. Cost was the most important barrier to contraception. Sexual health education was reported as inconsistent, even within provinces. Regional differences were highlighted, including limited access to family physicians in rural Canada and throughout Quebec. Physician bias and outdated practices were cited as significant barriers to quality. New immigrants, youth, young adults and women in small rural, Northern and Aboriginal communities were all identified as particularly vulnerable. Informants identified multiple opportunities for health policy and system restructuring, including subsidized contraception, and enhancing public and healthcare provider education. Sexual health clinics were viewed as a highly successful model. Task-sharing and expanded scope of practice of nurses, nurse practitioners and pharmacists, alongside telephone and virtual healthcare consultations, were suggested to create multiple points of entry into the system. Results underscore the need for a national strategic approach to family planning health policy and health services delivery in Canada. Copyright © 2015 Longwoods Publishing.

Incorporating ITS solutions into the metropolitan transportation planning process : overcoming institutional barriers

DOT National Transportation Integrated Search

2000-11-01

There are three conditions that help bring ITS solutions into the metropolitan transportation planning process: Condition 1: Endorsement of ITS by Elected Officials and Transportation Managers Condition 2: Improved Communication and Coordination Acro...

The role of law in public health: the case of family planning in the Philippines.

PubMed

Mello, Michelle Marie; Powlowski, Marcus; Nañagas, Juan M P; Bossert, Thomas

2006-07-01

Compared to neighboring countries, the Philippines has high fertility rates and a low prevalence of modern-method contraception use. The Philippine government faces political and cultural barriers to addressing family planning needs, but also legal barriers erected by its own policies. We conducted a review of laws and policies relating to family planning in the Philippines in order to examine how the law may facilitate or constrain service provision. The methodology consisted of three phases. First, we collected and analyzed laws and regulations relating to the delivery of family planning services. Second, we conducted a qualitative interview study. Third, we synthesized findings to formulate policy recommendations. We present a conceptual model for understanding the impact of law on public health and discuss findings in relation to the roles of health care provider regulation, drug regulation, tax law, trade policies, insurance law, and other laws on access to modern-method contraceptives.

School Travel Planning: Mobilizing School and Community Resources to Encourage Active School Transportation

ERIC Educational Resources Information Center

Buliung, Ron; Faulkner, Guy; Beesley, Theresa; Kennedy, Jacky

2011-01-01

Background: Active school transport (AST), school travel using an active mode like walking, may be important to children's overall physical activity. A "school travel plan" (STP) documents a school's transport characteristics and provides an action plan to address school and neighborhood barriers to AST. Methods: We conducted a pilot STP…

Theoretical domains framework to assess barriers to change for planning health care quality interventions: a systematic literature review.

PubMed

Mosavianpour, Mirkaber; Sarmast, Hamideh Helen; Kissoon, Niranjan; Collet, Jean-Paul

2016-01-01

Theoretical domains framework (TDF) provides an integrative model for assessing barriers to behavioral changes in order to suggest interventions for improvement in behavior and ultimately outcomes. However, there are other tools that are used to assess barriers. The objective of this study is to determine the degree of concordance between domains and constructs identified in two versions of the TDF including original (2005) and refined version (2012) and independent studies of other tools. We searched six databases for articles that studied barriers to health-related behavior changes of health care professionals or the general public. We reviewed quantitative papers published in English which included their questionnaires in the article. A table including the TDF domains of both original and refined versions and related constructs was developed to serve as a reference to describe the barriers assessed in the independent studies; descriptive statistics were used to express the results. Out of 552 papers retrieved, 50 were eligible to review. The barrier domains explored in these articles belonged to two to eleven domains of the refined TDF. Eighteen articles (36%) used constructs outside of the refined version. The spectrum of barrier constructs of the original TDF was broader and could meet the domains studied in 48 studies (96%). Barriers in domains of "environmental context and resources", "beliefs about consequences", and "social influences" were the most frequently explored in 42 (84%), 37 (74%), and 33 (66%) of the 50 articles, respectively. Both refined and original TDFs cataloged barriers measured by the other studies that did not use TDF as their framework. However, the original version of TDF explored a broader spectrum of barriers than the refined version. From this perspective, the original version of the TDF seems to be a more comprehensive tool for assessing barriers in practice.

Consumers’ Perceptions of Preconception Health

PubMed Central

Squiers, Linda; Mitchell, Elizabeth W.; Levis, Denise M.; Lynch, Molly; Dolina, Suzanne; Margolis, Marjorie; Scales, Monica; Kish-Doto, Julia

2015-01-01

Purpose To inform the development of a preconception health (PCH) social marketing plan, we conducted qualitative research with prospective consumers. Approach We present formative findings based on the four Ps of social marketing: product, price, promotion, and place. Setting We conducted focus groups with 10 groups of women in Atlanta, Georgia, in fall 2010. Participants We classified women aged 18 to 44 into five groups based on their pregnancy plans, and then further segmented the groups based on socioeconomic status for a total of 10 groups. Method The focus group guide was designed to elicit participants’ responses about the product, price, promotion, and placement of PCH. We used NVivo 9 software to analyze focus group data. Results Women planning a pregnancy in the future had different perspectives on PCH as a product than women not planning a pregnancy. Barriers to PCH included lack of social support, addiction, and lack of awareness about PCH. Participants preferred to think of PCH behaviors as “promoting” a healthy baby rather than preventing an unhealthy birth outcome. Many women in the focus groups preferred to hear PCH messages from a health care provider, among other channels. Conclusion The results from this research will inform the development of a social marketing plan for PCH and the development of concepts that will be tested with consumers to determine their viability for use in a national campaign. PMID:23286658

Strengthening government health and family planning programs: findings from an action research project in rural Bangladesh.

PubMed

Simmons, R; Phillips, J F; Rahman, M

1984-01-01

An ongoing study at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) is based on the premise that public sector health and family planning programs can be improved through an assessment of the dysfunctional aspects of their operations, the development of problem-solving capabilities, and the transfer of strategies successfully tested in a small-scale pilot project. This paper reports findings from a field trial implemented in a subunit of the project area at an early stage of the project. Operational barriers to public sector program implementation are discussed with regard to the quantity of work, the quality of work, supplies and facilities, integration of health and family planning, and leadership, supervision, and decision making. Initial results of the ICDDR,B intervention on these managerial processes are also indicated.

Integration of health into urban spatial planning through impact assessment: Identifying governance and policy barriers and facilitators

DOE Office of Scientific and Technical Information (OSTI.GOV)

Carmichael, Laurence, E-mail: Laurence.carmichael@uwe.ac.uk; Barton, Hugh; Gray, Selena

This article presents the results of a review of literature examining the barriers and facilitators in integrating health in spatial planning at the local, mainly urban level, through appraisals. Our literature review covered the UK and non UK experiences of appraisals used to consider health issues in the planning process. We were able to identify four main categories of obstacles and facilitators including first the different knowledge and conceptual understanding of health by different actors/stakeholders, second the types of governance arrangements, in particular partnerships, in place and the political context, third the way institutions work, the responsibilities they have andmore » their capacity and resources and fourth the timeliness, comprehensiveness and inclusiveness of the appraisal process. The findings allowed us to draw some lessons on the governance and policy framework regarding the integration of health impact into spatial planning, in particular considering the pros and cons of integrating health impact assessment (HIA) into other forms of impact assessment of spatial planning decisions such as environmental impact assessment (EIA) and strategic environment assessment (SEA). In addition, the research uncovered a gap in the literature that tends to focus on the mainly voluntary HIA to assess health outcomes of planning decisions and neglect the analysis of regulatory mechanisms such as EIA and SEA. - Highlights: Black-Right-Pointing-Pointer Governance and policy barriers and facilitators to the integration of health into urban planning. Black-Right-Pointing-Pointer Review of literature on impact assessment methods used across the world. Black-Right-Pointing-Pointer Knowledge, partnerships, management/resources and processes can impede integration. Black-Right-Pointing-Pointer HIA evaluations prevail uncovering research opportunities for evaluating other techniques.« less

Recruitment and Retention of Older Adults in Aging Research

PubMed Central

Mody, Lona; Miller, Douglas K.; McGloin, Joanne M.; Div, M; Freeman, Marcie; Marcantonio, Edward R.; Magaziner, Jay; Studenski, Stephanie

2009-01-01

Older adults continue to be underrepresented in clinical research despite their burgeoning population in the United States and worldwide. Physicians often propose treatment plans for older adults based on data from studies involving primarily younger, more-functional, healthier participants. Major barriers to recruitment of older adults in aging research relate to their substantial health problems, social and cultural barriers, and potentially impaired capacity to provide informed consent. Institutionalized older adults offer another layer of complexity that requires cooperation from the institutions to participate in research activities. This paper provides study recruitment and retention techniques and strategies to address concerns and overcome barriers to older adult participation in clinical research. Key approaches include early in-depth planning; minimizing exclusion criteria; securing cooperation from all interested parties; using advisory boards, timely screening, identification, and approach of eligible patients; carefully reviewing the benefit:risk ratio to be sure it is appropriate; and employing strategies to ensure successful retention across the continuum of care. Targeting specific strategies to the condition, site, and population of interest and anticipating potential problems and promptly employing predeveloped contingency plans are keys to effective recruitment and retention. PMID:19093934

Enhancing Effective Stakeholder Participation in Local Groundwater Sustainability Planning through Technical Assistance in California

NASA Astrophysics Data System (ADS)

Weintraub, C.; Christian-Smith, J.; Dobbin, K.; Cullen, K.

2017-12-01

This presentation will share content from UCS's new publication, Getting Involved in Groundwater; A Guide to Effective Engagement in California's Groundwater Sustainability Plans, as well as lessons learned from collaborating with community organizations to provide technical assistance to Groundwater Sustainability Agency (GSA) board members and stakeholders in the San Joaquin Valley on Groundwater Sustainability Plan (GSP) development. California's Sustainable Groundwater Management Act (SGMA) mandates extensive stakeholder engagement, presenting an opportunity for unincorporated, low-income communities that have historically been affected by but not included in water decisions. However, implementation requires a concerted, thoughtful effort. Through technical assistance and strategic outreach, the Union of Concerned Scientists (UCS) is working to ensure stakeholder engagement in GSP development is robust, diverse, and supported by the best science available. UCS created the GSP stakeholder engagement guide to equip GSA members, scientists and interested community members to meaningfully engage in the GSP development process. The guide serves as a technical primer on SGMA's GSP process and as a resource for understanding groundwater management in California. The guide is just one component of a larger effort to overcome barriers to effective engagement in sustainable groundwater management, especially those presented by technical information. In April, UCS co-hosted a technical assistance workshop for GSA and advisory committee members in Visalia, CA with the Community Water Center (CWC), a local environmental justice non-profit. The workshop was well received and UCS and the CWC were invited to host a second workshop in June. To deepen this engagement and provide one-on-one technical assistance, UCS developed a program to match relevant water experts in the UCS Science Network with GSA members or involved community members in need of specific technical support. Through these efforts, UCS is working to break down barriers to participation and ensure sound science is incorporated into the GSP process.

Human papillomavirus vaccine motivators and barriers among community college students: Considerations for development of a successful vaccination program.

PubMed

Hirth, Jacqueline M; Batuuka, Denise N; Gross, Tyra T; Cofie, Leslie; Berenson, Abbey B

2018-02-14

Previous interventions in colleges to improve human papillomavirus (HPV) vaccination have not been highly successful. Although barriers have been assessed in traditional colleges, less is known about vaccination barriers in community colleges. We approached students aged 18-26 years old enrolled at a community college for an in-person semi-structured qualitative interview on HPV vaccination and health, with questions guided by the Theory of Planned Behavior. Data collection took place between April 2015 and December 2015. Thematic analysis techniques were used to analyze the data. During interviews with 19 students, 4 themes emerged, including: general vaccine attitudes, barriers to HPV vaccination, motivators to HPV vaccination, and social influences. Participants felt that vaccines were beneficial, but were concerned about side effects. They felt that getting the HPV vaccine would be inconvenient, and they did not know enough about it to decide. Most would not trust their friends' opinions, but would want to know about side effects that their vaccinated friends experienced. Successful interventions at community colleges should include several components to increase convenience as well as utilize interactive methods to promote HPV vaccine awareness. Copyright © 2018. Published by Elsevier Ltd.

Research awareness, attitudes and barriers among clinical staff in a regional cancer centre. Part 1: a quantitative analysis.

PubMed

Caldwell, B; Coltart, K; Hutchison, C; McJury, M; Morrison, A; Paterson, C; Thomson, M

2017-09-01

Research is of key importance in delivering high-quality patient care through evidence-based practice. Attitude towards research and barriers to research can have an impact on research activity. A survey was conducted to establish the levels of research awareness and attitudes among clinical staff groups in this regional cancer centre and identify any barriers to participation in research. The survey consisted of 26 questions and was distributed electronically and completed online. The response rate was 22.3% (n = 123). All participants felt that clinical research will help the regional cancer centre develop and progress treatments in the future. A positive attitude towards research was evident and consistent across professional groups. The main identified barriers to research included lacking the required knowledge, skills and training, lacking support from managers, and lack of opportunity or time to be involved in research, in particular for allied health professionals. However, there appears to be the foundation of a healthy research culture for nurses supported by management. The results of the survey support the implementation of an action plan based on the recommendations of this journal article. © 2016 John Wiley & Sons Ltd.

Barriers to Expanding Advanced Pharmacy Practice Experience Site Availability in an Experiential Education Consortium

PubMed Central

Byrd, Debbie C.; Duke, Lori J.; Fetterman, James W.; Unterwagner, Whitney L.; Staton, April G.; Miller, Mindi S.; Sheffield, Melody C.; Kennedy, William K.; McDuffie, Charles H.; Stevenson, T. Lynn; Thompson, Paula A.; McCullough, Elizabeth S.

2009-01-01

Objectives To compare 2006-2007 and projected 2010-2011 advanced pharmacy practice experience (APPE) availability and needs for 4 colleges and schools of pharmacy in Georgia and Alabama and to examine barriers and offer potential solutions to increase APPE site and preceptor availability. Methods Data on APPE needs and availability were gathered prospectively and evaluated relative to current and projected enrollment and planned programmatic changes. Results Combined 2006-2007 non-community APPE needs and availabilities were 3,590 and 4,427, respectively, with a surplus availability of 837. Combined projected 2010-2011 non-community APPEs were estimated at 4,309. Assuming 2006-2007 non-community availability remained unchanged, the surplus availability declined to 118. Conclusions The need for quality experiential education represents a significant barrier and rate-limiting step to the matriculation of the increased numbers of pharmacists. Barriers to expanding APPE availability include: introductory pharmacy practice experience (IPPE) and APPE expansion, growth of new and existing pharmacy programs, financial instability of acute care facilities, and lack of preceptor development resources. Regional experiential education consortiums can provide a constructive approach to improve access to quality sites and preceptors through standardizing processes and leveraging resources. PMID:19777097

Assessing Flood Risks and Planning for Resiliency in New Jersey: A Case Study on the Use of Online Flood Mapping and Resilience Planning Tools

NASA Astrophysics Data System (ADS)

Auermuller, L. M.; Gatto, J.; Huch, C.

2015-12-01

The highly developed nature of New Jersey's coastline, barrier island and lagoon communities make them particularly vulnerable to storm surge, sea level rise and flooding. The impacts of Hurricane Sandy have enlightened coastal communities to these realities. Recognizing these vulnerabilities, the Jacques Cousteau National Research Reserve (JC NERR), Rutgers Center for Remote Sensing and Spatial Analysis (CRSSA), Rutgers Bloustein School and the Barnegat Bay Partnership (BBP) have developed web-based tools to assist NJ's coastal communities in visualizing and planning for future local impacts. NJFloodMapper and NJAdapt are two complementary interactive mapping websites that visualize different current and future flood hazards. These hazard layers can be combined with additional data including critical facilities, evacuation routes, socioeconomic and environmental data. Getting to Resilience is an online self-assessment tool developed to assist communities reduce vulnerability and increase preparedness by linking planning, mitigation, and adaptation. Through this interactive process communities will learn how their preparedness can yield valuable points through voluntary programs like FEMA's Community Rating System and Sustainable Jersey. The assessment process can also increase the community's understanding of where future vulnerabilities should be addressed through hazard mitigation planning. Since Superstorm Sandy, more than thirty communities in New Jersey have been provided technical assistance in assessing their risks and vulnerabilities to coastal hazards, and have begun to understand how to better plan and prepare for short and long-term changes along their shorelines.

[Care Plan for Resuming the Physical Activity of Patients With Pancreatic Cancer and Diabetes After Surgery].

PubMed

Yang, Hui-Ting; Wu, Mei-Chih; Shun, Shiow-Ching

2018-02-01

Many barriers influence the ability of postoperative cancer patients to reengage in normal physical activities. Training programs have been shown to be effective in helping restore physical activity in patients and in reducing the care burdens of family members. Nurses cannot use physical activity guidelines in their care plan to assess individual needs. The clinical practice guidelines for physical activity in survivorship were published by the National Comprehensive Cancer Network (NCCN) in 2016. These guidelines are used to assess patients' physical status, curable factors, physical barriers, and risk of postoperative pancreatic cancer and diabetes. In line with this assessment tool, the physical activity guidelines, and the recommendations for cancer patients, the authors planned a physical activity training program that addressed the actual needs of patients under their care. Further, the authors provided special notes for a diabetic diet that helped reduce the barriers to resuming physical activity and enhanced independent care efficacy. Meanwhile, the authors encouraged family members to participate in patient-care activities and family mental-health support and to promote patient participation in the training program in order to increase quality of life. The present project demonstrates that this care plan may provide an effective guide for nurses to help other cancer patients resume physical activity.

Extended-Release Naltrexone: A Qualitative Analysis of Barriers to Routine Use.

PubMed

Alanis-Hirsch, Kelly; Croff, Raina; Ford, James H; Johnson, Kim; Chalk, Mady; Schmidt, Laura; McCarty, Dennis

2016-03-01

The Medication Research Partnership (a national health plan and nine addiction treatment centers contracted with the health plan) sought to facilitate the adoption of pharmacotherapy for alcohol and opioid use disorders. Qualitative analysis of interviews with treatment center change leaders, individuals working for the manufacturer and its technical assistance contractor, and health plan managers extracted details on the processes used to order, store, bill for, and administer extended-release naltrexone. Qualitative themes were categorized using domains from the Consolidated Framework for Implementation Research (intervention characteristics, outer setting, inner setting, and provider characteristics). Characteristics of XR-NTX that inhibited use included the complexity of ordering and using the medication; cost was also a barrier. Outer setting barriers reflected patient needs and external health plan policies on formulary coverage, benefit management, and reimbursement. Program structures, the lack of physician linkages, a culture resistant to the use of medication, and unease with change were inner setting elements that limited use of XR-NTX. Patient stereotypes and a lack of knowledge about XR-NTX affected practitioner willingness to treat patients and prescribe XR-NTX. The Consolidated Framework for Implementation Research provided a useful lens to understand and interpret the processes affecting access to XR-NTX. Copyright © 2015 Elsevier Inc. All rights reserved.

Service user involvement for mental health system strengthening in India: a qualitative study.

PubMed

Samudre, Sandesh; Shidhaye, Rahul; Ahuja, Shalini; Nanda, Sharmishtha; Khan, Azaz; Evans-Lacko, Sara; Hanlon, Charlotte

2016-07-28

There is a wide recognition that involvement of service users and their caregivers in health system policy and planning processes can strengthen health systems; however, most evidence and experience has come from high-income countries. This study aimed to explore baseline experiences, barriers and facilitators to service user-caregiver involvement in the emerging mental health system in India, and stakeholders' perspectives on how greater involvement could be achieved. A qualitative study was conducted in Sehore district of Madhya Pradesh, India. In-depth interviews (n = 27) and a focus group discussion were conducted among service users, caregivers and their representatives at district, state and national levels and policy makers, service providers and mental health researchers. The topic guide explored the baseline situation in India, barriers and facilitators to service user and caregiver involvement in the following aspects of mental health systems: policy-making and planning, service development, monitoring and quality control, as well as research. Framework analysis was employed. Respondents spoke of the limited involvement of service users and caregivers in the current Indian mental health system. The major reported barriers to this involvement were (1) unmet treatment and economic needs arising from low access to mental health services coupled with the high burden of illness, (2) pervasive stigmatising attitudes operating at the level of service user, caregiver, community, healthcare provider and healthcare administrators, and (3) entrenched power differentials between service providers and service users. Respondents prioritised greater involvement of service users in the planning of their own individual-level mental health care before considering involvement at the mental health system level. A stepwise progression was endorsed, starting from needs assessment, through empowerment and organization of service users and caregivers, leading finally to meaningful involvement. Societal and system level barriers need to be addressed in order to facilitate the involvement of service users and caregivers to strengthen the Indian mental health system. Shifting from a largely 'provider-centric' to a more 'user-centric' model of mental health care may be a fundamental first step to sustainable user involvement at the system level.

Digital Skills Development and ICT in Inclusive Education: Experiences from Cyprus Schools.

PubMed

Mavrou, Katerina; Loizou-Raouna, Maria

2017-01-01

This qualitative research has been a pilot implementation of the ENTELS self-assessment framework for schools on digital skills development and Information and Communication Technologies (ICT) in inclusive education, in Cyprus. Results suggest that participant schools overall identified themselves as "getting started" to "some progress" in all areas with the highest evaluation in the one corresponding to "school commitment in the integration of ICT skills of all students, including those with disabilities". The planned and implemented actions which followed have taken into consideration the rating of each school and the theoretical background, aimed at reinforcing the participation of the diverse students and students with disabilities and other educational needs. Final analysis of the actions' effectiveness is planned whereas future tool implementation could concentrate on how to overcome barriers and concerns related to ICT integration for promoting inclusive education.

Implementing the national priorities for injury surveillance.

PubMed

Mitchell, Rebecca J; McClure, Rod J; Williamson, Ann M; McKenzie, Kirsten

2008-04-07

Injury is a leading cause of disability and death in Australia and is recognised as a national health priority area. The foundation of successful injury prevention is injury surveillance, and national policies and strategies developed over the past 20 years to reduce the burden of injury in Australia have included 22 recommendations on surveillance--only three of which have been completely implemented. Priorities for improving injury surveillance include: improving current injury mortality and morbidity data collection systems; filling the gaps in injury surveillance; maintaining vigilance over data quality; increasing the integration and accessibility of injury data; developing technical expertise in surveillance. Barriers to implementation of the current National Injury Prevention and Safety Promotion Plan include the lack of an implementation plan, performance management structure, appropriate national governance structure and resources--all of which could be overcome with government commitment.

Strategies to overcome barriers to implementing osteoporosis and fracture prevention guidelines in long-term care: a qualitative analysis of action plans suggested by front line staff in Ontario, Canada.

PubMed

Alamri, Sultan H; Kennedy, Courtney C; Marr, Sharon; Lohfeld, Lynne; Skidmore, Carly J; Papaioannou, Alexandra

2015-08-01

Osteoporosis is a major global health problem, especially among long-term care (LTC) facilities. Despite the availability of effective clinical guidelines to prevent osteoporosis and bone fractures, few LTC homes actually adhere to these practical recommendations. The purpose of this study was to identify barriers to the implementation of evidence-based practices for osteoporosis and fracture prevention in LTC facilities and elicit practical strategies to address these barriers. We performed a qualitative analysis of action plans formulated by Professional Advisory Committee (PAC) teams at 12 LTC homes in the intervention arm of the Vitamin D and Osteoporosis Study (ViDOS) in Ontario, Canada. PAC teams were comprised of medical directors, administrators, directors of care, pharmacists, dietitians, and other staff. Thematic content analysis was performed to identify the key themes emerging from the action plans. LTC teams identified several barriers, including lack of educational information and resources prior to the ViDOS intervention, difficulty obtaining required patient information for fracture risk assessment, and inconsistent prescribing of vitamin D and calcium at the time of admission. The most frequently suggested recommendations was to establish and adhere to standard admission orders regarding vitamin D, calcium, and osteoporosis therapies, improve the use of electronic medical records for osteoporosis and fracture risk assessment, and require bone health as a topic at quarterly reviews and multidisciplinary conferences. This qualitative study identified several important barriers and practical recommendations for improving the implementation of osteoporosis and fracture prevention guidelines in LTC settings.

26 CFR 1.190-3 - Election to deduct architectural and transportation barrier removal expenses.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 3 2010-04-01 2010-04-01 false Election to deduct architectural and transportation barrier removal expenses. 1.190-3 Section 1.190-3 Internal Revenue INTERNAL REVENUE SERVICE... and documentation, including architectural plans and blueprints, contracts, and any building permits...

Barriers to Technology Use in Large and Small School Districts

ERIC Educational Resources Information Center

Francom, Gregory M.

2016-01-01

Barriers to effective technology integration come in several different categories, including access to technology tools and resources, technology training and support, administrative support, time to plan and prepare for technology integration, and beliefs about the importance and usefulness of technology tools and resources. This study used…

Critical Elements of Scientist-Teacher Partnerships and Lessons Learned About Partnership Program Design

NASA Astrophysics Data System (ADS)

Walker, B.; Hall, M. K.; Regens, N. L.

2006-05-01

Partnerships between scientists and K-12 teachers have the potential for long-term impacts, but there are many barriers to forming sustainable relationships between these two work environment cultures. By analyzing data from an NSF GK-12 program that pairs graduate and undergraduate students (fellows) with K-12 teachers, we identified several key attributes of effective partnerships. Our data indicate that communicating openly about goals, roles, and dissatisfaction is the foundation of successful partnership evolution. Although it was possible to develop strong communication, goals, and roles over time, partnership pairs that achieved these elements through deliberate and early action experienced less frustration than those who did not. Undefined goals and roles represented major barriers to partnership formation. Often, dissatisfaction was related to one partner perceiving the other as being uninvested in the relationship. Direct communication about dissatisfaction was rare, but the majority of fellows and teachers who discussed their frustrations benefited. Communicating openly demonstrated partners' desire and commitment to collaborate and led to increased planning time, a shared division of labor, the exchange of scientific and pedagogical resources, and the development of new knowledge and skills. Program design is an influential factor in developing sustainable partnerships as well. We will give examples of how the GK-12 program studied has been modified over the last five years to promote the partnership characteristics that we identified. We will also discuss program elements that facilitate communication, goal setting, role definition, and planning time.

United States family planning providers' knowledge of and attitudes towards preexposure prophylaxis for HIV prevention: a national survey.

PubMed

Seidman, Dominika; Carlson, Kimberly; Weber, Shannon; Witt, Jacki; Kelly, Patricia J

2016-05-01

The Centers for Disease Control and Prevention defines HIV prevention as a core family planning service. The HIV community identified family planning visits as key encounters for women to access preexposure prophylaxis (PrEP) for HIV prevention. No studies explore US family planning providers' knowledge of and attitudes towards PrEP. We conducted a national survey of clinicians to understand barriers and facilitators to PrEP implementation in family planning. Family planning providers recruited via website postings, national meetings, and email completed an anonymous survey in 2015. Descriptive statistics were performed. Among 604 respondents, 495 were eligible for analysis and 342 were potential PrEP prescribers (physicians, nurse practitioners, midwives or physicians assistants). Among potential prescribers, 38% correctly defined PrEP [95% confidence interval (CI): 32.5-42.8], 37% correctly stated the efficacy of PrEP (95% CI: 32.0-42.4), and 36% chose the correct HIV test after a recent exposure (95% CI: 30.6-40.8). Characteristics of those who answered knowledge questions correctly included age less than 35 years, practicing in the Northeast or West, routinely offering HIV testing, providing rectal sexually transmitted infection screening or having seen any PrEP guidelines. Even among providers in the Northeast and West, the proportion of respondents answering questions correctly was less than 50%. Thirty-six percent of respondents had seen any PrEP guidelines. Providers identified lack of training as the main barrier to PrEP implementation; 87% wanted PrEP education. To offer comprehensive HIV prevention services, family planning providers urgently need training on PrEP and HIV testing. US family planning providers have limited knowledge about HIV PrEP and HIV testing, and report lack of provider training as the main barrier to PrEP provision. Provider education is needed to ensure that family planning clients access comprehensive HIV prevention methods. Copyright © 2016 Elsevier Inc. All rights reserved.

49 CFR 213.361 - Right of way.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF TRANSPORTATION TRACK SAFETY STANDARDS Train Operations at Track Classes 6 and Higher § 213.361 Right of way. The track owner in Class 8 and 9 shall submit a barrier plan, termed a “right-of-way plan...

Barriers and Enablers to Implementation of Dietary Guidelines in Early Childhood Education Centers in Australia: Application of the Theoretical Domains Framework.

PubMed

Grady, Alice; Seward, Kirsty; Finch, Meghan; Fielding, Alison; Stacey, Fiona; Jones, Jannah; Wolfenden, Luke; Yoong, Sze Lin

2018-03-01

To identify perceived barriers and enablers to implementation of dietary guidelines reported by early childhood education center cooks, and barriers and enablers associated with greater implementation based on assessment of center menu compliance. Cross-sectional telephone interview. Early childhood education centers, New South Wales, Australia. A total of 202 cooks responsible for menu planning; 70 centers provided a menu for review of compliance with dietary guidelines. Barriers and enablers to dietary guideline implementation were determined using a tool assessing constructs of the Theoretical Domains Framework (TDF). Higher scores (≥6) for each construct indicated enablers to guideline implementation; lower scores (<6) suggested barriers. Multivariable linear regression identified TDF constructs associated with greater guideline implementation. Scores were lowest for reinforcement (mean, 5.85) and goals (mean, 5.89) domains, and highest for beliefs about consequences (mean, 6.51) and social/professional role and identity (mean, 6.50). The skills domain was positively associated with greater implementation of guidelines based on menu review (P = .01). Cooks perceived social/professional role and identity, and beliefs about consequences to be enablers to dietary guideline implementation; however, only the skills domain was associated with greater implementation. There are opportunities to target the incongruence in perceptions vs reality of the barriers and enablers to implementation. Future research could examine the utility of the TDF to identify barriers and enablers to implementation to inform intervention development and for evaluating interventions to examine intervention mechanisms. Copyright © 2017 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Translational safety biomarkers of colonic barrier integrity in the rat.

PubMed

Erkens, Tim; Bueters, Ruud; van Heerden, Marjolein; Cuyckens, Filip; Vreeken, Rob; Goeminne, Nick; Lammens, Lieve

2018-05-20

The intestinal barrier controls intestinal permeability, and its disruption has been associated with multiple diseases. Therefore, preclinical safety biomarkers monitoring barrier integrity are essential during the development of drugs targeting the intestines, particularly if starting treatment early after onset of disease. Classical toxicology endpoints are not sensitive enough and therefore our objective was to identify non-invasive markers enabling early in vivo detection of colonic barrier perturbation. Male Sprague-Dawley rats were dosed intracolonically via the rectum, using sodium caprate or ibuprofen as tool compounds to alter barrier integrity. Several potentially translational biomarkers and probe molecules related to permeability, inflammation or tissue damage were evaluated, using various analytical platforms, including immunoassays, targeted metabolomics and highly sensitive ultra-performance liquid chromatography-tandem mass spectrometry. Several markers were identified that allow early in vivo detection of colonic barrier integrity changes, before histopathological evidence of tissue damage. The most promising permeability markers identified were plasma fluorescein isothiocyanate-dextran 4000 and a lactulose/mannitol/sucralose mixture in urine. These markers showed maximum increases over 100-fold or approximately 10-50-fold, respectively. Intracolonic administration of the above probe molecules outperformed oral administration and inflammatory or other biomarkers, such as α 2 -macroglobulin, calprotectin, cytokines, prostaglandins and a panel of metabolic molecules to identify early and subtle changes in barrier integrity. However, optimal timing of probe administration and sample collection is important for all markers evaluated. Inclusion of these probe molecules in preclinical toxicity studies might aid in risk assessment and the design of a clinical biomarker plan, as several of these markers have translational potential. Copyright © 2018 John Wiley & Sons, Ltd.

Preemptive clinical pharmacogenetics implementation: current programs in five US medical centers.

PubMed

Dunnenberger, Henry M; Crews, Kristine R; Hoffman, James M; Caudle, Kelly E; Broeckel, Ulrich; Howard, Scott C; Hunkler, Robert J; Klein, Teri E; Evans, William E; Relling, Mary V

2015-01-01

Although the field of pharmacogenetics has existed for decades, practioners have been slow to implement pharmacogenetic testing in clinical care. Numerous publications describe the barriers to clinical implementation of pharmacogenetics. Recently, several freely available resources have been developed to help address these barriers. In this review, we discuss current programs that use preemptive genotyping to optimize the pharmacotherapy of patients. Array-based preemptive testing includes a large number of relevant pharmacogenes that impact multiple high-risk drugs. Using a preemptive approach allows genotyping results to be available prior to any prescribing decision so that genomic variation may be considered as an inherent patient characteristic in the planning of therapy. This review describes the common elements among programs that have implemented preemptive genotyping and highlights key processes for implementation, including clinical decision support.

The GEOFAR Project - Geothermal Finance and Awareness in Europeans Regions - Development of new schemes to overcome non-technical barriers, focusing particularly on financial barriers

NASA Astrophysics Data System (ADS)

Poux, Adeline; Wendel, Marco; Jaudin, Florence; Hiegl, Mathias

2010-05-01

Numerous advantages of geothermal energy like its widespread distribution, a base-load power and availability higher than 90%, a small footprint and low carbon emissions, and the growing concerns about climate changes strongly promote the development of geothermal projects. Geothermal energy as a local energy source implies needs on surface to be located close to the geothermal resource. Many European regions dispose of a good geothermal potential but it is mostly not sufficiently developed due to non-technical barriers occurring at the very early stages of the project. The GEOFAR Project carried out within the framework of EU's "Intelligent Energy Europe" (IEE) program, gathers a consortium of European partners from Germany, France, Greece, Spain and Portugal. Launched in September 2008, the aim of this research project is to analyze the mentioned non-technical barriers, focusing most particularly on economic and financial aspects. Based on this analysis GEOFAR aims at developing new financial and administrative schemes to overcome the main financial barriers for deep geothermal projects (for electricity and direct use, without heat pumps). The analysis of the current situation and the future development of geothermal energy in GEOFAR target countries (Germany, France, Greece, Spain, Portugal, Slovakia, Bulgaria and Hungary) was necessary to understand and expose the diverging status of the geothermal sector and the more and less complicated situation for geothermal projects in different Europeans Regions. A deeper analysis of 40 cases studies (operating, planned and failed projects) of deep geothermal projects also contributed to this detailed view. An exhaustive analysis and description of financial mechanisms already existing in different European countries and at European level to support investors completed the research on non-technical barriers. Based on this profound analysis, the GEOFAR project has made an overview of the difficulties met by project planners, developers and politicians when developing a new geothermal project. Each of the analyzed countries is facing a distinct bundle of non-technical barriers. Globally, deep geothermal projects are characterized by high up-front costs and are facing the geological risk of the non discovery of the resources in adequacy to the initial expectations. Moreover, investors are facing directly the competitiveness of fossils energy. The very long pay back period makes it also difficult for them to face the geological risk. GEOFAR will propose new targeting financing and funding schemes, in order to remove the financial barriers hindering the initial stages of geothermal energy projects. GEOFAR also considers a lack of awareness as important barrier hindering the future development of geothermal energy projects. Public opinion is globally positive to geothermal energy, but deep geothermal projects are often suffering from a lack of information leading sometimes to non public acceptance. By underlining the range of possibilities offered by the geothermal energy and the potential and emerging technologies, GEOFAR tends to increase the awareness of geothermal energy in order to boost the development and the investment in new geothermal energy projects. Geothermal energy is expected to contribute significantly to the future European energy sources and the GEOFAR project aims to facilitate it.

PACFEST : enabling technologies in the war on terrorism in the Pacific region.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moore, Judy Hennessey; Whitley, John B.; Sugimura, Tak

2003-12-01

On October 22-24, 2003, about 40 experts involved in various aspects of homeland security from the United States and four other Pacific region countries meet in Kihei, Hawaii to engage in a free-wheeling discussion and brainstorm (a 'fest') of the role that technology could play in winning the war on terrorism in the Pacific region. The result of this exercise is a concise and relatively thorough definition of the terrorism problem in the Pacific region, emphasizing the issues unique to Island nations in the Pacific setting, along with an action plan for developing working demonstrators of advanced technological solutions tomore » these issues. In this approach, the participants were asked to view the problem and their potential solutions from multiple perspectives, and then to identify barriers (especially social and policy barriers) to any proposed technological solution. The final step was to create a roadmap for further action. This roadmap includes plans to: (1) create a conceptual monitoring and tracking system for people and things moving around the region that would be 'scale free', and develop a simple concept demonstrator; (2) pursue the development of a system to improve local terrorism context information, perhaps through the creation of an information clearinghouse for Pacific law enforcement; (3) explore the implementation of a Hawaii based pilot system to explore hypothetical terrorist scenarios and the development of fusion and analysis tools to work with this data (Sandia); and (4) share information concerning the numerous activities ongoing at various organizations around the understanding and modeling of terrorist behavior.« less

Evolving the Land Information System into a Cloud Computing Service

DOE Office of Scientific and Technical Information (OSTI.GOV)

Houser, Paul R.

The Land Information System (LIS) was developed to use advanced flexible land surface modeling and data assimilation frameworks to integrate extremely large satellite- and ground-based observations with advanced land surface models to produce continuous high-resolution fields of land surface states and fluxes. The resulting fields are extremely useful for drought and flood assessment, agricultural planning, disaster management, weather and climate forecasting, water resources assessment, and the like. We envisioned transforming the LIS modeling system into a scientific cloud computing-aware web and data service that would allow clients to easily setup and configure for use in addressing large water management issues.more » The focus of this Phase 1 project was to determine the scientific, technical, commercial merit and feasibility of the proposed LIS-cloud innovations that are currently barriers to broad LIS applicability. We (a) quantified the barriers to broad LIS utility and commercialization (high performance computing, big data, user interface, and licensing issues); (b) designed the proposed LIS-cloud web service, model-data interface, database services, and user interfaces; (c) constructed a prototype LIS user interface including abstractions for simulation control, visualization, and data interaction, (d) used the prototype to conduct a market analysis and survey to determine potential market size and competition, (e) identified LIS software licensing and copyright limitations and developed solutions, and (f) developed a business plan for development and marketing of the LIS-cloud innovation. While some significant feasibility issues were found in the LIS licensing, overall a high degree of LIS-cloud technical feasibility was found.« less

Multidisciplinary Care Models for Patients With Psoriatic Arthritis.

PubMed

Queiro, Rubén; Coto, Pablo; Rodríguez, Jesús; Notario, Jaume; Navío Marco, Teresa; de la Cueva, Pablo; Pujol Busquets, Manel; García Font, Mercè; Joven, Beatriz; Rivera, Raquel; Alvarez Vega, Jose Luis; Chaves Álvarez, Antonio Javier; Sánchez Parera, Ricardo; Ruiz Carrascosa, Jose Carlos; Rodríguez Martínez, Fernando José; Pardo Sánchez, José; Feced Olmos, Carlos; Pujol, Conrad; Galindez, Eva; Pérez Barrio, Silvia; Urruticoechea Arana, Ana; Hergueta, Mercedes; Luelmo, Jesús; Gratacós, Jordi

To describe (structure, processes) of the multidisciplinary care models in psoriatic arthritis (PsA) in Spain, as well as barriers and facilitators of their implementation. A qualitative study was performed following structured interviews with 24 professionals (12 rheumatologists, 12 dermatologists who provide multidisciplinary care for patients with PsA). We collected data related to the hospital, department, population and multidisciplinary care model (type, physical and human resources, professional requirements, objectives, referral criteria, agendas, protocols, responsibilities, decision- making, research and education, clinical sessions, development and planning of the model, advantages and disadvantages of the model, barriers and facilitators in the implementation of the model. The models characteristics are described. We analyzed 12 multidisciplinary care models in PsA, with at least 1-2 years of experience, and 3 subtypes of models, face-to-face, parallel, and preferential circuit. All are adapted to the hospital and professionals characteristics. A proper implementation planning is essential. The involvement and empathy between professionals and an access and well-defined referral criteria are important facilitators in the implementation of a model. The management of agendas and data collection to measure the multidisciplinary care models health outcomes are the main barriers. There are different multidisciplinary care models in PsA that can improve patient outcomes, system efficiency and collaboration between specialists. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Design and implementation of a web-based patient portal linked to an ambulatory care electronic health record: patient gateway for diabetes collaborative care.

PubMed

Grant, Richard W; Wald, Jonathan S; Poon, Eric G; Schnipper, Jeffrey L; Gandhi, Tejal K; Volk, Lynn A; Middleton, Blackford

2006-10-01

Despite the availability of expert guidelines and widespread diabetes quality improvement efforts, care of patients with diabetes remains suboptimal. Two key barriers to care that may be amenable to informatics-based interventions include (1) lack of patient engagement with therapeutic care plans and (2) lack of medication adjustment by physicians ("clinical inertia") during clinical encounters. The authors describe the conceptual framework, design, implementation, and analysis plan for a diabetes patient web-portal linked directly to the electronic health record (EHR) of a large academic medical center via secure Internet access designed to overcome barriers to effective diabetes care. Partners HealthCare System (Boston, MA), a multi-hospital health care network comprising several thousand physicians caring for over 1 million individual patients, has developed a comprehensive patient web-portal called Patient Gateway that allows patients to interact directly with their EHR via secure Internet access. Using this portal, a specific diabetes interface was designed to maximize patient engagement by importing the patient's current clinical data in an educational format, providing patient-tailored decision support, and enabling the patient to author a "Diabetes Care Plan." The physician view of the patient's Diabetes Care Plan was designed to be concise and to fit into typical EHR clinical workflow. We successfully designed and implemented a Diabetes Patient portal that allows direct interaction with our system's EHR. We are assessing the impact of this advanced informatics tool for collaborative diabetes care in a clinic-randomized controlled trial among 14 primary care practices within our integrated health care system.

Social marketing campaign promoting the use of respiratory protection devices among farmers.

PubMed

Pounds, Lea; Duysen, Ellen; Romberger, Debra; Cramer, Mary E; Wendl, Mary; Rautiainen, Risto

2014-01-01

This article describes the formal use of marketing concepts in a systematic approach to influence farmers to voluntarily increase respiratory protective device (RPD) use. The planning process for the project incorporated six key decision or action points, each informed by formative research or health behavior theory. The planning process included developing behavior change strategies based on a 4P model (product, price, place, and promotion). The resulting campaign elements included print and e-mail messages that leveraged motivators related to family and health in order to increase farmers' knowledge about the risks of exposure to dusty environments, four instructional videos related to the primary barriers identified in using RPDs, and a brightly colored storage bag to address barriers to using RPDs related to mask storage. Campaign implementation included a series of e-mails using a bulk e-mail subscription service, use of social media in the form of posting instructional videos on a YouTube channel, and in-person interactions with members of the target audience at farm shows throughout the Central States Center for Agricultural Safety and Health seven-state region. Evaluation of the e-mail campaigns indicated increased knowledge about RPD use and intent to use RPDs in dusty conditions. YouTube analytic data indicated continuing exposure of the instructional videos beyond the life of the campaign. The project demonstrates the efficacy of a planning process that incorporates formative research and clear decision points throughout. This process could be used to plan health behavior change interventions to address other agriculture-related health and safety issues.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Alderfer, B.; Eldridge, M.; Starrs, T.

Distributed power is modular electric generation or storage located close to the point of use. Based on interviews of distributed generation project proponents, this report reviews the barriers that distributed generators of electricity are encountering when attempting to interconnect to the electrical grid. Descriptions of 26 of 65 case studies are included in the report. The survey found and the report describes a wide range of technical, business-practice, and regulatory barriers to interconnection. An action plan for reducing the impact of these barriers is also included.

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

USGS Publications Warehouse

Szaro, Robert C.; Boyce, D.A.; Puchlerz, T.

2005-01-01

Planning activities over large landscapes poses a complex of challenges when trying to balance the implementation of a conservation strategy while still allowing for a variety of consumptive and nonconsumptive uses. We examine a case in southeast Alaska to illustrate the breadth of these challenges and an approach to developing a science-based resource plan. Not only was the planning area, the Tongass National Forest, USA, exceptionally large (approximately 17 million acres or 6.9 million ha), but it also is primarily an island archipelago environment. The water system surrounding and going through much of the forest provides access to facilitate the movement of people, animals, and plants but at the same time functions as a barrier to others. This largest temperate rainforest in the world is an exceptional example of the complexity of managing at such a scale but also illustrates the role of science in the planning process. As we enter the 21st century, the list of questions needing scientific investigation has not only changed dramatically, but the character of the questions also has changed. Questions are contentious, cover broad scales in space and time, and are highly complex and interdependent. The provision of unbiased and objective information to all stakeholders is an important step in informed decision-making.

Healthcare workers' attitudes to working during pandemic influenza: a qualitative study

PubMed Central

Ives, Jonathan; Greenfield, Sheila; Parry, Jayne M; Draper, Heather; Gratus, Christine; Petts, Judith I; Sorell, Tom; Wilson, Sue

2009-01-01

Background Healthcare workers (HCWs) will play a key role in any response to pandemic influenza, and the UK healthcare system's ability to cope during an influenza pandemic will depend, to a large extent, on the number of HCWs who are able and willing to work through the crisis. UK emergency planning will be improved if planners have a better understanding of the reasons UK HCWs may have for their absenteeism, and what might motivate them to work during an influenza pandemic. This paper reports the results of a qualitative study that explored UK HCWs' views (n = 64) about working during an influenza pandemic, in order to identify factors that might influence their willingness and ability to work and to identify potential sources of any perceived duty on HCWs to work. Methods A qualitative study, using focus groups (n = 9) and interviews (n = 5). Results HCWs across a range of roles and grades tended to feel motivated by a sense of obligation to work through an influenza pandemic. A number of significant barriers that may prevent them from doing so were also identified. Perceived barriers to the ability to work included being ill oneself, transport difficulties, and childcare responsibilities. Perceived barriers to the willingness to work included: prioritising the wellbeing of family members; a lack of trust in, and goodwill towards, the NHS; a lack of information about the risks and what is expected of them during the crisis; fear of litigation; and the feeling that employers do not take the needs of staff seriously. Barriers to ability and barriers to willingness, however, are difficult to separate out. Conclusion Although our participants tended to feel a general obligation to work during an influenza pandemic, there are barriers to working, which, if generalisable, may significantly reduce the NHS workforce during a pandemic. The barriers identified are both barriers to willingness and to ability. This suggests that pandemic planning needs to take into account the possibility that staff may be absent for reasons beyond those currently anticipated in UK planning documents. In particular, staff who are physically able to attend work may nonetheless be unwilling to do so. Although there are some barriers that cannot be mitigated by employers (such as illness, transport infrastructure etc.), there are a number of remedial steps that can be taken to lesson the impact of others (providing accommodation, building reciprocity, provision of information and guidance etc). We suggest that barriers to working lie along an ability/willingness continuum, and that absenteeism may be reduced by taking steps to prevent barriers to willingness becoming perceived barriers to ability. PMID:19216738

Planned Pregnancy, Planned Parenting: Enabling Choice for Adults with a Learning Disability

ERIC Educational Resources Information Center

Conder, Jennifer; Mirfin-Veitch, Brigit; Sanders, Jackie; Munford, Robyn

2011-01-01

For adults with learning disabilities, becoming a parent can fulfil childhood dreams to take their place in society through a highly valued social role. Recent research aimed at describing the experience of parents with a learning disability suggests that there are barriers to successful planning for both pregnancy and parenthood. However, with…

Exploring the Factors of an Enterprise Resource Planning System in a Local Government Organization

ERIC Educational Resources Information Center

Shaw, Bryan T.

2012-01-01

The enterprise resource planning (ERP) system industry accounts for $8.8 billion annually. Enterprise resource planning systems are not performing as expected due to implementation barriers, changes in job responsibilities, and access to information; 50% of all information technology failures are due to the implementation of ERP systems. Guided by…

Unpacking the Complexity of Planning with Persons with Cognitive Disability and Complex Support Needs

ERIC Educational Resources Information Center

Collings, Susan; Dew, Angela; Dowse, Leanne

2018-01-01

Background: Planners will engage with people with cognitive disability and complex support needs in the Australian National Disability Insurance Scheme, but the specific skills needed to build sustainable plans with this group are not yet known. Method: A qualitative study was conducted to explore the barriers and facilitators to planning with…

Developing health visitor prescribing.

PubMed

Brooks, Christina

2013-04-01

Prescribing is an essential element of the health visitor's role. However, in one inner-city locality prescribing in practice was evaluated to be at a low level. A number of barriers to prescribing were identified through a focus group. A project to support health visitors was planned and delivered. The project involved clinical updates and improvement to the registration process, thereby reducing delays for practitioners in getting prescribing pads. The result was that prescribing confidence improved and prescribing activity increased.

WIPP Magnesium Oxide (MgO) - Planned Change Request

EPA Pesticide Factsheets

On April 10, 2006, the DOE submitted a planned change request pertaining to the amount of MgO emplaced in the WIPP repository. MgO is an engineered barrier that DOE included as part of the original WIPP Certification Decision.

Evacuating damaged and destroyed buildings on 9/11: behavioral and structural barriers.

PubMed

Groeger, Justina L; Stellman, Steven D; Kravitt, Alexandra; Brackbill, Robert M

2013-12-01

Evacuation of the World Trade Center (WTC) twin towers and surrounding buildings damaged in the September 11, 2001 attacks provides a unique opportunity to study factors that affect emergency evacuation of high rise buildings. Problem The goal of this study is to understand the extent to which structural and behavioral barriers and limitations of personal mobility affected evacuation by occupants of affected buildings on September 11, 2001. This analysis included 5,023 civilian, adult enrollees within the World Trade Center Health Registry who evacuated the two World Trade Center towers and over 30 other Lower Manhattan buildings that were damaged or destroyed on September 11, 2001. Multinomial logistic regression was used to predict total evacuation time (<30 to ≤60 minutes, >1 hour to <2 hours relative to ≤30 minutes) in relation to number of infrastructure barriers and number of behavioral barriers, adjusted for demographic and other factors. A higher percentage of evacuees reported encountering at least one behavioral barrier (84.9%) than reported at least one infrastructure barrier (51.9%). This pattern was consistent in all buildings except WTC 1, the first building attacked, where >90% of evacuees reported encountering both types of barriers. Smoke and poor lighting were the most frequently-reported structural barriers. Extreme crowding, lack of communication with officials, and being surrounded by panicked crowds were the most frequently-reported behavioral barriers. Multivariate analyses showed evacuation time to be independently associated with the number of each type of barrier as well as gender (longer times for women), but not with the floor from which evacuation began. After adjustment, personal mobility impairment was not associated with increased evacuation time. Because most high-rise buildings have unique designs, infrastructure factors tend to be less predictable than behavioral factors, but both need to be considered in developing emergency evacuation plans in order to decrease evacuation time and, consequently, risk of injury and death during an emergency evacuation.

A Pilot Study of Determinants of Ongoing Participation in EnhanceFitness: A Community-Based Group Exercise Program for Older Adults.

PubMed

Gillette, David B; Petrescu-Prahova, Miruna; Herting, Jerald R; Belza, Basia

2015-01-01

Physical activity has many benefits for older adults, but adherence is often low. The purposes of this study were to (1) identify motivators and barriers for participation in EnhanceFitness (EF), a group-based exercise program; and (2) quantitatively examine the association between motivators, barriers and individual characteristics, and ongoing participation in the program. This was a prospective, cross-sectional study. We mailed a pilot, investigator-developed survey to assess motivators and barriers to exercising to 340 adults who started a new EF class, regardless of their attendance rate. We precoded surveys on the basis of class attendance, with former participants defined as having no attendance a month or more before a 4-month fitness check. Of the 241 respondents (71% response rate), 61 (25%) were precoded as former participants and 180 (75%) as current participants. The mean age of respondents was 71 years and they were predominately female (89%). More than half of respondents were whites (58%), and almost half were married (46%). Former participants reported lower total motivation scores than current participants (P < .01) and had a significantly higher mean total barrier score (P < .001). The effects of 5 barriers ("Class was too hard," "Class was too easy," "I don't like to exercise," "Personal illness," and "Exercise caused pain") and 2 motivators ("I want to exercise" and "I plan exercise as part of my day") were significantly different between current and former participants. Discrete event history models show that dropout was related positively to ethnicity (whites were more likely to drop out) and health-related barriers. In newly formed EF classes, participants who drop out report more program, psychosocial, and health barriers, and fewer program and psychosocial motivators. Total barrier score and health barriers significantly predict a participant's dropping out, and white ethnicity is associated with a higher likelihood of dropping out. Employing strategies that address health barriers to participation could improve attendance rates for group-based exercise programs.

Workplace managers' view of the role of co-workers in return-to-work.

PubMed

Dunstan, Debra A; MacEachen, Ellen

2016-11-01

Theoretical and empirical research findings attest to the workplace being a social environment in which co-workers have a critical influence on the employment outcomes and return-to-work (RTW) success of other employees. However, co-workers do not have a formal role in RTW planning. The aim of this study was to explore how managers responsible for developing and implementing RTW procedures view the role of co-workers in this process. An exploratory qualitative pilot study was conducted in Canada. Participants (1 male; 13 females; mean experience in RTW = 11.8 years) were workplace (n=8) or RTW managers (n=6) with direct oversight of RTW plans. The participants were recruited via invitation from a research institute and were drawn from three different provinces. Data were gathered via open-ended questions and were coded and subject to thematic analysis. Three key themes were identified: (1) Managers view RTW as having little relevance to co-workers but expect them to cooperate with the arrangements; (2) Formal procedures are inadequate when psychosocial barriers to work resumption are present, so managers use informal strategies to engage co-workers' emotional and social support; and (3) Managers have difficulty integrating RTW procedures with other legal obligations, such as privacy and confidentiality requirements. Existing arrangements for the development and implementation of RTW are sufficient most of the time, but may be inadequate when an injured worker presents with psychosocial barriers to work resumption. Implications for Rehabilitation Standard RTW arrangements can be inadequate when a RTW plan requires active co-worker support. Privacy and confidentiality provisions can result in managers using informal procedures for information exchange and to engage co-workers. The use of risk management strategies - assessment, consultation and communication - could be used to include co-workers when workplace issues threaten the success of a RTW plan.

Insights into the government's role in food system policy making: improving access to healthy, local food alongside other priorities.

PubMed

Wegener, Jessica; Raine, Kim D; Hanning, Rhona M

2012-11-12

Government actors have an important role to play in creating healthy public policies and supportive environments to facilitate access to safe, affordable, nutritious food. The purpose of this research was to examine Waterloo Region (Ontario, Canada) as a case study for "what works" with respect to facilitating access to healthy, local food through regional food system policy making. Policy and planning approaches were explored through multi-sectoral perspectives of: (a) the development and adoption of food policies as part of the comprehensive planning process; (b) barriers to food system planning; and (c) the role and motivation of the Region's public health and planning departments in food system policy making. Forty-seven in-depth interviews with decision makers, experts in public health and planning, and local food system stakeholders provided rich insight into strategic government actions, as well as the local and historical context within which food system policies were developed. Grounded theory methods were used to identify key overarching themes including: "strategic positioning", "partnerships" and "knowledge transfer" and related sub-themes ("aligned agendas", "issue framing", "visioning" and "legitimacy"). A conceptual framework to illustrate the process and features of food system policy making is presented and can be used as a starting point to  engage multi-sectoral stakeholders in plans and actions to facilitate access to healthy food.

The Perinatal Palliative Care Perceptions and Barriers Scale Instrument©: development and validation.

PubMed

Wool, Charlotte; Northam, Sally

2011-12-01

To devise and test an instrument measuring clinician perceptions of perinatal palliative care (PPC) and barriers to care delivery. PPC was theorized to involve the care of pregnant women and their families after prenatal testing resulted in a life-limiting fetal diagnosis. Both giving birth to a child with a life-limiting condition or termination of pregnancy for fetal anomaly can be emotionally traumatic life events. Clinicians were thought to face ethical dilemmas that involved approaches to care for this population. The ethical dilemmas were measured on a perceptions scale using items about informed consent, justice, beneficence, and autonomy. Barriers were theorized as obstacles to delivering quality PPC and included insufficient education, personal discomfort, and difficulty garnering team or administrative support for care. Licensed clinicians practicing in the perinatal field. Stage 1 entailed instrument development and validation, which was achieved through a Delphi study involving 11 expert panelists. The devised instrument included 64 six-point Likert items. In stage 2, a computer survey gathered data from a multidisciplinary, clinician group. A total of 264 clinicians completed the survey. Exploratory factor analysis with varimax rotation was used to validate the instrument, evaluate the factors, and summarize the explained variance achieved by sum scores of the perceptions and barriers scales. The perceptions scale was reduced to 23 items with a 6-factor solution explaining 67% of the variance with a good internal consistency reliability of 0.77 (Cronbach α). The 22-item barriers scale had a 6-factor solution explaining 71% of the variance with an alpha reliability of 0.83. The Perinatal Palliative Care Perceptions and Practice Barriers Scale instrument is a valid and reliable measure of PPC perceptions and barriers for measuring the attitudes of physicians and nurses. Use of this instrument can foster educational programs and hospital planning for PPC teams that provide grieving families with the varied support they need. It is also a useful instrument for examining trends in the clinician perspectives and practice barriers as more genetic testing and subsequent terminal diagnoses occur.

Household waste compositional analysis variation from insular communities in the framework of waste prevention strategy plans.

PubMed

Zorpas, Antonis A; Lasaridi, Katia; Voukkali, Irene; Loizia, Pantelitsa; Chroni, Christina

2015-04-01

Waste management planning requires reliable data regarding waste generation, affecting factors on waste generation and forecasts of waste quantities based on facts. In order to decrease the environmental impacts of waste management the choice of prevention plan as well as the treatment method must be based on the features of the waste that are produced in a specific area. Factors such as culture, economic development, climate, and energy sources have an impact on waste composition; composition influences the need of collecting waste more or less frequently of waste collection and disposition. The research question was to discover the main barriers concerning the compositional analysis in Insular Communities under warm climate conditions and the findings from this study enabled the main contents of a waste management plan to be established. These included advice to residents on waste minimisation, liaison with stakeholders and the expansion of kerbside recycling schemes. Copyright © 2015 Elsevier Ltd. All rights reserved.

Adaptive management areas: achieving the promise, avoiding the peril.

Treesearch

George H. Stankey; Bruce Shindler

1997-01-01

Ten Adaptive Management Areas (AMAs) were created in compliance with the Northwest Forest Plan. Although the essence of adaptive management is to treat management as an experiment and to "learn how to learn," several barriers affect the successful implementation of AMAs. Four propositions are identified that address these potential barriers: (1) area...

From Barrier Free to Safe Environments: The New Zealand Experience. Monograph #44.

ERIC Educational Resources Information Center

Wrightson, William; Pope, Campbell

Intrinsically safe design is presented as a logical extension of the principles of barrier free design, and as a higher level design strategy for effecting widespread implementation of the basic accessibility requirements for people with disabilities. Two fundamental planning procedures are proposed: including principles of safe and accessible…

An Analytic Hierarchy Process-based Method to Rank the Critical Success Factors of Implementing a Pharmacy Barcode System.

PubMed

Alharthi, Hana; Sultana, Nahid; Al-Amoudi, Amjaad; Basudan, Afrah

2015-01-01

Pharmacy barcode scanning is used to reduce errors during the medication dispensing process. However, this technology has rarely been used in hospital pharmacies in Saudi Arabia. This article describes the barriers to successful implementation of a barcode scanning system in Saudi Arabia. A literature review was conducted to identify the relevant critical success factors (CSFs) for a successful dispensing barcode system implementation. Twenty-eight pharmacists from a local hospital in Saudi Arabia were interviewed to obtain their perception of these CSFs. In this study, planning (process flow issues and training requirements), resistance (fear of change, communication issues, and negative perceptions about technology), and technology (software, hardware, and vendor support) were identified as the main barriers. The analytic hierarchy process (AHP), one of the most widely used tools for decision making in the presence of multiple criteria, was used to compare and rank these identified CSFs. The results of this study suggest that resistance barriers have a greater impact than planning and technology barriers. In particular, fear of change is the most critical factor, and training is the least critical factor.

Building capacity in local government for integrated planning to increase physical activity: evaluation of the VicHealth MetroACTIVE program.

PubMed

Thomas, M M; Hodge, W; Smith, B J

2009-12-01

Integrated planning is a holistic approach to addressing the needs of local communities built on partnerships between those responsible for development, environmental quality and service provision. This study investigated the extent and key influences on the use of integrated planning to promote physical activity among six metropolitan councils in Melbourne Australia, which took part in the MetroACTIVE Project funded by the Victorian Health Promotion Foundation from 2005 to 2007. The evaluation entailed interviews conducted at the mid-term (N = 67) and completion (N = 50) of the project, and the review of relevant documents. Respondents included elected councillors, chief executive officers, officers from different council divisions and the project staff employed in each council. Three councils showed evidence of integrated planning for physical activity, whereas the remainder focused on the delivery of community participation programs. Leadership from senior management and an organizational culture that supported collaboration across council departments were prerequisites for integrated planning. Employment of a dedicated project officer with skills for engaging management and building partnerships within the organization was important. Barriers to integrated planning were a complex organization structure, high demands on the council due to a growing residential population and a poor climate among staff. Overall, integrated planning was found to be a viable approach for developing a coordinated approach to this issue involving the range of council services and functions. Ongoing strategies are needed to facilitate senior management commitment and organizational capacity for integrated planning, with leadership provided by departments responsible for infrastructure or corporate planning.

Integrating ergonomics into production system development--the Volvo Powertrain case.

PubMed

Neumann, W Patrick; Ekman, Marianne; Winkel, Jørgen

2009-05-01

Understanding the barriers and assists to integrating ergonomics into production system design remains a research issue. An action research case study at Volvo Powertrain/Sweden was conducted. Researchers worked collaboratively with the firm in efforts to improve the company's ability to handle ergonomics in their daily work of improving and developing production systems. Researchers observed and reflected collectively on the change process using field notes and recordings to support their observations. Observed integration barriers included both individual level issues like life events, and organisational aspects such as communication barriers between groups or assignment of tasks to people not involved in decision-making. Observed assists included the 'political reflective navigation' (c.f. Broberg, O., Hermund, I., 2004. The OHS consultant as a 'political reflective navigator' in technological change processes. International Journal of Industrial Ergonomics 33 (4), 315-326) by the project owner to find new ways to overcome barriers and anchor ergonomics into the organisation. While special 'ergonomics' groups did not survive long, progress was observed in including ergonomics in regular design groups. A cross-functional workshop that fostered discussion across organisational boundaries helped shift focus from retrofitting systems to future production systems and improve engagement of engineering teams. Progress was marked by both success and setbacks and full integration appears to require more than 2 years time. It is concluded that support by senior managers should include succession planning for personnel that are key to the change effort.

Key facilitators and best practices of hotel-style room service in hospitals.

PubMed

Sheehan-Smith, Lisa

2006-04-01

This qualitative study sought to identify the features, advantages, and disadvantages of hotel-style room service; the barriers to, and facilitators for, implementing the process; and "best practices." The study took place in four heterogeneous hospitals. Participants included hospital administrators, managers, and room-service employees. Data-collection methods included semi-structured interviews, observations, and document analysis. Common features of hotel-style room service were meal delivery within 30 to 45 minutes, a restaurant-style menu, procedures to feed ineligible patients, tray assembly on demand, scripting, and waitstaff uniforms for room-service employees. The major barrier to implementing room service was obtaining nursing support. The key facilitators were the hospital's service-oriented culture, using a multidisciplinary planning team, engaging nursing departments early in the planning stages, and intense customer-service training of room-service employees. The overwhelming advantage was patients' control over their food choices. The main disadvantage was cost. Initial best practices in hotel-style room service include: (a) taking a multidisciplinary team approach for developing and implementing the process, (b) customer-service training, (c) using a customer-driven menu, (d) wearing waitstaff uniforms, and (e) using carts with airpots for dispensing hot beverages.

A web-based and mobile patient-centered ''microblog'' messaging platform to improve care team communication in acute care.

PubMed

Dalal, Anuj K; Schnipper, Jeffrey; Massaro, Anthony; Hanna, John; Mlaver, Eli; McNally, Kelly; Stade, Diana; Morrison, Constance; Bates, David W

2017-04-01

Communication in acute care settings is fragmented and occurs asynchronously via a variety of electronic modalities. Providers are often not on the same page with regard to the plan of care. We designed and developed a secure, patient-centered "microblog" messaging platform that identifies care team members by synchronizing with the electronic health record, and directs providers to a single forum where they can communicate about the plan of care. The system was used for 35% of patients admitted to a medical intensive care unit over a 6-month period. Major themes in messages included care coordination (49%), clinical summarization (29%), and care team collaboration (27%). Message transparency and persistence were seen as useful features by 83% and 62% of respondents, respectively. Availability of alternative messaging tools and variable use by non-unit providers were seen as main barriers to adoption by 83% and 62% of respondents, respectively. This approach has much potential to improve communication across settings once barriers are addressed. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Connected commercial vehicles-integrated truck project : vehicle build and build test plan, final technical report.

DOT National Transportation Integrated Search

2000-12-01

This paper brings together the findings of activities that addressed the impacts of nontechnical barriers and constraints that might impede the progress of Intelligent Transportation Systems (ITS) programs. It discusses how the planning and deploymen...

Barriers and strategies to an iterative model of advance care planning communication.

PubMed

Ahluwalia, Sangeeta C; Bekelman, David B; Huynh, Alexis K; Prendergast, Thomas J; Shreve, Scott; Lorenz, Karl A

2015-12-01

Early and repeated patient-provider conversations about advance care planning (ACP) are now widely recommended. We sought to characterize barriers and strategies for realizing an iterative model of ACP patient-provider communication. A total of 2 multidisciplinary focus groups and 3 semistructured interviews with 20 providers at a large Veterans Affairs medical center. Thematic analysis was employed to identify salient themes. Barriers included variation among providers in approaches to ACP, lack of useful information about patient values to guide decision making, and ineffective communication between providers across settings. Strategies included eliciting patient values rather than specific treatment choices and an increased role for primary care in the ACP process. Greater attention to connecting providers across the continuum, maximizing the potential of the electronic health record, and linking patient experiences to their values may help to connect ACP communication across the continuum. © The Author(s) 2014.

Mental Health Service Use Among Firefighters With Suicidal Thoughts and Behaviors.

PubMed

Hom, Melanie A; Stanley, Ian H; Ringer, Fallon B; Joiner, Thomas E

2016-06-01

This study aimed to characterize rates and correlates of mental health service use, as well as barriers to care, among a sample of firefighters reporting a history of suicide ideation, plans, or attempts during their firefighting careers. Participants (N=483) completed a Web-based survey assessing history of suicidal thoughts and behaviors, prior mental health service utilization, and barriers to treatment. Overall, 77% of participants reported receipt of mental health services during their firefighting careers (attempt history, 93%; plan but no attempt, 77%; and ideation only 68%). Firefighters with fewer years of service were less likely than those with more years to have accessed treatment. Service nonusers were more likely than service users to report concerns regarding reputation and embarrassment as barriers to care. Findings from this preliminary investigation suggest that the majority of firefighters with a history of elevated suicide risk have received mental health services.

Household waste compositional analysis variation from insular communities in the framework of waste prevention strategy plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zorpas, Antonis A., E-mail: antonis.zorpas@ouc.ac.cy; Lasaridi, Katia, E-mail: klasaridi@hua.gr; Voukkali, Irene

Highlights: • Waste framework directive has set clear waste prevention procedures. • Household Compositional analysis. • Waste management plans. • Zero waste approach. • Waste generation. - Abstract: Waste management planning requires reliable data regarding waste generation, affecting factors on waste generation and forecasts of waste quantities based on facts. In order to decrease the environmental impacts of waste management the choice of prevention plan as well as the treatment method must be based on the features of the waste that are produced in a specific area. Factors such as culture, economic development, climate, and energy sources have an impactmore » on waste composition; composition influences the need of collecting waste more or less frequently of waste collection and disposition. The research question was to discover the main barriers concerning the compositional analysis in Insular Communities under warm climate conditions and the findings from this study enabled the main contents of a waste management plan to be established. These included advice to residents on waste minimisation, liaison with stakeholders and the expansion of kerbside recycling schemes.« less

Rural families caring for a relative with dementia: barriers to use of formal services.

PubMed

Morgan, Debra G; Semchuk, Karen M; Stewart, Norma J; D'Arcy, Carl

2002-10-01

Planning for the care of increasing numbers of elderly persons with dementia has become an urgent health services concern in Canada and elsewhere, yet little is known about the challenges of providing appropriate dementia care in rural areas. A community-based approach was used to obtain input from decision-makers and others to develop the objectives and design for a study of rural dementia care in the province of Saskatchewan, Canada. The resulting study design, which used both qualitative and quantitative methods, was then pilot tested in one rural health district (16,000 km2, population 20,000). This paper describes the study development process and reports selected findings from focus groups conducted with home care staff and family members, focussing on the theme of low use of formal supportive services such as home care and support groups by family caregivers. Participants identified eight barriers to the use of formal services, described consequences of low service use, and suggested strategies for addressing this concern.

Diabetes risk factors in children: a partnership between nurse practitioner and high school students.

PubMed

Lipman, Terri H; Schucker, Mary McGrath; Ratcliffe, Sarah J; Holmberg, Tyler; Baier, Scott; Deatrick, Janet A

2011-01-01

This project was a 4-year university/community collaboration to (1) screen for diabetes risk factors in children from in an inner-city community; (2) assess children's knowledge of nutrition and measure their physical endurance; and (3) survey parents about barriers to healthy living. Descriptive cross-sectional study utilizing a community participatory-based research approach. For a 4-week period each year, nurse practitioner students and high school students partnered in an evaluation of elementary school children that included assessment of (1) height, weight, waist circumference, BMI, and acanthosis nigricans; (2) scores on a nutrition knowledge test; and (3) recovery heart rate after a dance activity. Parents of the children were surveyed regarding barriers to healthy eating and activity. A total of 240 African American children were evaluated: 25% were obese, 24% had a waist circumference >95th percentile, and 14% had acanthosis nigricans. The mean score of a nutrition knowledge test was 65%, and recovery heart rates were significantly higher than preexercise heart rates. Of 48 parents surveyed, the most common barrier to eating healthy reported was the children's picky eating (62%), and most common barrier to activity was lack of access to safe places to play (54%). Nurses working with children from inner-city communities should be especially aware of the children's many risk factors for diabetes. Clinicians who hope to make a difference in altering these risks should collaborate with the community to target high-risk populations for diabetes screening, promote good nutrition and exercise, and address barriers to healthy living. When developing plans of care for children, regardless of setting, it is critical to understand the community and incorporate the families as partners in developing culturally relevant interventions.

Vouchers in Fragile States: Reducing Barriers to Long-Acting Reversible Contraception in Yemen and Pakistan

PubMed Central

Boddam-Whetham, Luke; Gul, Xaher; Al-Kobati, Eman; Gorter, Anna C

2016-01-01

ABSTRACT In conflict-affected states, vouchers have reduced barriers to reproductive health services and have enabled health programs to use targeted subsidies to increase uptake of specific health services. Vouchers can also be used to channel funds to public- and private-service providers and improve service quality. The Yamaan Foundation for Health and Social Development in Yemen and the Marie Stopes Society (MSS) in Pakistan—both working with Options Consultancy Services—have developed voucher programs that subsidize voluntary access to long-acting reversible contraceptives (LARCs) and permanent methods (PMs) of family planning in their respective fragile countries. The programs focus on LARCs and PMs because these methods are particularly difficult for poor women to access due to their cost and to provider biases against offering them. Using estimates of expected voluntary uptake of LARCs and PMs for 2014 based on contraceptive prevalence rates, and comparing these with uptake of LARCs and PMs through the voucher programs, we show the substantial increase in service utilization that vouchers can enable by contributing to an expanded method choice. In the governorate of Lahj, Yemen, vouchers for family planning led to an estimated 38% increase in 2014 over the expected use of LARCs and PMs (720 vs. 521 expected). We applied the same approach in 13 districts of Punjab, Khyber Pakhtunkhwa (KPK), and Sindh provinces in Pakistan. Our calculations suggest that vouchers enabled 10 times more women than expected to choose LARCs and PMs in 2014 in those areas of Pakistan (73,639 vs. 6,455 expected). Voucher programs can promote and maintain access to family planning services where existing health systems are hampered. Vouchers are a flexible financing approach that enable expansion of contraceptive choice and the inclusion of the private sector in service delivery to the poor. They can keep financial resources flowing where the public sector is prevented from offering services, and ensure that alternative sources are available for reproductive health services such as family planning. Programs should consider using vouchers in fragile states to facilitate access to family planning services and support the countries’ health systems. PMID:27540129

Better, Sooner, More Convenient? The reality of pursuing greater integration between primary and secondary healthcare providers in New Zealand

PubMed Central

Lovelock, Kirsten; Martin, Greg; Gauld, Robin; MacRae, Jayden

2017-01-01

Objectives: This article focuses on the results of evaluations of two business plans developed in response to a policy initiative which aimed to achieve greater integration between primary and secondary health providers in New Zealand. We employ the Consolidated Framework for Implementation Research to inform our analysis. The Better, Sooner, More Convenient policy programme involved the development of business plans and, within each business plan, a range of areas of focus and associated work-streams. Methods: The evaluations employed a mixed method multi-level case study design, involving qualitative face-to-face interviews with front-line staff, clinicians and management in two districts, one in the North Island and the other in the South Island, and an analysis of routine data tracked ambulatory sensitive hospitalisations and emergency department presentations. Two postal surveys were conducted, one focussing on the patient care experiences of integration and care co-ordination and the second focussing on the perspectives of health professionals in primary and secondary settings in both districts. Results: Both evaluations revealed non-significant changes in ambulatory sensitive hospitalisations and emergency department presentation rates and slow uneven progress with areas of focus and their associated work-streams. Our evaluations revealed a range of implementation issues, the barriers and facilitators to greater integration of healthcare services and the implications for those who were responsible for putting policy into practice. Conclusion: The business plans were shown to be overly ambitious and compromised by the size and scope of the business plans; dysfunctional governance arrangements and associated accountability issues; organisational inability to implement change quickly with appropriate and timely funding support; an absence of organisational structural change allowing parity with the policy objectives; barriers that were encountered because of inadequate attention to organisational culture; competing additional areas of focus within the same timeframe; and consequent overloading of front-line staff which led to workload stress, fatigue and disillusionment. Where success was achieved, this largely hinged on the enthusiasm of a small pool of front-line workers and their initial buy-into the idea of integrated care. PMID:28491307

Better, Sooner, More Convenient? The reality of pursuing greater integration between primary and secondary healthcare providers in New Zealand.

PubMed

Lovelock, Kirsten; Martin, Greg; Gauld, Robin; MacRae, Jayden

2017-01-01

This article focuses on the results of evaluations of two business plans developed in response to a policy initiative which aimed to achieve greater integration between primary and secondary health providers in New Zealand. We employ the Consolidated Framework for Implementation Research to inform our analysis. The Better, Sooner, More Convenient policy programme involved the development of business plans and, within each business plan, a range of areas of focus and associated work-streams. The evaluations employed a mixed method multi-level case study design, involving qualitative face-to-face interviews with front-line staff, clinicians and management in two districts, one in the North Island and the other in the South Island, and an analysis of routine data tracked ambulatory sensitive hospitalisations and emergency department presentations. Two postal surveys were conducted, one focussing on the patient care experiences of integration and care co-ordination and the second focussing on the perspectives of health professionals in primary and secondary settings in both districts. Both evaluations revealed non-significant changes in ambulatory sensitive hospitalisations and emergency department presentation rates and slow uneven progress with areas of focus and their associated work-streams. Our evaluations revealed a range of implementation issues, the barriers and facilitators to greater integration of healthcare services and the implications for those who were responsible for putting policy into practice. The business plans were shown to be overly ambitious and compromised by the size and scope of the business plans; dysfunctional governance arrangements and associated accountability issues; organisational inability to implement change quickly with appropriate and timely funding support; an absence of organisational structural change allowing parity with the policy objectives; barriers that were encountered because of inadequate attention to organisational culture; competing additional areas of focus within the same timeframe; and consequent overloading of front-line staff which led to workload stress, fatigue and disillusionment. Where success was achieved, this largely hinged on the enthusiasm of a small pool of front-line workers and their initial buy-into the idea of integrated care.

Systematic planning of disconnection to enhance conservation success in a modified world.

PubMed

Hermoso, Virgilio; Januchowski-Hartley, Stephanie R; Linke, Simon

2015-12-01

Maintaining spatial-temporal connectivity for conservation is necessary to allow the persistence of ecological processes and the biodiversity they sustain. However, conservation practice in human-modified environments can also benefit from prescribed disconnection through the implementation of barriers. Barriers, such as fences or dams, and buffer zones can be a cost-effective way of addressing threats caused by a globally connected world, such as the propagation of invasive species and diseases, creating refuge areas for native biodiversity and helping reduce economic losses caused by native wildlife or invasive species. Despite the global attention that disconnection has received, no clear framework exists to guide the allocation of barriers for conservation management. Here we propose that the implementation of barriers for conservation should be systematically planned, considering ecological trade-offs for multiple species (easing threats vs. interruption of ecosystem processes) and socio-economic cost-benefits (implementation cost vs. reduced human-wildlife conflicts), rather than using ad-hoc opportunistic criteria or accommodating conservation needs for individual species. Such a systematic approach is necessary to ensure both socially acceptable and ecologically effective use of disconnections as a conservation tool and ideally planned across different realms so co-benefits or trade-offs can be accounted for. However, any implementation of disconnection for conservation should be cautiously considered if uncertainty in effectiveness of the barrier and ecological impacts to other species are high. We also suggest the need for improved approaches to monitoring to learn from previous successes and failures. Our recommendations should guide the systematic evaluation and allocation of barriers to help enhance the value of this conservation tool in the face of increasing propagation of threats worldwide. However, new tools and collaborative frameworks across different realms are needed to help stakeholders make better informed decision. Copyright © 2015 Elsevier B.V. All rights reserved.

[Group psychotherapy for Turkish patients with a translator--a report with comments of the first, constituting session].

PubMed

Röder, F; Hersfeld, B

1995-07-01

The needs of insufficiently treated Turkish patients motivated to offer a group-psychotherapy in cooperation with an interpreter. Only on a trickful way his expenses could be paid by the health insurance. While the plan for such a group was made, it was estimated just as a second-rate escape for such patients. But already during the course of the first group-session a therapeutic concept developed which overcame barriers of language and culture. So this experiment turned out to be an important step for developing suitable therapeutic structures for migrants.

Development of an outcome measurement system for service planning for children and youth with special needs

PubMed Central

Kertoy, M K; Russell, D J; Rosenbaum, P; Jaffer, S; Law, M; McCauley, D; Gorter, J W

2013-01-01

Aim This study described the process used in developing an outcome measurement framework for system planning to improve services for children and youth with special needs and their families in a Canadian province. The study reports the results of several parent-completed measures, which would be useful in service planning as well as the acceptability and utility of these measures for use by families and service centres. Methods/results Development of a theoretical framework, consultation with key stakeholders, testing the utility of selected outcome measures and initial dissemination of results were critical elements in the successful development of an outcome system. Consultation with stakeholders confirmed use of the International Classification of Functioning, Disability and Health and the child-within-family-within community model as theoretical frameworks while building valuable partnerships and identifying potential barriers to implementation. Pilot testing showed three outcome measures were feasible for families to complete and the measures provided information about services for children that was valuable to families as well as service providers. Gaps in service delivery were identified and the need for better communication between service providers and communities to facilitate integrated services was highlighted. Conclusion The findings from this study can be used to implement an outcome measurement system for children with special needs and may serve as a resource for international researchers who are working to develop valid tools as well as outcome systems that are useful for system planning. PMID:22845889

Factors blocking the development of north - central Rzeszów

NASA Astrophysics Data System (ADS)

Rybka, Adam; Mazur, Rafał

2017-12-01

Rzeszów is one of the best developing cities in Poland. Once the small HQ of a principality - due to complicated historical conditioning - it has now become a place where an increasing number of people choose to live. The city with its bursting life, streets and squares starts and ends, however, in an area which only a few dozen years ago still catered for one fifth of the current population. The main reason for this phenomenon is the presence of spatial barriers, which significantly limit the development of the central urban area. This article analyzes the elements, which block the development of the north-central part of Rzeszów. An appropriate diagnosis of the problem may in the future allow the right actions in urban planning to be taken in order to cross these barriers. This may lead to the future development of areas with huge urbanization potential. Investments undertaken by city authorities to develop the northern peripheries of Rzeszów may trigger the development of the central district in this direction. This may occur as a result of concrete design interventions. The new part of the central district should have the scale and proportions of urban space that answer to the needs of a dynamically developing capital of the Podkarpacie region.

Are joint health plans effective for coordination of health services? An analysis based on theory and Danish pre-reform results

PubMed Central

Strandberg-Larsen, Martin; Bernt Nielsen, Mikkel; Krasnik, Allan

2007-01-01

Background Since 1994 formal health plans have been used for coordination of health care services between the regional and local level in Denmark. From 2007 a substantial reform has changed the administrative boundaries of the system and a new tool for coordination has been introduced. Purpose To assess the use of the pre-reform health plans as a tool for strengthening coordination, quality and preventive efforts between the regional and local level of health care. Methods A survey addressed to: all counties (n=15), all municipalities (n=271) and a randomised selected sample of general practitioners (n=700). Results The stakeholders at the administrative level agree that health plans have not been effective as a tool for coordination. The development of health plans are dominated by the regional level. At the functional level 27 percent of the general practitioners are not familiar with health plans. Among those familiar with health plans 61 percent report that health plans influence their work to only a lesser degree or not at all. Conclusion Joint health planning is needed to achieve coordination of care. Efforts must be made to overcome barriers hampering efficient whole system planning. Active policies emphasising the necessity of health planning, despite involved cost, are warranted to insure delivery of care that benefits the health of the population. PMID:17925882

Water safety plans: bridges and barriers to implementation in North Carolina.

PubMed

Amjad, Urooj Quezon; Luh, Jeanne; Baum, Rachel; Bartram, Jamie

2016-10-01

First developed by the World Health Organization, and now used in several countries, water safety plans (WSPs) are a multi-step, preventive process for managing drinking water hazards. While the beneficial impacts of WSPs have been documented in diverse countries, how to successfully implement WSPs in the United States remains a challenge. We examine the willingness and ability of water utility leaders to implement WSPs in the US state of North Carolina. Our findings show that water utilities have more of a reactive than preventive organizational culture, that implementation requires prioritization of time and resources, perceived comparative advantage to other hazard management plans, leadership in implementation, and identification of how WSPs can be embedded in existing work practices. Future research could focus on whether WSP implementation provides benefits such as decreases in operational costs, and improved organization of records and communication.

It Comes With the Job: Work Organizational, Job Design, and Self-Regulatory Barriers to Improving the Health Status of Train Drivers.

PubMed

Naweed, Anjum; Chapman, Janine; Allan, Matthew; Trigg, Joshua

2017-03-01

This study aimed to examine the impacts of key barriers to improving the occupational health status of Australian train drivers. From May to June, 2015, five semi-structured qualitative focus groups were conducted with 29 train drivers from South Australian, Victorian, and New South Wales-based rail organizations in Australia. Occupational health was impeded by multiple barriers regarding sleep (patterns/fatigue), diet (planning/context), mental health (occupational stress), rostering (low autonomy), sedentary time, low fitness motivation, and family/social life conflicts. Work organizational barriers included communication issues, low organizational support, and existing social norms. Job design barriers included rostering, fatigue, stimulant reliance, and family/social life imbalances. Self-regulatory barriers included dietary and exercise patterns habits and patterns. Occupational health interventions for Australian train drivers must address work organizational, job design, and self-regulatory barriers to healthier lifestyle behaviors.

Facilitators and Barriers to Healthy Pregnancy Spacing among Medicaid Beneficiaries: Findings from the National Strong Start Initiative.

PubMed

Cross-Barnet, Caitlin; Courtot, Brigette; Hill, Ian; Benatar, Sarah; Cheeks, Morgan; Markell, Jenny

Closely spaced, unintended pregnancies are common among Medicaid beneficiaries and create avoidable risks for women and infants, including preterm birth. The Strong Start for Mothers and Newborns Initiative, a program of the Center for Medicare and Medicaid Innovation, intended to prevent preterm birth through psychosocially based enhanced prenatal care in maternity care homes, group prenatal care, and birth centers. Comprehensive care offers the opportunity for education and family planning to promote healthy pregnancy spacing. As of March 30, 2016, there were 42,138 women enrolled in Strong Start and 23,377 women had given birth. Individual-level data were collected through three participant survey instruments and a medical chart review, and approximately one-half of women who had delivered (n = 10,374) had nonmissing responses on a postpartum survey that asked about postpartum family planning. Qualitative case studies were conducted annually for the first 3 years of the program and included 629 interviews with staff and 122 focus groups with 887 Strong Start participants. Most programs tried to promote healthy pregnancy spacing through family planning education and provision with some success. Group care sites in particular established protocols for patient-centered family planning education and decision making. Despite program efforts, however, barriers to uptake remained. These included state and institutional policies, provider knowledge and bias, lack of protocols for timing and content of education, and participant issues such as transportation or cultural preferences. The Strong Start initiative introduced a number of successful strategies for increasing women's knowledge regarding healthy pregnancy spacing and access to family planning. Multiple barriers can impact postpartum Medicaid participants' capacity to plan and space pregnancies, and addressing such issues holistically is an important strategy for facilitating healthy interpregnancy intervals. Published by Elsevier Inc.

"I sleep better at night:" How peer review of radiation treatment plans indirectly improves quality of care across radiation treatment programs.

PubMed

Brundage, Michael D; Hart, Margaret; O'Donnell, Jennifer; Reddeman, Lindsay; Gutierrez, Eric; Foxcroft, Sophie; Warde, Padraig

Peer review of radiation oncology treatment plans is increasingly recognized as an important component of quality assurance in radiation treatment planning and delivery. Peer review of treatment plans can directly improve the quality of those plans and can also have indirect effects on radiation treatment programs. We undertook a systematic, qualitative approach to describing the indirect benefits of peer review, factors that were seen to facilitate or act as barriers to the implementation of peer review, and strategies to address these barriers across a provincial jurisdiction of radiation oncology programs (ROPs). Semistructured qualitative interviews were held with radiation oncology department heads and radiation therapy managers (or delegates) in all 14 ROPs in Ontario, Canada. We used a theoretically guided phenomenological qualitative approach to design and analyze the interview content. Themes were recorded by 2 independent reviewers, and any discordance was resolved by consensus. A total of 28 interviews were completed with 32 interviewees. Twenty-two unique themes addressed perceived benefits of peer review, relating to either peer review structure (n = 3), process (n = 9), or outcome (n = 10). Of these 22 themes, 19 related to indirect benefits to ROPs. In addition, 18 themes related to factors that facilitated peer review activities and 30 themes related to key barriers to implementing peer review were identified. Findings were consistent with, and enhanced the understanding of, previous survey-based assessments of the benefits and challenges of implementing peer review programs. Although challenges and concerns regarding the implementation of peer review were evident, the indirect benefits to radiation programs are numerous, far outweigh the implementation challenges, and strongly complement the direct individual-patient benefits that result from peer review quality assurance of radiation treatment plans. Copyright © 2016. Published by Elsevier Inc.

Development and pilot testing of a mental healthcare plan in Nepal

PubMed Central

Jordans, M. J. D.; Luitel, N. P.; Pokhrel, P.; Patel, V.

2016-01-01

Background Mental health service delivery models that are grounded in the local context are needed to address the substantial treatment gap in low- and middle-income countries. Aims To present the development, and content, of a mental healthcare plan (MHCP) in Nepal and assess initial feasibility. Method A mixed methods formative study was conducted. Routine monitoring and evaluation data, including client flow and reports of satisfaction, were obtained from patients (n = 135) during the pilot-testing phase in two health facilities. Results The resulting MHCP consists of 12 packages, divided over community, health facility and organisation platforms. Service implementation data support the real-life applicability of the MHCP, with reasonable treatment uptake. Key barriers were identified and addressed, namely dissatisfaction with privacy, perceived burden among health workers and high drop-out rates. Conclusions The MHCP follows a collaborative care model encompassing community and primary healthcare interventions. PMID:26447173

Development and pilot testing of a mental healthcare plan in Nepal.

PubMed

Jordans, M J D; Luitel, N P; Pokhrel, P; Patel, V

2016-01-01

Mental health service delivery models that are grounded in the local context are needed to address the substantial treatment gap in low- and middle-income countries. To present the development, and content, of a mental healthcare plan (MHCP) in Nepal and assess initial feasibility. A mixed methods formative study was conducted. Routine monitoring and evaluation data, including client flow and reports of satisfaction, were obtained from patients (n = 135) during the pilot-testing phase in two health facilities. The resulting MHCP consists of 12 packages, divided over community, health facility and organisation platforms. Service implementation data support the real-life applicability of the MHCP, with reasonable treatment uptake. Key barriers were identified and addressed, namely dissatisfaction with privacy, perceived burden among health workers and high drop-out rates. The MHCP follows a collaborative care model encompassing community and primary healthcare interventions. © The Royal College of Psychiatrists 2016.

Perceived barriers to completing an e-learning program on evidence-based medicine.

PubMed

Gagnon, Marie-Pierre; Légaré, France; Labrecque, Michel; Frémont, Pierre; Cauchon, Michel; Desmartis, Marie

2007-01-01

The Continuing Professional Development Center of the Faculty of Medicine at Laval University offers an internet-based program on evidence-based medicine (EBM). After one year, only three physicians out of the 40 who willingly paid to register had completed the entire program. This descriptive study aimed to identify physicians' beliefs regarding their completion of this online program. Using theoretical concepts from the Theory of Planned Behaviour, a semi-structured telephone interview guide was developed to assess respondents' attitudes, perceived subjective norms, perceived obstacles and facilitating conditions with respect to completing this internet-based program. Three independent reviewers performed content analysis of the interview transcripts to obtain an appropriate level of reliability. Findings were shared and organised according to theoretical categories of beliefs. A total of 35 physicians (88% response rate) were interviewed. Despite perceived advantages to completing the internet-based program, barriers remained, especially those related to physicians' perceptions of time constraints. Lack of personal discipline and unfamiliarity with computers were also perceived as important barriers. This study offers a theoretical basis to understand physicians' beliefs towards completing an internet-based continuing medical education (CME) program on EBM. Based upon respondents' insights, several modifications were carried out to enhance the uptake of the program by physicians and, therefore, its implementation.

Paths to improving care of Australian Aboriginal and Torres Strait Islander women following gestational diabetes.

PubMed

Campbell, Sandra; Roux, Nicolette; Preece, Cilla; Rafter, Eileen; Davis, Bronwyn; Mein, Jackie; Boyle, Jacqueline; Fredericks, Bronwyn; Chamberlain, Catherine

2017-11-01

Aim To understand enablers and barriers influencing postpartum screening for type 2 diabetes following gestational diabetes in Australian Indigenous women and how screening might be improved. Australian Indigenous women with gestational diabetes mellitus (GDM) are less likely than other Australian women to receive postpartum diabetes screening. This is despite a fourfold higher risk of developing type 2 diabetes within eight years postpartum. We conducted interviews with seven Indigenous women with previous GDM, focus groups with 20 Indigenous health workers and workshops with 24 other health professionals. Data collection included brainstorming, visualisation, sorting and prioritising activities. Data were analysed thematically using the Theoretical Domains Framework. Barriers are presented under the headings of 'capability', 'motivation' and 'opportunity'. Enabling strategies are presented under 'intervention' and 'policy' headings. Findings Participants generated 28 enabling environmental, educational and incentive interventions, and service provision, communication, guideline, persuasive and fiscal policies to address barriers to screening and improve postpartum support for women. The highest priorities included providing holistic social support, culturally appropriate resources, improving Indigenous workforce involvement and establishing structured follow-up systems. Understanding Indigenous women's perspectives, developing strategies with health workers and action planning with other health professionals can generate context-relevant feasible strategies to improve postpartum care after GDM. Importantly, we need evidence which can demonstrate whether the strategies are effective.

[Who should decide at the end of life? International practice of advance care planning and possibilities for adaptation in Hungary].

PubMed

Busa, Csilla; Zeller, Judit; Csikós, Ágnes

2018-01-01

At the advanced stage of serious illness, end-of-life decisions need to be made. Advance care planning offers patients the right to decide on their own future care when independent decision-making is no longer possible. The most complex and effective advance care plans include patients' preferred or refused medical treatments, care-related wishes, and individual values as well. Advance care planning can improve end-of-life care and contribute to higher satisfaction. It can also reduce distress in relatives and the costs of care. Patients' preferences provide a guidance for professional care. A number of studies have identified the benefits of advance care planning, and it has been included in guidelines. Potential barriers to advance care planning could be as follows: taboo of talking about dying, negative attitudes of patients and relatives, poor knowledge of professional caregivers, lack of necessary circumstances to have the conversation. Advance care planning is almost unknown in Hungary, although it is possible to refuse certain types of treatments. Cooperation of professionals, development of gradual and postgraduate trainings, and improvement of social awareness are also needed so that advance care planning can be adapted in Hungary. Orv Hetil. 2018; 159(4): 131-140.

Facilitating Deployment of Community Solar PV systems on Rooftops and Vacant Land in Northeast IL - Final Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stone, Deborah; Oakleaf, Laura

The Cook County Community Solar project set out to unlock the potential of community solar in the Chicago region with lessons that could be applied nationally. One of the first steps was to prove out the potential market. This was done through an opportunity assessment which showed there is over 9,000 megawatts worth of site capacity available for community solar projects in Cook County – nearly enough to offset all of Cook County’s residential electricity use. The assessment also showed that almost 75% of Cook County households are not able to invest directly in solar photovoltaic systems due to amore » variety of issues from physical barriers such as shading, or condition of the roof, to financial barriers such as lack of roof ownership, or the up-front costs of installation. Because of these barriers, community solar is an essential part of making the benefits of renewable energy available to all of the residents of Cook County. In addition to the opportunity assessment the project team also worked with the over 200 individuals who participated in the stakeholder advisory group to develop a number of other products including: 1) an Economic & Policy Barriers Resolutions and Work Plan document which laid out best practices to address the policy barriers that existed at the time (May of 2016) 2) Value Proposition Report I and Report II which summarize the value of community solar to potential developers and subscribers, 3) The Community Solar Business Case Tool, which provides a flexible financial model that projects the costs and befits to the system developer and subscriber for a project, 4) Bill Crediting Analysis and the 5) Final Report. The Final Report contains 15 case studies which prove that community solar projects are economically feasible in Cook County with a variety of sites, solar designs, ownership and subscriber models.« less

The open prototype for educational NanoSats: Fixing the other side of the small satellite cost equation

NASA Astrophysics Data System (ADS)

Berk, Josh; Straub, Jeremy; Whalen, David

Government supported nano-satellite launch programs and emerging commercial small satellite launch services are reducing the cost of access to space for educational and other CubeSat projects. The cost and complexity of designing and building these satellites remains a vexing complication for many would be CubeSat aspirants. The Open Prototype for Educational NanoSats (OPEN), a proposed nano-satellite development platform, is described in this paper. OPEN endeavors to reduce the costs and risks associated with educational, government and commercial nano-satellite development. OPEN provides free and publicly available plans for building, testing and operating a versatile, low-cost satellite, based on the standardized CubeSat form-factor. OPEN consists of public-domain educational reference plans, complete with engineering schematics, CAD files, construction and test instructions as well as ancillary reference materials relevant to satellite building and operation. By making the plan, to produce a small but capable spacecraft freely available, OPEN seeks to lower the barriers to access on the other side (non-launch costs) of the satellite cost equation.

The Challenge of Writing for Publication: Implications for Teaching-Learning Nursing.

PubMed

Yancey, Nan Russell

2016-10-01

Disseminating new scientific knowledge through publication is critical for any discipline, including nursing. The challenge for nurse faculty is preparing emerging nurses with the skills, enthusiasm, and disposition to fully assume professional roles as nurse scientists and scholars, including that of author. Exploring how students learn to write for publication and barriers to writing for publication, recommendations are offered for teaching-learning as a guide to faculty in planning programs, developing curriculum, and identifying teaching-learning strategies. © The Author(s) 2016.

Army Mobility Energy Research & Development Plan.

DTIC Science & Technology

1980-01-01

goal by the time specified. It does not make 3-22 uoiienjeA3 xx c IOLIOse9 o0 S sisAlojpAH oaewAzu3 0 f >A6Jau3 461H0 (n) wawdolaAao] JSO[ r, COq ulpue...requirements to syn- thetic or alternate fuels by the year 2000. STOG REFERENCE: 80-7.1:4,6,23 MAJOR TECHNOLOGICAL BARRIERS: Enzyme production...substrate pretreatment, and fermentation of enzymatic hydrolyzates to ethanol. APPROACH: a. Fungal mutation and enzyme production process optimization. b

Making the most of learning needs assessments.

PubMed

Williams, M L

1998-01-01

Identifying learning needs of nurses is an important role of the staff development educator. However, few educators have specific training in the preparation and evaluation of a learning needs assessment. This article describes the assumptions, benefits, and potential barriers when planning a needs assessment survey. Specific strategies to maximize the benefits of the survey are shared. Competent nurses are the cornerstone of professional nursing care, and identifying and responding to learning needs through a needs assessment is a critical step in assuring competence.

Preemptive Clinical Pharmacogenetics Implementation: Current programs in five United States medical centers

PubMed Central

Dunnenberger, Henry M.; Crews, Kristine R.; Hoffman, James M.; Caudle, Kelly E.; Broeckel, Ulrich; Howard, Scott C.; Hunkler, Robert J.; Klein, Teri E.; Evans, William E.; Relling, Mary V.

2015-01-01

Although the field of pharmacogenetics has existed for decades, the implementation of, pharmacogenetic testing in clinical care has been slow. There are numerous publications, describing the barriers to clinical implementation of pharmacogenetics. Recently, several freely, available resources have been developed to help address these barriers. In this review we, discuss current programs that use preemptive genotyping to optimize the pharmacotherapy of, patients. Array-based preemptive testing includes a large number of relevant pharmacogenes, that impact multiple high-risk drugs. Using a preemptive approach allows genotyping results to, be available prior to any prescribing decision so that genomic variation may be considered as, an inherent patient characteristic in the planning of therapy. This review describes the common, elements among programs that have implemented preemptive genotyping and highlights key, processes for implementation, including clinical decision support. PMID:25292429

Cost/benefit studies of advanced materials technologies for future aircraft turbine engines: Materials for advanced turbine engines

NASA Technical Reports Server (NTRS)

Stearns, M.; Wilbers, L.

1982-01-01

Cost benefit studies were conducted on six advanced materials and processes technologies applicable to commercial engines planned for production in the 1985 to 1990 time frame. These technologies consisted of thermal barrier coatings for combustor and high pressure turbine airfoils, directionally solidified eutectic high pressure turbine blades, (both cast and fabricated), and mixers, tail cones, and piping made of titanium-aluminum alloys. A fabricated titanium fan blisk, an advanced turbine disk alloy with improved low cycle fatigue life, and a long-life high pressure turbine blade abrasive tip and ceramic shroud system were also analyzed. Technologies showing considerable promise as to benefits, low development costs, and high probability of success were thermal barrier coating, directionally solidified eutectic turbine blades, and abrasive-tip blades/ceramic-shroud turbine systems.

Control of barrier island shape by inlet sediment bypassing: East Frisian Islands, West Germany

USGS Publications Warehouse

FitzGerald, D.M.; Penland, S.; Nummedal, D.

1984-01-01

A study of the East Frisian Islands has shown that the plan form of these islands can be explained by processes of inlet sediment bypassing. This island chain is located on a high wave energy, high tide range shoreline where the average deep-water significant wave height exceeds 1.0 m and the spring tidal range varies from 2.7 m at Juist to 2.9 m at Wangerooge. An abundant sediment supply and a strong eastward component of wave power (4.4 ?? 103 W m-1) have caused a persistent eastward growth of the barrier islands. The eastward extension of the barriers has been accommodated more by inlet narrowing, than by inlet migration. It is estimated from morphological evidence that a minimum of 2.7 ?? 105 m3 of sand is delivered to the inlets each year via the easterly longshore transport system. Much of this sand ultimately bypasses the inlets in the form of large, migrating swash bars. The location where the swash bars attach to the beach is controlled by the amount of overlap of the ebb-tidal delta along the downdrift inlet shoreline. The configuration of the ebbtidal delta, in turn, is a function of inlet size and position of the main ebb channel. The swash bar welding process has caused preferential beach nourishment and historical shoreline progradation. Along the East Frisian Islands this process has produced barrier islands with humpbacked, bulbous updrift and bulbous downdrift shapes. The model of barrier island development presented in this paper not only explains well the configuration of the German barriers but also the morphology of barriers along many other mixed energy coasts. ?? 1984.

Improving occupational physicians' adherence to a practice guideline: feasibility and impact of a tailored implementation strategy.

PubMed

Joosen, Margot C W; van Beurden, Karlijn M; Terluin, Berend; van Weeghel, Jaap; Brouwers, Evelien P M; van der Klink, Jac J L

2015-04-24

Although practice guidelines are important tools to improve quality of care, implementation remains challenging. To improve adherence to an evidence-based guideline for the management of mental health problems, we developed a tailored implementation strategy targeting barriers perceived by occupational physicians (OPs). Feasibility and impact on OPs' barriers were evaluated. OPs received 8 training-sessions in small peer-learning groups, aimed at discussing the content of the guideline and their perceived barriers to adhere to guideline recommendations; finding solutions to overcome these barriers; and implementing solutions in practice. The training had a plan-do-check-act (PDCA) structure and was guided by a trainer. Protocol compliance and OPs' experiences were qualitatively and quantitatively assessed. Using a questionnaire, impact on knowledge, attitude, and external barriers to guideline adherence was investigated before and after the training. The training protocol was successfully conducted; guideline recommendations and related barriers were discussed with peers, (innovative) solutions were found and implemented in practice. The participating 32 OPs were divided into 6 groups and all OPs attended 8 sessions. Of the OPs, 90% agreed that the peer-learning groups and the meetings spread over one year were highly effective training components. Significant improvements (p < .05) were found in knowledge, self-efficacy, motivation to use the guideline and its applicability to individual patients. After the training, OPs did not perceive any barriers related to knowledge and self-efficacy. Perceived adherence increased from 48.8% to 96.8% (p < .01). The results imply that an implementation strategy focusing on perceived barriers and tailor-made implementation interventions is a feasible method to enhance guideline adherence. Moreover, the strategy contributed to OPs' knowledge, attitudes, and skills in using the guideline. As a generic approach to overcome barriers perceived in specific situations, this strategy provides a useful method to guideline implementation for other health care professionals too.

Identifying emerging issues in forestry as a tool for research planning.

Treesearch

Hans M. Gregersen; Allen L. Lundgren; Pamela J. Jakes; David N. Bengston

1989-01-01

A Delphi exercise is used to identify emerging issues in National Forest management and use, the relative importance of the issues, and barriers to resolving issues. USDA Forest Service managers agree on the importance of the 11 issues identified; however, researchers and National Forest managers do not always agree on the importance of issues or barriers.

Gaps and Barriers in Services for Children in State Mental Health Plans

ERIC Educational Resources Information Center

Gould, Sara R.; Beals-Erickson, Sarah E.; Roberts, Michael C.

2012-01-01

Significant gaps exist in children's mental healthcare, and barriers prevent access to existing services. Current federal initiatives call for state governmental agencies to recognize and resolve deficits in their systems of care. Previous work has acknowledged some of the problems in meeting the mental health needs of children within a system of…

A Study of the Barriers K-12 Teachers Encounter when Integrating Technology into the Curriculum

ERIC Educational Resources Information Center

Brown-Joseph, Theresa Denise

2010-01-01

This study utilized an outlined plan for a qualitative case study to explore the perceived barriers that teachers in K-12 grades encounter when integrating technology into the curriculum. A purposive sample of 20 teachers from both elementary and high schools provided information during structured interviews about their experiences with…

A Barrier-Free Home: Considerations and Recommendations for Design. Information Support Packet #3.

ERIC Educational Resources Information Center

Stevens, John H.

This guide is intended to assist people with physical disabilities who are wheelchair users and their families in the construction of a barrier-free home. Introductory information notes the importance of specific planning for individual needs and full participation by the homeowner as well as the architect and contractor. Briefly addressed are:…

Dialectical Behavior Therapy in College Counseling Centers: Current Trends and Barriers to Implementation

ERIC Educational Resources Information Center

Chugani, Carla D.; Landes, Sara J.

2016-01-01

The purpose of this study was to examine trends and barriers in implementation of dialectical behavior therapy (DBT) programs in college counseling centers (CCCs). Participants were 107 CCC employees who participated in an electronic survey. One third of respondents endorsed use or planned use of DBT at their centers. The most prevalent primary…

Mobile Phone Use in Psychiatry Residents in the United States: Multisite Cross-Sectional Survey Study

PubMed Central

Torous, John; Boland, Robert; Conrad, Erich

2017-01-01

Background Mobile technology ownership in the general US population and medical professionals is increasing, leading to increased use in clinical settings. However, data on use of mobile technology by psychiatry residents remain unclear. Objective In this study, our aim was to provide data on how psychiatric residents use mobile phones in their clinical education as well as barriers relating to technology use. Methods An anonymous, multisite survey was given to psychiatry residents in 2 regions in the United States, including New Orleans and Boston, to understand their technology use. Results All participants owned mobile phones, and 79% (54/68) used them to access patient information. The majority do not use mobile phones to implement pharmacotherapy (62%, 42/68) or psychotherapy plans (90%, 61/68). The top 3 barriers to using mobile technology in clinical care were privacy concerns (56%, 38/68), lack of clinical guidance (40%, 27/68), and lack of evidence (29%, 20/68). Conclusions We conclude that developing a technology curriculum and engaging in research could address these barriers to using mobile phones in clinical practice. PMID:29092807

Root causes occurrence of low BIM adoption in Malaysia: System dynamics modelling approach

NASA Astrophysics Data System (ADS)

Mamter, Shahela; Aziz, Abdul Rashid Abdul; Zulkepli, Jafri

2017-11-01

The global implementation of BIM in the construction field is increasing worldwide. Due to the advantages offered by BIM, its implementation is considered important in the construction projects. Nevertheless, the Construction Industry Transformation Plan has reported that the adoption of Building Information Modelling (BIM) in Malaysia is still low and it is estimated at only 10 percent adoption amongst construction stake players. The barriers influencing the occurrence of low adoption BIM in Malaysia have been studied by some researchers. However, these researchers did not investigate the root causes which might lead to the recurring of the barriers to BIM adoption. Root causes that immediately occurrence of barriers, also known as precipitants or trigger causes. This conceptual paper developed the causal loop diagram (CLD) which presents the relationship between the perceived variables using system dynamic modelling approach. The findings revealed a novelty validated diagrams that design the holistic dynamic relationship on the root causes occurrence of low BIM adoption. Nonetheless, the diagram subject to more empirical testing for its practicability and further refinement upon more results expected to emerge as the research progresses.

The Health Action Process Approach as a motivational model for physical activity self-management for people with multiple sclerosis: a path analysis.

PubMed

Chiu, Chung-Yi; Lynch, Ruth T; Chan, Fong; Berven, Norman L

2011-08-01

To evaluate the Health Action Process Approach (HAPA) as a motivational model for physical activity self-management for people with multiple sclerosis (MS). Quantitative descriptive research design using path analysis. One hundred ninety-five individuals with MS were recruited from the National Multiple Sclerosis Society and a neurology clinic at a university teaching hospital in the Midwest. Outcome was measured by the Physical Activity Stages of Change Instrument, along with measures for nine predictors (severity, action self-efficacy, outcome expectancy, risk perception, perceived barriers, intention, maintenance self-efficacy, action and coping planning, and recovery self-efficacy). The respecified HAPA physical activity model fit the data relatively well (goodness-of-fit index = .92, normed fit index = .91, and comparative fit index = .93) explaining 38% of the variance in physical activity. Recovery self-efficacy, action and coping planning, and perceived barriers directly contributed to the prediction of physical activity. Outcome expectancy significantly influenced intention and the relationship between intention and physical activity is mediated by action and coping planning. Action self-efficacy, maintenance self-efficacy, and recovery self-efficacy directly or indirectly affected physical activity. Severity of MS and action self-efficacy had an inverse relationship with perceived barriers and perceived barriers influenced physical activity. Empirical support was found for the proposed HAPA model of physical activity for people with MS. The HAPA model appears to provide useful information for clinical rehabilitation and health promotion interventions.

Barriers and enablers to good communication and information-sharing practices in care planning for chronic condition management.

PubMed

Lawn, Sharon; Delany, Toni; Sweet, Linda; Battersby, Malcolm; Skinner, Timothy

2015-01-01

Our aim was to document current communication and information-sharing practices and to identify the barriers and enablers to good practices within the context of care planning for chronic condition management. Further aims were to make recommendations about how changes to policy and practice can improve communication and information sharing in primary health care. A mixed-method approach was applied to seek the perspectives of patients and primary health-care workers across Australia. Data was collected via interviews, focus groups, non-participant observations and a national survey. Data analysis was performed using a mix of thematic, discourse and statistical approaches. Central barriers to effective communication and information sharing included fragmented communication, uncertainty around client and interagency consent, and the unacknowledged existence of overlapping care plans. To be most effective, communication and information sharing should be open, two-way and inclusive of all members of health-care teams. It must also only be undertaken with the appropriate participant consent, otherwise this has the potential to cause patients harm. Improvements in care planning as a communication and information-sharing tool may be achieved through practice initiatives that reflect the rhetoric of collaborative person-centred care, which is already supported through existing policy in Australia. General practitioners and other primary care providers should operationalise care planning, and the expectation of collaborative and effective communication of care that underpins it, within their practice with patients and all members of the care team. To assist in meeting these aims, we make several recommendations.

Perspectives on family planning services among adolescents at a Boston community health center.

PubMed

Johnson, Katherine M; Dodge, Laura E; Hacker, Michele R; Ricciotti, Hope A

2015-04-01

The aim of this project was to investigate adolescent perspectives on family planning services at a community-health center, with the intent to inform health center programs aimed at stemming the adolescent pregnancy rate. This project was cross-sectional and employed mixed methods, including surveys and interviews, for the purposes of quality improvement. The project was conducted in the obstetrics and gynecology clinic at an urban community health center in Boston. Twenty adolescent females (age 16-20) who used services at the health center. Participants were individually interviewed to assess perspectives on family planning services and to identify major influences on methods of pregnancy prevention. Major themes were categorized into contraceptive usage, reproductive health knowledge, adult influence and communication, barriers to contraceptive care and expectations of a family planning clinic. All participants were sexually active and 80% had experienced pregnancy. Reproductive health knowledge was variable and in many cases limited. Concern about disapproval was a prominent barrier to going to a clinician for contraception or advice and parents were not often involved in the initial contraception discussion. Other barriers to use of contraception included forgetting to use the methods and fear of side effects. We identified several potentially modifiable factors, including lack of knowledge, concern for provider disapproval and fear of side effects that may limit effective use of family planning services by adolescents. Further attention should be paid to these factors in designing and improving youth-friendly services in ob-gyn clinics. Copyright © 2015 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Chlamydia screening for sexually active young women under the Affordable Care Act: new opportunities and lingering barriers.

PubMed

Loosier, Penny S; Malcarney, Mary-Beth; Slive, Lauren; Cramer, Ryan C; Burgess, Brittany; Hoover, Karen W; Romaguera, Raul

2014-09-01

The Affordable Care Act of 2010 (ACA) contains a provision requiring private insurers issuing or renewing plans on or after September 23, 2010, to provide, without cost sharing, preventive services recommended by US Preventive Services Task Force (grades A and B), among other recommending bodies. As a grade A recommendation, chlamydia screening for sexually active young women 24 years and younger and older women at risk for chlamydia falls under this requirement. This article examines the potential effect on chlamydia screening among this population across private and public health plans and identifies lingering barriers not addressed by this legislation. Examination of the impact on women with private insurance touches upon the distinction between coverage under grandfathered plans, where the requirement does not apply, and nongrandfathered plans, where the requirement does apply. Acquisition of private health insurance through health insurance Marketplaces is also discussed. For public health plans, coverage of preventive services without cost sharing differs for individuals enrolled in standard Medicaid, covered under the Medicaid expansion included in the ACA, or those enrolled under the Children's Health Insurance Program or who fall under Early, Periodic, Screening, Diagnosis and Treatment criteria. The discussion of lingering barriers not addressed by the ACA includes the uninsured, physician reimbursement, cost sharing, confidentiality, low rates of appropriate sexual history taking by providers, and disclosures of sensitive information. In addition, the role of safety net programs that provide health care to individuals regardless of ability to pay is examined in light of the expectation that they also remain a payer of last resort.

A new scale for disaster nursing core competencies: Development and psychometric testing.

PubMed

Al Thobaity, Abdulellah; Williams, Brett; Plummer, Virginia

2016-02-01

All nurses must have core competencies in preparing for, responding to and recovering from a disaster. In the Kingdom of Saudi Arabia (KSA), as in many other countries, disaster nursing core competencies are not fully understood and lack reliable, validated tools. Thus, it is imperative to develop a scale for exploring disaster nursing core competencies, roles and barriers in the KSA. This study's objective is to develop a valid, reliable scale that identifies and explores core competencies of disaster nursing, nurses' roles in disaster management and barriers to developing disaster nursing in the KSA. This study developed a new scale testing its validity and reliability. A principal component analysis (PCA) was used to develop and test psychometric properties of the new scale. The PCA used a purposive sample of nurses from emergency departments in two hospitals in the KSA. Participants rated 93 paper-based, self-report questionnaire items from 1 to 10 on a Likert scale. PCA using Varimax rotation was conducted to explore factors emerging from responses. The study's participants were 132 nurses (66% response rate). PCA of the 93 questionnaire items revealed 49 redundant items (which were deleted) and 3 factors with eigenvalues of >1. The remaining 44 items accounted for 77.3% of the total variance. The overall Cronbach's alpha was 0.96 for all factors: 0.98 for Factor 1, 0.92 for Factor 2 and 0.86 for Factor 3. This study provided a validated, reliable scale for exploring nurses' core competencies, nurses' roles and barriers to developing disaster nursing in the KSA. The new scale has many implications, such as for improving education, planning and curricula. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

Organizational factors, planning capacity, and integration challenges constrain provincial planning processes for nutrition in decentralizing Vietnam.

PubMed

Lapping, Karin; Frongillo, Edward A; Nguyen, Phuong H; Coates, Jennifer; Webb, Patrick; Menon, Purnima

2014-09-01

Translating national policies and guidelines into effective action at the subnational level (e.g., province or region) is a prerequisite for ensuring an impact on nutrition. In several countries, including Vietnam, the focus of this paper, this process is affected by the quality of the decentralized process of planning and action. This study examined how provincial planning processes for nutrition occurred in Vietnam during 2009 and 2010. Key goals were to understand variability in processes across provinces, identify factors that influenced the process, and assess the usefulness of the process for individuals involved in planning and action. A qualitative case-study methodology was used. Data were drawn from interviews with 51 government officials in eight provinces. The study found little variability in the planning process among these eight provinces, probably due to a planning process that was predominantly a fiscal exercise within the confines of a largely centralized structure. Respondents were almost unanimous about the main barriers: a top-down approach to planning, limited human capacity for effective planning at subnational levels, and difficulty in integrating actions from multiple sectors. Provincial-level actors were deeply dissatisfied with the nature of their role in the process. Despite the rhetoric to the contrary, too much power is probably still retained at the central level. A strategic multiyear approach is needed to strengthen the provincial planning process and address many of the key barriers identified in this study.

Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model.

PubMed

Wallace, Cara L

2016-08-01

This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care.

A waterborne outbreak of campylobacteriosis in the South Island of New Zealand due to a failure to implement a multi-barrier approach.

PubMed

Bartholomew, Nadia; Brunton, Cheryl; Mitchell, Peter; Williamson, Judy; Gilpin, Brent

2014-09-01

Outbreaks of waterborne gastroenteritis continue to occur in developed countries. Darfield, a rural town in the South Island of New Zealand experienced an outbreak of campylobacteriosis following a transgression of Escherichia coli on 16 August 2012. A descriptive outbreak investigation was performed. As a result, 29 cases had a laboratory-confirmed diagnosis of campylobacteriosis and 138 were identified as probable cases. Heavy rains, contamination of water with animal effluent from nearby paddocks and failures in the treatment of drinking water led to pathogens being distributed through the town's water supply. A multi-barrier approach is advocated to ensure the quality of water and many countries have legislation or programmes to address this. Although legislation for water safety plans based on a multi-barrier approach is in place in New Zealand, at the time of the outbreak it was not a requirement for the Darfield water supply. In addition, despite the awareness of the importance of a multi-barrier approach, competing interests, including those from the agricultural industry and financial restraints on water suppliers, can prevent it from being implemented. Governments need to be more willing to enforce legislation and standards to protect the public from waterborne disease.

Stimulating a Sustainable Construction through Holistic BIM Adoption: The Root Causes of Recurring Low BIM Adoption in Malaysia

NASA Astrophysics Data System (ADS)

Mamter, S.; Abdul-Aziz, AR; Mamat, ME

2017-06-01

Fostering the Building Information Modelling (BIM) implementation is one of Malaysia sustainable strategies towards greener construction. Hence, the Eleventh Malaysia plan focuses on transforming construction industry through the increase of technology adoption in order to enhance construction productivity. Therefore, there is a growing and urgent demand to provide BIM competent. However, a significant number of parties are reluctant to develop and invest in BIM due to unsolved root causes. Scholars have identified barriers relating to the infancy stage of BIM adoption in Malaysia. Unfortunately, there is a lack of study to explore deeper the root causes of recurring for the barriers anticipate the low BIM adoption. This paper attempts to delve into the initiatives of BIM stake players in fostering BIM adoption and to determine the root causes of recurring barriers due to low BIM adoption. The study adopted the semi-structured interviews which involved BIM stake players as a sample population. From the findings, authors revealed four root causes of recurring barriers; absence of BIM policy and BIM compulsion, poor holistic readiness, software integration competition strategy, and reluctant in sharing knowledge. The findings espoused here are preliminary and more results are expected to emerge as the research progresses.

Development of a mentorship strategy: a knowledge translation case study.

PubMed

Straus, Sharon E; Graham, Ian D; Taylor, Mark; Lockyer, Jocelyn

2008-01-01

There are many theories and frameworks for achieving knowledge translation, and the assortment can be confusing to those responsible for planning, evaluation, or policymaking in knowledge translation. A conceptual framework developed by Graham and colleagues provides an approach that builds on the commonalities found in an assessment of planned-action theories. This article describes the application of this knowledge to action framework to a mentorship initiative in academic medicine. Mentorship influences career success but is threatened in academia by increased clinical, research, and administrative demands. A case study review was undertaken of the role of mentors, the experiences of mentors and mentees, and mentorship initiatives in developing and retaining clinician scientists at two universities in Alberta, Canada. This project involved relevant stakeholders including researchers, university administrators, and research funders. The knowledge to action framework was used to develop a strategy for mentorship for clinician researchers. The framework highlights the need to identify and engage stakeholders in the process of knowledge implementation. A series of initiatives were selected and tailored to barriers and facilitators to implementation of the mentorship initiative; strategies for evaluating the knowledge use and its impact on outcomes were developed. The knowledge to action framework can be used to develop a mentorship initiative for clinician researchers. Future work to evaluate the impact of this intervention on recruitment and retention is planned.

USGS approach to real-time estimation of earthquake-triggered ground failure - Results of 2015 workshop

USGS Publications Warehouse

Allstadt, Kate E.; Thompson, Eric M.; Wald, David J.; Hamburger, Michael W.; Godt, Jonathan W.; Knudsen, Keith L.; Jibson, Randall W.; Jessee, M. Anna; Zhu, Jing; Hearne, Michael; Baise, Laurie G.; Tanyas, Hakan; Marano, Kristin D.

2016-03-30

The U.S. Geological Survey (USGS) Earthquake Hazards and Landslide Hazards Programs are developing plans to add quantitative hazard assessments of earthquake-triggered landsliding and liquefaction to existing real-time earthquake products (ShakeMap, ShakeCast, PAGER) using open and readily available methodologies and products. To date, prototype global statistical models have been developed and are being refined, improved, and tested. These models are a good foundation, but much work remains to achieve robust and defensible models that meet the needs of end users. In order to establish an implementation plan and identify research priorities, the USGS convened a workshop in Golden, Colorado, in October 2015. This document summarizes current (as of early 2016) capabilities, research and operational priorities, and plans for further studies that were established at this workshop. Specific priorities established during the meeting include (1) developing a suite of alternative models; (2) making use of higher resolution and higher quality data where possible; (3) incorporating newer global and regional datasets and inventories; (4) reducing barriers to accessing inventory datasets; (5) developing methods for using inconsistent or incomplete datasets in aggregate; (6) developing standardized model testing and evaluation methods; (7) improving ShakeMap shaking estimates, particularly as relevant to ground failure, such as including topographic amplification and accounting for spatial variability; and (8) developing vulnerability functions for loss estimates.

Critical research and advanced technology (CRT) support project

NASA Technical Reports Server (NTRS)

Furman, E. R.; Anderson, D. N.; Hodge, P. E.; Lowell, C. E.; Nainiger, J. J.; Schultz, D. F.

1983-01-01

A critical technology base for utility and industrial gas turbines by planning the use of coal-derived fuels was studied. Development tasks were included in the following areas: (1) Combustion - investigate the combustion of coal-derived fuels and methods to minimize the conversion of fuel-bound nitrogen to NOx; (2) materials - understand and minimize hot corrosion; (3) system studies - integrate and focus the technological efforts. A literature survey of coal-derived fuels was completed and a NOx emissions model was developed. Flametube tests of a two-stage (rich-lean) combustor defined optimum equivalence ratios for minimizing NOx emissions. Sector combustor tests demonstrated variable air control to optimize equivalence ratios over a wide load range and steam cooling of the primary zone liner. The catalytic combustion of coal-derived fuels was demonstrated. The combustion of coal-derived gases is very promising. A hot-corrosion life prediction model was formulated and verified with laboratory testing of doped fuels. Fuel additives to control sulfur corrosion were studied. The intermittent application of barium proved effective. Advanced thermal barrier coatings were developed and tested. Coating failure modes were identified and new material formulations and fabrication parameters were specified. System studies in support of the thermal barrier coating development were accomplished.

Patient-Reported Outcomes in Cancer Drug Development and US Regulatory Review: Perspectives From Industry, the Food and Drug Administration, and the Patient.

PubMed

Basch, Ethan; Geoghegan, Cindy; Coons, Stephen Joel; Gnanasakthy, Ari; Slagle, Ashley F; Papadopoulos, Elektra J; Kluetz, Paul G

2015-06-01

Data reported directly by patients about how they feel and function are rarely included in oncology drug labeling in the United States, in contrast to Europe and to nononcology labeling in the United States, where this practice is more common. Multiple barriers exist, including challenges unique to oncology trials, and industry's concerns regarding cost, logistical complexities, and the Food and Drug Administration's (FDA's) rigorous application of its 2009 guidance on the use of patient-reported outcome (PRO) measures. A panel consisting of representatives of industry, FDA, the PRO Consortium, clinicians, and patients was assembled at a 2014 workshop cosponsored by FDA to identify practical recommendations for overcoming these barriers. Key recommendations included increasing proactive encouragement by FDA to clinical trial sponsors for including PROs in drug development programs; provision of comprehensive PRO plans by sponsors to FDA early in drug development; promotion of an oncology-specific PRO research agenda; development of an approach to existing ("legacy") PRO measures, when appropriate (focused initially on symptoms and functional status); and increased FDA and industry training in PRO methodology. FDA has begun implementing several of these recommendations.

The Great Barrier Reef World Heritage Area seagrasses: Managing this iconic Australian ecosystem resource for the future

NASA Astrophysics Data System (ADS)

Coles, Robert G.; Rasheed, Michael A.; McKenzie, Len J.; Grech, Alana; York, Paul H.; Sheaves, Marcus; McKenna, Skye; Bryant, Catherine

2015-02-01

The Great Barrier Reef World Heritage Area (GBRWHA) includes one of the world's largest areas of seagrass (35,000 km2) encompassing approximately 20% of the world's species. Mapping and monitoring programs sponsored by the Australian and Queensland Governments and Queensland Port Authorities have tracked a worrying decrease in abundance and area since 2007. This decline has almost certainly been the result of a series of severe tropical storms and associated floods exacerbating existing human induced stressors. A complex variety of marine and terrestrial management actions and plans have been implemented to protect seagrass and other habitats in the GBRWHA. For seagrasses, these actions are inadequate. They provide an impression of effective protection of seagrasses; reduce the sense of urgency needed to trigger action; and waste the valuable and limited supply of "conservation capital". There is a management focus on ports, driven by public concerns about high profile development projects, which exaggerates the importance of these relatively concentrated impacts in comparison to the total range of threats and stressors. For effective management of seagrass at the scale of the GBRWHA, more emphasis needs to be placed on the connectivity between seagrass meadow health, watersheds, and all terrestrial urban and agricultural development associated with human populations. The cumulative impacts to seagrass from coastal and marine processes in the GBRWHA are not evenly distributed, with a mosaic of high and low vulnerability areas. This provides an opportunity to make choices for future coastal development plans that minimise stress on seagrass meadows.

Integrating interdisciplinary pain management into primary care: development and implementation of a novel clinical program.

PubMed

Dorflinger, Lindsey M; Ruser, Christopher; Sellinger, John; Edens, Ellen L; Kerns, Robert D; Becker, William C

2014-12-01

The aims of this study were to develop and implement an interdisciplinary pain program integrated in primary care to address stakeholder-identified gaps. Program development and evaluation project utilizing a Plan-Do-Study-Act (PDSA) approach to address the identified problem of insufficient pain management resources within primary care. A large Healthcare System within the Veterans Health Administration, consisting of two academically affiliated medical centers and six community-based outpatients clinics. An interprofessional group of stakeholders participated in a Rapid Process Improvement Workshop (RPIW), a consensus-building process to identify systems-level gaps and feasible solutions and obtain buy-in. Changes were implemented in 2012, and in a 1-year follow-up, we examined indicators of engagement in specialty and multimodal pain care services as well as patient and provider satisfaction. In response to identified barriers, RPIW participants proposed and outlined two readily implementable, interdisciplinary clinics embedded within primary care: 1) the Integrated Pain Clinic, providing in-depth assessment and triage to targeted resources; and 2) the Opioid Reassessment Clinic, providing assessment and structured monitoring of patients with evidence of safety, efficacy, or misuse problems with opioids. Implementation of these programs led to higher rates of engagement in specialty and multimodal pain care services; patients and providers reported satisfaction with these services. Our PDSA cycle engaged an interprofessional group of stakeholders that recommended introduction of new systems-based interventions to better integrate pain resources into primary care to address reported barriers. Early data suggest improved outcomes; examination of additional outcomes is planned. Wiley Periodicals, Inc.

A Qualitative Approach to Women's Perspectives on Exercise in Iran.

PubMed

Kalani, Zohreh; Pourmovahed, Zahra; Farajkhoda, Tahmineh; Bagheri, Imane

2018-04-01

It is believed that women of all ages do less physical activities compared to men. The development of interventional projects for increasing the women's participation in physical activity needs the recognition of resources and exploration of women's perspectives on exercise in their lives in the Iranian culture and context. This qualitative study was conducted in an urban area of Iran on 46 women attending healthcare centers, volunteer health care providers, university students, sportswomen and one of the officials of the provincial women's sports. This study was done from April 2015 to June 2016. Four focus group discussions and one in depth semi-structured interview was conducted. A qualitative conventional content analysis approach was used for data analysis. Four categories were developed as follows: 'preferences', 'planning', 'motivators' and 'inhibitors'. Preferences had three distinct subcategories: preferences to do exercise in specific settings, specific exercise and group exercise. The family role, exercise as one part of daily routines, and exercise as a habit were subcategories of planning. Motivators were physical, emotional and social benefits; physician advice and encouragement; being alarmed; and championship. The inhibitors of doing exercise were various: gender issues, economical and costs issues, geographical access, making excuses, cultural infrastructures, shortage of sports experts, fears, concerns and misconceptions, inappropriate facilities and inadequate administrative cooperation and official barriers. The findings showed that the women were sensitive to and interested in doing exercise. However, barriers to exercise were multiple and complex. Nursing interventions are required to increase the individuals' awareness of misconceptions and also develop strategic programs for improving exercise among women.

Targeting safety improvements through identification of incident origination and detection in a near-miss incident learning system.

PubMed

Novak, Avrey; Nyflot, Matthew J; Ermoian, Ralph P; Jordan, Loucille E; Sponseller, Patricia A; Kane, Gabrielle M; Ford, Eric C; Zeng, Jing

2016-05-01

Radiation treatment planning involves a complex workflow that has multiple potential points of vulnerability. This study utilizes an incident reporting system to identify the origination and detection points of near-miss errors, in order to guide their departmental safety improvement efforts. Previous studies have examined where errors arise, but not where they are detected or applied a near-miss risk index (NMRI) to gauge severity. From 3/2012 to 3/2014, 1897 incidents were analyzed from a departmental incident learning system. All incidents were prospectively reviewed weekly by a multidisciplinary team and assigned a NMRI score ranging from 0 to 4 reflecting potential harm to the patient (no potential harm to potential critical harm). Incidents were classified by point of incident origination and detection based on a 103-step workflow. The individual steps were divided among nine broad workflow categories (patient assessment, imaging for radiation therapy (RT) planning, treatment planning, pretreatment plan review, treatment delivery, on-treatment quality management, post-treatment completion, equipment/software quality management, and other). The average NMRI scores of incidents originating or detected within each broad workflow area were calculated. Additionally, out of 103 individual process steps, 35 were classified as safety barriers, the process steps whose primary function is to catch errors. The safety barriers which most frequently detected incidents were identified and analyzed. Finally, the distance between event origination and detection was explored by grouping events by the number of broad workflow area events passed through before detection, and average NMRI scores were compared. Near-miss incidents most commonly originated within treatment planning (33%). However, the incidents with the highest average NMRI scores originated during imaging for RT planning (NMRI = 2.0, average NMRI of all events = 1.5), specifically during the documentation of patient positioning and localization of the patient. Incidents were most frequently detected during treatment delivery (30%), and incidents identified at this point also had higher severity scores than other workflow areas (NMRI = 1.6). Incidents identified during on-treatment quality management were also more severe (NMRI = 1.7), and the specific process steps of reviewing portal and CBCT images tended to catch highest-severity incidents. On average, safety barriers caught 46% of all incidents, most frequently at physics chart review, therapist's chart check, and the review of portal images; however, most of the incidents that pass through a particular safety barrier are not designed to be capable of being captured at that barrier. Incident learning systems can be used to assess the most common points of error origination and detection in radiation oncology. This can help tailor safety improvement efforts and target the highest impact portions of the workflow. The most severe near-miss events tend to originate during simulation, with the most severe near-miss events detected at the time of patient treatment. Safety barriers can be improved to allow earlier detection of near-miss events.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Novak, Avrey; Nyflot, Matthew J.; Ermoian, Ralph P.

Purpose: Radiation treatment planning involves a complex workflow that has multiple potential points of vulnerability. This study utilizes an incident reporting system to identify the origination and detection points of near-miss errors, in order to guide their departmental safety improvement efforts. Previous studies have examined where errors arise, but not where they are detected or applied a near-miss risk index (NMRI) to gauge severity. Methods: From 3/2012 to 3/2014, 1897 incidents were analyzed from a departmental incident learning system. All incidents were prospectively reviewed weekly by a multidisciplinary team and assigned a NMRI score ranging from 0 to 4 reflectingmore » potential harm to the patient (no potential harm to potential critical harm). Incidents were classified by point of incident origination and detection based on a 103-step workflow. The individual steps were divided among nine broad workflow categories (patient assessment, imaging for radiation therapy (RT) planning, treatment planning, pretreatment plan review, treatment delivery, on-treatment quality management, post-treatment completion, equipment/software quality management, and other). The average NMRI scores of incidents originating or detected within each broad workflow area were calculated. Additionally, out of 103 individual process steps, 35 were classified as safety barriers, the process steps whose primary function is to catch errors. The safety barriers which most frequently detected incidents were identified and analyzed. Finally, the distance between event origination and detection was explored by grouping events by the number of broad workflow area events passed through before detection, and average NMRI scores were compared. Results: Near-miss incidents most commonly originated within treatment planning (33%). However, the incidents with the highest average NMRI scores originated during imaging for RT planning (NMRI = 2.0, average NMRI of all events = 1.5), specifically during the documentation of patient positioning and localization of the patient. Incidents were most frequently detected during treatment delivery (30%), and incidents identified at this point also had higher severity scores than other workflow areas (NMRI = 1.6). Incidents identified during on-treatment quality management were also more severe (NMRI = 1.7), and the specific process steps of reviewing portal and CBCT images tended to catch highest-severity incidents. On average, safety barriers caught 46% of all incidents, most frequently at physics chart review, therapist’s chart check, and the review of portal images; however, most of the incidents that pass through a particular safety barrier are not designed to be capable of being captured at that barrier. Conclusions: Incident learning systems can be used to assess the most common points of error origination and detection in radiation oncology. This can help tailor safety improvement efforts and target the highest impact portions of the workflow. The most severe near-miss events tend to originate during simulation, with the most severe near-miss events detected at the time of patient treatment. Safety barriers can be improved to allow earlier detection of near-miss events.« less

Barriers to Uptake of Conservation Agriculture in southern Africa: Multi-level Analyses from Malawi

NASA Astrophysics Data System (ADS)

Dougill, Andrew; Stringer, Lindsay; Whitfield, Stephen; Wood, Ben; Chinseu, Edna

2015-04-01

Conservation agriculture is a key set of actions within the growing body of climate-smart agriculture activities being advocated and rolled out across much of the developing world. Conservation agriculture has purported benefits for environmental quality, food security and the sustained delivery of ecosystem services. In this paper, new multi-level analyses are presented, assessing the current barriers to adoption of conservation agriculture practices in Malawi. Despite significant donor initiatives that have targeted conservation agriculture projects, uptake rates remain low. This paper synthesises studies from across 3 levels in Malawi: i.) national level- drawing on policy analysis, interviews and a multi-stakeholder workshop; ii.) district level - via assessments of development plans and District Office and extension service support, and; iii) local level - through data gained during community / household level studies in Dedza District that have gained significant donor support for conservation agriculture as a component of climate smart agriculture initiatives. The national level multi-stakeholder Conservation Agriculture workshop identified three areas requiring collaborative research and outlined routes for the empowerment of the National Conservation Agriculture Task Force to advance uptake of conservation agriculture and deliver associated benefits in terms of agricultural development, climate adaptation and mitigation. District level analyses highlight that whilst District Development Plans are now checked against climate change adaptation and mitigation criteria, capacity and knowledge limitations exist at the District level, preventing project interventions from being successfully up-scaled. Community level assessments highlight the need for increased community participation at the project-design phase and identify a pressing requirement for conservation agriculture planning processes (in particular those driven by investments in climate-smart agriculture) to better accommodate, and respond to, the differentiated needs of marginalised groups (e.g. poor, elderly, carers). We identify good practices that can be used to design, plan and implement conservation agriculture projects such that the multiple benefits can be realised. We further outline changes to multi-level policy and institutional arrangements to facilitate greater adoption of conservation agriculture in Malawi, noting the vital importance of District-level institutions and amendments and capacity building required within agricultural extension services. We highlight the need for capacity building and support to ensure conservation agriculture's multiple benefits are realised more widely as a route towards sustainable land management.

Adherence to systemic therapies for immune-mediated inflammatory diseases in Lebanon: a physicians' survey from three medical specialties.

PubMed

Ammoury, Alfred; Okais, Jad; Hobeika, Mireille; Sayegh, Raymond B; Shayto, Rani H; Sharara, Ala I

2017-01-01

Immune-mediated inflammatory diseases (IMIDs) are chronic conditions that may cause tissue damage and disability, reduced quality of life and increased mortality. Various treatments have been developed for IMIDs, including immune modulators and targeted biologic agents. However, adherence remains suboptimal. An adherence survey was used to evaluate physicians' beliefs about adherence to medication in IMID and to evaluate if and how they manage adherence. The survey was distributed to 100 randomly selected physicians from three different specialties. Results were analyzed by four academic experts commissioned to develop an action plan to address practical and perceptual barriers to adherence, integrating it into treatment goals to maximize outcomes in IMID, thereby elevating local standards of care. Eighty-two physicians participated in this study and completed the questionnaire. Most defined adherence as compliance with prescribed treatment. Although the majority of surveyed physicians (74%) did not systematically measure adherence in their practice, 54% identified adherence as a treatment goal of equal or greater importance to therapeutic endpoints. Lack of time and specialized nursing support was reported as an important barrier to measuring adherence. The expert panel identified four key areas for action: 360° education (patient-nurse-physician), patient-physician communication, patient perception and concerns, and market access/cost. An action plan was developed centered on education and awareness, enhanced benefit-risk communication, development of adherence assessment tools and promotion of patient support programs. Nonadherence to medication is a commonly underestimated problem with important consequences. A customized target-based strategy to address the root causes of non-adherence is essential in the management of chronic immune-mediated diseases.

A qualitative evaluation of the implementation of guidelines and a support tool for asthma management in primary care.

PubMed

Watkins, Kim; Fisher, Colleen; Misaghian, Jila; Schneider, Carl R; Clifford, Rhonda

2016-01-01

Asthma management in Australia is suboptimal. The "Guidelines for provision of a Pharmacist Only medicine: short acting beta agonists" (SABA guidelines) and a novel West Australian "Asthma Action Plan card" (AAP card) were concurrently developed to improve asthma management. The aim of this qualitative research was to evaluate the collaborative, multidisciplinary and multifaceted implementation of these asthma resources and identify the lessons learnt to inform future initiatives. Feedback was sought about the implementation of the SABA guidelines and the AAP card using focus groups with key stakeholders including pharmacists (×2), pharmacy assistants, asthma educators, general practitioners, practice nurses and people with asthma (patients). Audio recordings were transcribed verbatim. Data were analysed thematically using constant comparison. The common themes identified from the focus groups were categorised according to a taxonomy of barriers including barriers related to knowledge, attitudes and behaviour. Seven focus group sessions were held with 57 participants. Knowledge barriers were identified included a lack of awareness and lack of familiarity of the resources. There was a significant lack of awareness of the AAP card where passive implementation methods had been utilised. Pharmacists had good awareness of the SABA guidelines but pharmacy assistants were unaware of the guidelines despite significant involvement in the sale of SABAs. Environmental barriers included time and workflow issues and the role of the pharmacy assistant in the organisation workflows of the pharmacy. The attitudes and behaviours of health professionals and patients with asthma were discordant and this undermined optimal asthma management. Suggestions to improve asthma management included the use of legislation, the use of electronic resources integrated into workflows and training pharmacists or practice nurses to provide patients with written asthma action plans. Greater consideration needs to be given to implementation of resources to improve awareness and overcome barriers to utilisation. Attitudes and behaviours of both health professionals and patients with asthma need to be addressed. Interventions directed toward health professionals should focus on skills needs related to achieving improved communication and patient behaviour change.

Perceptıon scale of barrıers to contraceptıve use: a methodologıcal study.

PubMed

Sen, Selma; Cetinkaya, Aynur; Cavuslar, Aysel

2017-01-01

The objective of this study was to design and develop the Perception Scale of Barriers to Contraceptive Use (PSBCU) as a measurement tool for the qualitative assessment of the barriers and obstacles women perceived with regard to contraceptive use or low rates of contraceptive use in women using family planning services. The data for this methodological study were collected using the face-to-face interview technique from 320 married women between the ages of 15-49 who were attending clinics at the Hafsa Sultan Hospital, CBU. The data collection tools used in the study, which was carried out from May to September 2014, were the "Introductory Information Form" and the "Perception Scale of Barriers to Contraceptive Use". Language validity and construct validity (explanatory factor analysis) were applied in order to test the validity of the Perception Scale of Barriers to Contraceptive Use. Kaiser Meier Olkin (KMO) analysis was performed to determine the availability of the scale for the size of participants. The sample adequacy calculated as the KMO value was 0.916 and the Bartlett's Test of Sphericity (X 2  = 6721.793 p  < 0.000) sample size analysis value was found to be sufficient for factor analysis. The total Cronbach's Alpha coefficient of 34 items which included three factors explaining 54.95% of the variance after Varimax rotation was calculated to be 0.95. The largest factor was the "cognitive domain" explaining 18.89% of the variance, followed by the "emotional domain" explaining 18.05% of the variance, and finally the "social domain" explaining 18.01% of the variance. Item-total score correlation coefficients of scale items were found to be between 0.54 and 0.83. The study demonstrateded that the "Perception Scale of Barriers to Contraceptive Use" was valid and reliable. We believe that the scale is suitable for use by women in a family planning education and training programs in order to evaluate their situation. It should also be assessed for validity and reliability for different groups (adolescents, men, etc.).

Planning by 12-Month-Old Infants.

ERIC Educational Resources Information Center

Willatts, Peter; Rosie, Karen

In an investigation of 1-year-olds' ability to plan a sequence of steps, 20 infants were administered a compound means-ends problem. In a planning condition, a barrier was placed in front of a cloth at the far end of which was placed one end of a long string. A toy was fastened to the other end of the string and was placed on a table at some…

The Master Plan for Florida Postsecondary Education. Supplement Number 3: Disabled Student Access to Postsecondary Education. Report and Recommendations of the Postsecondary Education Planning Commission.

ERIC Educational Resources Information Center

Florida State Postsecondary Education Commission, Tallahassee.

This third supplement to the Florida master plan for postsecondary education considers resources and barriers to education for disabled students and offers 21 recommendations. To provide a foundation to discuss the needs of disabled students, characteristics of the following major functional impairments are described: hearing impairment, learning…

Mobilizing male opinion leaders’ support for family planning to improve maternal health: a theory-based qualitative study from Pakistan

PubMed Central

Azmat, Syed Khurram

2011-01-01

Purpose Pakistan is a patriarchal society in which male opinion leaders play an important role in determining health-seeking behaviors pertaining to family planning (FP) among their respective communities. This research focuses on cataloguing the perceptions of opinion leaders (clergymen, health professionals, and social workers) about the barriers for using services and practical solutions for promoting FP in the slums of Karachi, Pakistan. Materials and methods A qualitative study using an open-ended, semistructured interview schedule with hypothetical scenarios and in-depth interviews with a purposive sample of 45 opinion leaders (25 mosque imams/clergymen, 12 nonallopathic health professionals, and eight social workers/activists) was conducted in 2006–2007 in Karachi, Pakistan. Transcripts were coded thematically utilizing NVivo by using an adapted constant comparison analysis process as described by Strauss and Corbin. Results Seven key themes were derived from the in-depth interviews. Five themes provide insight into the opinion leaders’ perceptions of barriers to FP and modern contraception methods. Among the barriers religious taboos and cultural pressures were particularly note-worthy. Two themes offered opportunities for more effective development and implementation of FP programs. Conclusion It is evident from the study that opinion leaders in the community and the clergy lack the understanding of the importance of birth spacing. However, because they have a great deal of influence on the community at large, it is imperative to interact with them to build their capacity in order to propagate the messages of FP and improve maternal health and reproductive health in general. PMID:22247617

Development of the SALdável programme to reduce salt intake among hypertensive Brazilian women: an intervention mapping approach.

PubMed

Cornélio, Marilia Estevam; Godin, Gaston; Rodrigues, Roberta; Agondi, Rúbia; Spana, Thaís; Gallani, Maria-Cecilia

2013-08-01

Despite strong evidence for a relationship between high salt intake and hypertension, plus the widespread recommendations for dietary salt restriction among hypertensive subjects, there are no nursing studies describing effective theory-based interventions. To describe a systematic process for development of a theory-based nursing intervention that is aimed at reducing salt intake among hypertensive women, by applying the 'intervention mapping' protocol. We developed our intervention following the six steps of the 'intervention mapping' protocol: assessing needs, creating a matrix of change objectives, selecting theoretical methods and practical applications, defining the intervention programme, organizing the adoption and implementation plan, and defining the evaluation plan. Addition of salt during cooking is identified as the main source for salt consumption, plus women are identified as the people responsible for cooking meals at home. In our study, the motivational predictors of this behaviour were self-efficacy and habit. Guided practice, verbal persuasion, coping barriers, consciousness-raising and counter-conditioning were the theoretical methods we selected for enhancing self-efficacy and promoting habit change, respectively. Brainstorming, role-playing, cookbook use, measuring spoon use, label reading, hands-on skill-building activities and reinforcement phone calls were the chosen practical applications. We designed our intervention programme, and then organized the adoption and implementation plans. Finally, we generated a plan to evaluate our intervention. 'Intervention mapping' was a feasible methodological framework to guide the development of a theory-based nursing intervention for dietary salt reduction among hypertensive women.

Storm impacts and shoreline recovery: Mechanisms and controls in the southern North Sea

NASA Astrophysics Data System (ADS)

Brooks, S. M.; Spencer, T.; Christie, E. K.

2017-04-01

Storm impacts play a significant role in shoreline dynamics on barrier coastlines. Furthermore, inter-storm recovery is a key parameter determining long-term coastal resilience to climate change, storminess variability and sea level rise. Over the last decade, four extreme storms, with strong energetic waves and high still water levels resulting from high spring tides and large skew surge residuals, have impacted the shoreline of the southern North Sea. The 5th December 2013 storm, with the highest run-up levels recorded in the last 60 years, resulted in large sections of the frontline of the North Norfolk coast being translated inland by over 10 m. Storms in March and November 2007 also generated barrier scarping and shoreline retreat, although not on the scale of 2013. Between 2008 and 2013, a calm period, recovery dominated barrier position and elevation but was spatially differentiated alongshore. For one study area, Scolt Head Island, no recovery was seen; this section of the coast is being reset episodically landwards during storms. By contrast, the study area at Holkham Bay showed considerable recovery between 2008 and 2013, with barrier sections developing seaward through foredune recovery. The third study area, Brancaster Bay, showed partial recovery in barrier location and elevation. Results suggest that recovery is promoted by high sediment supply and onshore intertidal bar migration, at rates of 40 m a- 1. These processes bring sand to elevations where substrate drying enables aeolian processes to entrain and transport sand from upper foreshores to foredunes. We identify three potential sediment transport pathways that create a region of positive diffusivity at Holkham Bay. During calm periods, a general westward movement of sediment from the drift divide at Sheringham sources the intertidal bar and foredune development at Holkham Bay. However, during and following storms the drift switches to eastward, not only on the beach itself but also below the - 7 m isobath. Sediment from the eroding barrier at Brancaster Bay, and especially Scolt Head Island, also sources the sediment sink of Holkham Bay. Knowledge of foredune growth and barrier recovery in natural systems are vital aspects of future coastal management planning with accelerated sea-level rise and storminess variability.

Evaluating the impact a proposed family planning model would have on maternal and infant mortality in Afghanistan.

PubMed

Rahmani, Ahmad Masoud; Wade, Benjamin; Riley, William

2015-01-01

This study aimed to assess the potential impact a proposed family planning model would have on reducing maternal and infant mortality in Afghanistan. Afghanistan has a high total fertility rate, high infant mortality rate, and high maternal mortality rate. Afghanistan also has tremendous socio-cultural barriers to and misconceptions about family planning services. We applied predictive statistical models to a proposed family planning model for Afghanistan to better understand the impact increased family planning can have on Afghanistan's maternal mortality rate and infant mortality rate. We further developed a sensitivity analysis that illustrates the number of maternal and infant deaths that can be averted over 5 years according to different increases in contraceptive prevalence rates. Incrementally increasing contraceptive prevalence rates in Afghanistan from 10% to 60% over the course of 5 years could prevent 11,653 maternal deaths and 317,084 infant deaths, a total of 328,737 maternal and infant deaths averted. Achieving goals in reducing maternal and infant mortality rates in Afghanistan requires a culturally relevant approach to family planning that will be supported by the population. The family planning model for Afghanistan presents such a solution and holds the potential to prevent hundreds of thousands of deaths. Copyright © 2013 John Wiley & Sons, Ltd.

Implementation of a new advanced graduate education program in oral implantology.

PubMed

Gallucci, German O; Weber, Hans Peter; Kalenderian, Elsbeth

2012-10-01

The academic program for the Harvard School of Dental Medicine's Advanced Graduate Program in Oral Implantology is based on scientific evidence applied to educational quality, translational research, patient care, and service. The objective of the program is to enable highly motivated individuals with proven scholarship and excellence in patient care to achieve academic leadership in the clinical and scientific fields of implant dentistry and tissue regeneration. A detailed curriculum describing the academic program, as well as a business plan (which included a management plan describing the organizational structure, financial implications, and market forces) and implementation and communication plans, were developed before moving forward. With careful academic and business planning, the result was a vibrant implant program, in which all placements and restorations of implants are coordinated with regard to practice management. The program is integrated into the existing clinical care model and has been financially self-sustaining from its inception. Six students have participated in the last two years. On average, each student performed seventy-nine procedures on twenty-nine patients, generating over $46,000 in production. The curriculum includes didactics, hands-on clinical learning, and research activities. Research is a critical component as well. The results demonstrate that the time taken to develop a detailed curriculum and business plan for a new academic program, which anticipated and resolved potential barriers to success, was instrumental in the successful implementation of an oral implantology residency program.

Absenteeism, Educational Plans, and Anxiety among Children with Incontinence and Their Parents

ERIC Educational Resources Information Center

Filce, Hollie G.; LaVergne, Leslie

2015-01-01

Background: Children with incontinence have more absenteeism, poorer academic performance, and potential social difficulties during the school years. These children and their parents are at risk for illness-related anxiety. Whereas educational plans are designed to remediate educational, medical, and social-emotional barriers at school, little…

Picture this

Treesearch

Gary Bentrup; Gary Wells

2005-01-01

Despite the use of planting plans and engineering drawings, many landowners find it difficult to conceptualize what a future conservation practice or system will actually look like on their landscape. This lack of understanding can create challenging barriers in the planning process and is exacerbated by the long-term commitment that many conservation systems require...

School District Information Technology Disaster Recovery Planning: An Explanatory Case Study

ERIC Educational Resources Information Center

Gray, Shaun L.

2017-01-01

Despite research and practitioner articles outlining the importance information technology disaster plans (ITDRPs) to organizational success, barriers have impeded the process of disaster preparation for Burlington County New Jersey school districts. The purpose of this explanatory qualitative case study was to understand how technology leader…

Practical Team-Based Learning from Planning to Implementation

PubMed Central

Bell, Edward; Eng, Marty; Fuentes, David G.; Helms, Kristen L.; Maki, Erik D.; Vyas, Deepti

2015-01-01

Team-based learning (TBL) helps instructors develop an active teaching approach for the classroom through group work. The TBL infrastructure engages students in the learning process through the Readiness Assessment Process, problem-solving through team discussions, and peer feedback to ensure accountability. This manuscript describes the benefits and barriers of TBL, and the tools necessary for developing, implementing, and critically evaluating the technique within coursework in a user-friendly method. Specifically, the manuscript describes the processes underpinning effective TBL development, preparation, implementation, assessment, and evaluation, as well as practical techniques and advice from authors’ classroom experiences. The paper also highlights published articles in the area of TBL in education, with a focus on pharmacy education. PMID:26889061

Ceramic Technology for Advanced Heat Engines Project. Semiannual progress report, October 1984-March 1985

DOE Office of Scientific and Technical Information (OSTI.GOV)

Not Available

1985-09-01

A five-year project plan was developed with extensive input from private industry. The objective of the project is to develop the industrial technology base required for reliable ceramics for application in advanced automotive heat engines. The project approach includes determining the mechanisms controlling reliability, improving processes for fabricating existing ceramics, developing new materials with increased reliability, and testing these materials in simulated engine environments to confirm reliability. Although this is a generic materials project, the focus is on structural ceramics for advanced gas turbine and diesel engines, ceramic bearings and attachments, and ceramic coatings for thermal barrier and wear applicationsmore » in these engines.« less

Insights into the Government’s Role in Food System Policy Making: Improving Access to Healthy, Local Food Alongside Other Priorities

PubMed Central

Wegener, Jessica; Raine, Kim D.; Hanning, Rhona M.

2012-01-01

Government actors have an important role to play in creating healthy public policies and supportive environments to facilitate access to safe, affordable, nutritious food. The purpose of this research was to examine Waterloo Region (Ontario, Canada) as a case study for “what works” with respect to facilitating access to healthy, local food through regional food system policy making. Policy and planning approaches were explored through multi-sectoral perspectives of: (a) the development and adoption of food policies as part of the comprehensive planning process; (b) barriers to food system planning; and (c) the role and motivation of the Region’s public health and planning departments in food system policy making. Forty-seven in-depth interviews with decision makers, experts in public health and planning, and local food system stakeholders provided rich insight into strategic government actions, as well as the local and historical context within which food system policies were developed. Grounded theory methods were used to identify key overarching themes including: “strategic positioning”, “partnerships” and “knowledge transfer” and related sub-themes (“aligned agendas”, “issue framing”, “visioning” and “legitimacy”). A conceptual framework to illustrate the process and features of food system policy making is presented and can be used as a starting point to engage multi-sectoral stakeholders in plans and actions to facilitate access to healthy food. PMID:23202834

Parent Support for Children's Physical Activity: A Qualitative Investigation of Barriers and Strategies

ERIC Educational Resources Information Center

Bassett-Gunter, Rebecca; Rhodes, Ryan; Sweet, Shane; Tristani, Lauren; Soltani, Yasaman

2017-01-01

Purpose: Parents play an important role in supporting children's physical activity (PA) behavior. Parent PA support is a behavior unto itself that has been examined within the framework of an adapted theory of planned behavior (TPB). The primary purpose of this research was to identify key barriers to parent PA support to understand perceptions of…

Safety Barrier Guidelines for Home Pools [and] How To Plan for the Unexpected.

ERIC Educational Resources Information Center

Consumer Product Safety Commission, Washington, DC.

Each year, hundreds of young children die and thousands come close to death due to submersion in residential swimming pools. The United States Consumer Products Safety Commission studied data on drownings and child behavior, as well as information on pool and pool barrier construction, and concluded that the best way to reduce child drownings in…

Adolescents and the right to health: eliminating age-related barriers to HIV/AIDS services in Rwanda.

PubMed

Binagwaho, Agnes; Fuller, Arlan; Kerry, Vanessa; Dougherty, Sarah; Agbonyitor, Mawuena; Wagner, Claire; Nzayizera, Rodrigue; Farmer, Paul

2012-01-01

Under international, regional, and domestic law, adolescents are entitled to measures ensuring the highest attainable standard of health. For HIV/AIDS, this is essential as adolescents lack many social and economic protections and are disproportionately vulnerable to the effects of the disease. In many countries, legal protections do not always ensure access to health care for adolescents, including for HIV/AIDS prevention, treatment, and care. Using Rwanda as an example, this article identifies gaps, policy barriers, and inconsistencies in legal protection that can create age-related barriers to HIV/AIDS services and care. One of the most pressing challenges is defining an age of majority for access to prevention measures, such as condoms, testing and treatment, and social support. Occasionally drawing on examples of existing and proposed laws in other African countries, Rwanda and other countries may strengthen their commitment to adolescents' rights and eliminate barriers to prevention, family planning, testing and disclosure, treatment, and support. Among the improvements, Rwanda and other countries must align its age of consent with the actual behavior of adolescents and ensure privacy to adolescents regarding family planning, HIV testing, disclosure, care, and treatment.

Physician perspectives on the management of viral hepatitis and hepatocellular carcinoma in Myanmar

PubMed Central

Kim, Yoona A.; Trinh, Sam; Thura, Si; Kyi, Khin Pyone; Lee, Thomas; Sze, Stan; Richards, Adam; Aronsohn, Andrew; Wong, Grace L. H.; Tanaka, Yasuhito; Dusheiko, Geoffrey

2017-01-01

Background In Myanmar, over five million people are infected with hepatitis B virus (HBV) and hepatitis C virus (HCV). Hepatitis has been a recent focus with the development of a National Strategic Plan on Hepatitis and plans to subsidize HCV treatment. Methods During a two-day national liver disease symposium covering HCV, HBV, hepatocellular (HCC), and end-stage liver disease (ESLD), physician surveys were administered using the automated response system (ARS) to assess physician knowledge, perceptions of barriers to screening and treatment, and proposed solutions. Multivariate logistic regression was used to estimate odds ratio (OR) relating demography and practice factors with higher provider knowledge and improvement. Results One hundred two physicians attending from various specialty areas (31.0% specializing in gastroenterology/hepatology and/or infectious disease) were of mixed gender (46.8% male), were younger than or equal to 40 years old (51.1% 20 to 40 years), had less experience (61.6% with ≤10 years of medical practice), were from the metropolitan area of Yangon (72.1%), and saw <10 liver disease patients per week (74.3%). The majority of physicians were not comfortable with treating or managing patients with liver disease. The post-test scores demonstrated an improvement in liver disease knowledge (9.0% ± 27.0) compared to the baseline pre-test scores; no variables were associated with significant improvement in hepatitis knowledge. Physicians identified the cost of diagnostic blood tests and treatment as the most significant barrier to treatment. Top solutions proposed were universal screening policies (46%), removal of financial barriers for treatment (29%), patient education (14%) and provider education (11%). Conclusions Physician knowledge improved after this symposium, and many other needs were revealed by the physician input on barriers to care and their solutions. These survey results are important in guiding the next steps to improve liver disease management and future medical education efforts in Myanmar. PMID:28797080

Physician perspectives on the management of viral hepatitis and hepatocellular carcinoma in Myanmar.

PubMed

Kim, Yoona A; Trinh, Sam; Thura, Si; Kyi, Khin Pyone; Lee, Thomas; Sze, Stan; Richards, Adam; Aronsohn, Andrew; Wong, Grace L H; Tanaka, Yasuhito; Dusheiko, Geoffrey; Nguyen, Mindie H

2017-01-01

In Myanmar, over five million people are infected with hepatitis B virus (HBV) and hepatitis C virus (HCV). Hepatitis has been a recent focus with the development of a National Strategic Plan on Hepatitis and plans to subsidize HCV treatment. During a two-day national liver disease symposium covering HCV, HBV, hepatocellular (HCC), and end-stage liver disease (ESLD), physician surveys were administered using the automated response system (ARS) to assess physician knowledge, perceptions of barriers to screening and treatment, and proposed solutions. Multivariate logistic regression was used to estimate odds ratio (OR) relating demography and practice factors with higher provider knowledge and improvement. One hundred two physicians attending from various specialty areas (31.0% specializing in gastroenterology/hepatology and/or infectious disease) were of mixed gender (46.8% male), were younger than or equal to 40 years old (51.1% 20 to 40 years), had less experience (61.6% with ≤10 years of medical practice), were from the metropolitan area of Yangon (72.1%), and saw <10 liver disease patients per week (74.3%). The majority of physicians were not comfortable with treating or managing patients with liver disease. The post-test scores demonstrated an improvement in liver disease knowledge (9.0% ± 27.0) compared to the baseline pre-test scores; no variables were associated with significant improvement in hepatitis knowledge. Physicians identified the cost of diagnostic blood tests and treatment as the most significant barrier to treatment. Top solutions proposed were universal screening policies (46%), removal of financial barriers for treatment (29%), patient education (14%) and provider education (11%). Physician knowledge improved after this symposium, and many other needs were revealed by the physician input on barriers to care and their solutions. These survey results are important in guiding the next steps to improve liver disease management and future medical education efforts in Myanmar.

Cross-cultural differences in dementia: the Sociocultural Health Belief Model.

PubMed

Sayegh, Philip; Knight, Bob G

2013-04-01

Many minority ethnic (ME) older adults face several culturally associated and systemic barriers to timely dementia diagnoses that may result in delays to dementia care-seeking. We aimed to develop and propose a model illustrating variables that influence dementia care-seeking among ME older adults. We conducted a literature review on the effects of these barriers on diagnostic delays and impairment levels at initial evaluation. We also strived to provide a basis for the Sociocultural Health Belief Model (SHBM) to guide future research and service planning pertaining to culture and dementia care-seeking. There was consistent evidence that ME older adults with dementia tended to have greater diagnostic delays and higher levels of cognitive impairment and behavioral and psychological symptoms of dementia at initial evaluation than their non-Hispanic White counterparts. We also found several barriers to dementia care-seeking among ME groups. These barriers included lower levels of acculturation and accurate knowledge about dementia, more culturally associated beliefs about dementia, such as the perception of memory loss as normal aging and stigma associated with dementia, and health system barriers. The SHBM provides an empirically based conceptual framework for examining cross-cultural differences in dementia care-seeking among diverse groups. We provide recommendations for future research, such as the need for research with more diverse ethnic subgroups and the examination of group-specific cultural values. We conclude with a discussion of the clinical and service implications of our review, including potential interventions aimed at facilitating timely dementia diagnoses among ME older adults.

Using a Bayesian network to predict barrier island geomorphologic characteristics

USGS Publications Warehouse

Gutierrez, Ben; Plant, Nathaniel G.; Thieler, E. Robert; Turecek, Aaron

2015-01-01

Quantifying geomorphic variability of coastal environments is important for understanding and describing the vulnerability of coastal topography, infrastructure, and ecosystems to future storms and sea level rise. Here we use a Bayesian network (BN) to test the importance of multiple interactions between barrier island geomorphic variables. This approach models complex interactions and handles uncertainty, which is intrinsic to future sea level rise, storminess, or anthropogenic processes (e.g., beach nourishment and other forms of coastal management). The BN was developed and tested at Assateague Island, Maryland/Virginia, USA, a barrier island with sufficient geomorphic and temporal variability to evaluate our approach. We tested the ability to predict dune height, beach width, and beach height variables using inputs that included longer-term, larger-scale, or external variables (historical shoreline change rates, distances to inlets, barrier width, mean barrier elevation, and anthropogenic modification). Data sets from three different years spanning nearly a decade sampled substantial temporal variability and serve as a proxy for analysis of future conditions. We show that distinct geomorphic conditions are associated with different long-term shoreline change rates and that the most skillful predictions of dune height, beach width, and beach height depend on including multiple input variables simultaneously. The predictive relationships are robust to variations in the amount of input data and to variations in model complexity. The resulting model can be used to evaluate scenarios related to coastal management plans and/or future scenarios where shoreline change rates may differ from those observed historically.

Identifying gaps, barriers, and solutions in implementing pressure ulcer prevention programs.

PubMed

Jankowski, Irene M; Nadzam, Deborah Morris

2011-06-01

Patients continue to suffer from pressure ulcers (PUs), despite implementation of evidence-based pressure ulcer (PU) prevention protocols. In 2009, Joint Commission Resources (JCR) and Hill-Rom created the Nurse Safety Scholar-in-Residence (nurse scholar) program to foster the professional development of expert nurse clinicians to become translators of evidence into practice. The first nurse scholar activity has focused on PU prevention. Four hospitals with established PU programs participated in the PU prevention implementation project. Each hospital's team completed an inventory of PU prevention program components and provided copies of accompanying documentation, along with prevalence and incidence data. Site visits to the four participating hospitals were arranged to provide opportunities for more in-depth analysis and support. Following the initial site visit, the project team at each hospital developed action plans for the top three barriers to PU program implementation. A series of conference calls was held between the site visits. Pressure Ulcer Program Gaps and Recommendations. The four hospitals shared common gaps in terms of limitations in staff education and training; lack of physician involvement; limited involvement of unlicensed nursing staff; lack of plan for communicating at-risk status; and limited quality improvement evaluations of bedside practices. Detailed recommendations were identified for addressing each of these gaps. these Recommendations for eliminating gaps have been implemented by the participating teams to drive improvement and to reduce hospital-acquired PU rates. The nurse scholars will continue to study implementation of best practices for PU prevention.

Hydrogen-enriched fuels

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roser, R.

1998-08-01

NRG Technologies, Inc. is attempting to develop hardware and infrastructure that will allow mixtures of hydrogen and conventional fuels to become viable alternatives to conventional fuels alone. This commercialization can be successful if the authors are able to achieve exhaust emission levels of less than 0.03 g/kw-hr NOx and CO; and 0.15 g/kw-hr NMHC at full engine power without the use of exhaust catalysts. The major barriers to achieving these goals are that the lean burn regimes required to meet exhaust emissions goals reduce engine output substantially and tend to exhibit higher-than-normal total hydrocarbon emissions. Also, hydrogen addition to conventionalmore » fuels increases fuel cost, and reduces both vehicle range and engine output power. Maintaining low emissions during transient driving cycles has not been demonstrated. A three year test plan has been developed to perform the investigations into the issues described above. During this initial year of funding research has progressed in the following areas: (a) a cost effective single-cylinder research platform was constructed; (b) exhaust gas speciation was performed to characterize the nature of hydrocarbon emissions from hydrogen-enriched natural gas fuels; (c) three H{sub 2}/CH{sub 4} fuel compositions were analyzed using spark timing and equivalence ratio sweeping procedures and finally; (d) a full size pick-up truck platform was converted to run on HCNG fuels. The testing performed in year one of the three year plan represents a baseline from which to assess options for overcoming the stated barriers to success.« less

Planning for retirement from medicine: a mixed-methods study.

PubMed

Pannor Silver, Michelle; Easty, Laura K

2017-01-01

Evidence suggests there are important personal and social consequences associated with inadequate retirement planning for physicians. We evaluated whether academic physicians felt satisfied with their retirement planning, and identified obstacles to retirement planning and a set of factors to facilitate retirement planning. We applied a sequential mixed-methods research design to explore and examine factors that facilitate academic physician retirement planning using data collected from multiple sources (including 7 focus groups, an internet-based survey and 23 in-depth interviews). We examined survey results regarding retirement planning satisfaction and preferences for complete versus gradual retirement. We used thematic analysis to examine verbatim transcripts and notes from the focus groups and interviews. Survey data (response rate 51%) indicated that 10% of respondents were very satisfied with their retirement planning and 89.5% would prefer to retire gradually rather than stop work completely. Key barriers to retirement planning that emerged included poor personal financial management, rigid institutional structures and professional norms. Facilitators included financial planning resources for physicians at multiple career stages, opportunities and resources for later-career transitions and later-career mentorship support for intergenerational collaboration, and recognition of retirees. Key findings highlight perceived barriers to retirement planning at various career stages in addition to factors that can enhance physicians' retirement planning, including creating gradual and flexible retirement options, supporting ongoing discussions about financial planning and later career transitions, and fostering a culture that continues to honour and involve retirees. Medical institutions could foster innovative models for later-career transitions from medicine in ways that address physicians' needs at various career stages, support gradual transitions from practice and recognize the value of experienced, capable later-career physicians and retirees.

Planning for retirement from medicine: a mixed-methods study

PubMed Central

Pannor Silver, Michelle; Easty, Laura K.

2017-01-01

Background: Evidence suggests there are important personal and social consequences associated with inadequate retirement planning for physicians. We evaluated whether academic physicians felt satisfied with their retirement planning, and identified obstacles to retirement planning and a set of factors to facilitate retirement planning. Methods: We applied a sequential mixed-methods research design to explore and examine factors that facilitate academic physician retirement planning using data collected from multiple sources (including 7 focus groups, an internet-based survey and 23 in-depth interviews). We examined survey results regarding retirement planning satisfaction and preferences for complete versus gradual retirement. We used thematic analysis to examine verbatim transcripts and notes from the focus groups and interviews. Results: Survey data (response rate 51%) indicated that 10% of respondents were very satisfied with their retirement planning and 89.5% would prefer to retire gradually rather than stop work completely. Key barriers to retirement planning that emerged included poor personal financial management, rigid institutional structures and professional norms. Facilitators included financial planning resources for physicians at multiple career stages, opportunities and resources for later-career transitions and later-career mentorship support for intergenerational collaboration, and recognition of retirees. Interpretation: Key findings highlight perceived barriers to retirement planning at various career stages in addition to factors that can enhance physicians' retirement planning, including creating gradual and flexible retirement options, supporting ongoing discussions about financial planning and later career transitions, and fostering a culture that continues to honour and involve retirees. Medical institutions could foster innovative models for later-career transitions from medicine in ways that address physicians' needs at various career stages, support gradual transitions from practice and recognize the value of experienced, capable later-career physicians and retirees. PMID:28401128

Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs.

PubMed

Nakku, Juliet E M; Okello, Elialilia S; Kizza, Dorothy; Honikman, Simone; Ssebunnya, Joshua; Ndyanabangi, Sheila; Hanlon, Charlotte; Kigozi, Fred

2016-07-22

Perinatal mental illness is a common and important public health problem, especially in low and middle-income countries (LMICs). This study aims to explore the barriers and facilitators, as well as perceptions about the feasibility and acceptability of plans to deliver perinatal mental health care in primary care settings in a low income, rural district in Uganda. Six focus group discussions comprising separate groups of pregnant and postpartum women and village health teams as well as eight key informant interviews were conducted in the local language using a topic guide. Transcribed data were translated into English, analyzed, and coded. Key themes were identified using a thematic analysis approach. Participants perceived that there was an important unmet need for perinatal mental health care in the district. There was evidence of significant gaps in knowledge about mental health problems as well as negative attitudes amongst mothers and health care providers towards sufferers. Poverty and inability to afford transport to services, poor partner support and stigma were thought to add to the difficulties of perinatal women accessing care. There was an awareness of the need for interventions to respond to this neglected public health problem and a willingness of both community- and facility-based health care providers to provide care for mothers with mental health problems if equipped to do so by adequate training. This study highlights the acceptability and relevance of perinatal mental health care in a rural, low-income country community. It also underscores some of the key barriers and potential facilitators to delivery of such care in primary care settings. The results of this study have implications for mental health service planning and development for perinatal populations in Uganda and will be useful in informing the development of integrated maternal mental health care in this rural district and in similar settings in other low and middle income countries.

Perspective of patients, patients' families, and healthcare providers towards designing and delivering hospice care services in a middle income Country.

PubMed

Azami-Aghdash, Saber; Ghojazadeh, Morteza; Aghaei, Mir Hossein; Naghavi-Behzad, Mohammad; Asgarlo, Zoleikha

2015-01-01

In view of the recent surge in chronic disease rates and elderly population in the developing countries, there is an urgent felt need for palliative and hospice care services. The present study investigates the views and attitudes of patients and their families, physicians, nurses, healthcare administrators, and insurers regarding designing and delivering hospice care service in a middle income country. In this qualitative study, the required data was collected using semi structured interviews and was analyzed using thematic analysis. Totally 65 participants from hospitals and Tabriz University of Medical Sciences were selected purposively to achieve data saturation. Analyzing the data, five main themes (barriers, facilitators, strategies, attitudes, and service provider) were extracted. Barriers included financial issues, cultural-religious beliefs, patient and family-related obstacles, and barriers related to healthcare system. Facilitators included family-related issues, cultural-religious beliefs, as well as facilitators associated with patients, healthcare status, and benefits of hospice service. Most participants (79%) had positive attitude towards hospice care service. Participant suggested 10 ways to design and deliver effective and efficient hospice care service. They thought the presence of physicians, nurses, and psychologists and other specialists and clergy were necessary in the hospice care team. Due to lack of experience in hospice care in developing countries, research for identifying probable barriers and appropriate management for reducing unsuccessfulness in designing and delivering hospice care service seems necessary. Input from the facilitators and their suggested solutions can be useful in planning the policy for hospice care system.

Defined contribution health care: future direction or fantasy?

PubMed

Ostuw, R

2000-01-01

Will payers embrace defined contribution plans as an alternative to traditional health insurance or is this new approach a pipe dream? Are consumers truly ready to make informed decisions on purchasing their own health care? This article explores barriers to defined contribution health plans, including consumer reluctance to take ownership of buying insurance and a preference for the cost predictability of liberal coverage in employer-sponsored programs versus MSAs or higher co-payment arrangements. For the ultimate form of defined contribution health care to work, several tax and insurance barriers must be overcome. As a practical matter, the author argues that the current employer-sponsored approach is the most efficient system for large employers.

Intersections of girl child marriage and family planning beliefs and use: qualitative findings from Ethiopia and India.

PubMed

McClendon, Katherine A; McDougal, Lotus; Ayyaluru, Sankari; Belayneh, Yemeserach; Sinha, Anand; Silverman, Jay G; Raj, Anita

2017-10-18

Child marriage and subsequent early first birth is a considerable social, economic and health concern, and a pervasive practice in sub-Saharan Africa and South Asia. This study explores barriers and facilitators to family planning among women and girls, and their marital decision-makers subsequent to receipt of child marriage prevention programmes in Ethiopia and India. In-depth interviews with 128 women and girls who were married as minors or who cancelled or postponed marriage as minors and their marital decision-makers were analysed using content analysis. Respondents identified social norms, including child marriage and pressure to have children, and lack of information as barriers to family planning. Benefits included delayed first birth and increased birth spacing, improved maternal and child health and girls' educational attainment. Respondents associated family planning use with delayed pregnancy and increased educational attainment, particularly in Ethiopia. Child marriage prevention programmes were identified as important sources of family planning information. Ethiopia's school-based programme strengthened access to health workers and contraception more so than India's community-based programme. Findings highlight young wives' vulnerability with regard to reproductive control, and support the need for multi-sector approaches across communities, schools and community health workers to improve family planning among young wives.

Identifying climate risk perceptions, information needs, and barriers to information exchange among public land managers.

PubMed

Peters, Casey B; Schwartz, Mark W; Lubell, Mark N

2018-03-01

Meeting ecosystem management challenges posed by climate change requires building effective communication channels among researchers, planners and practitioners to focus research on management issues requiring new knowledge. We surveyed resource managers within two regions of the western United States regions to better understand perceived risks and vulnerabilities associated with climate change and barriers to obtaining and using relevant climate science information in making ecosystem management decisions. We sought to understand what types of climate science information resource managers find most valuable, and the formats in which they prefer to receive climate science information. We found broad concern among natural resource managers in federal agencies that climate change will make it more difficult for them to achieve their management goals. Primary barriers to incorporating climate science into planning are distributed among challenges identifying, receiving, and interpreting appropriate science and a lack of direction provided by agency leadership needed to meaningfully use this emerging science in resource planning. Copyright © 2017 Elsevier B.V. All rights reserved.

Physician participation in clinical research and trials: issues and approaches

PubMed Central

Rahman, Sayeeda; Majumder, Md Anwarul Azim; Shaban, Sami F; Rahman, Nuzhat; Ahmed, Moslehuddin; Abdulrahman, Khalid Bin; D’Souza, Urban JA

2011-01-01

The rapid development of new drugs, therapies, and devices has created a dramatic increase in the number of clinical research studies that highlights the need for greater participation in research by physicians as well as patients. Furthermore, the potential of clinical research is unlikely to be reached without greater participation of physicians in research. Physicians face a variety of barriers with regard to participation in clinical research. These barriers are system-or organization-related as well as research-and physician-related. To encourage physician participation, appropriate organizational and operational infrastructures are needed in health care institutes to support research planning and management. All physicians should receive education and training in the fundamentals of research design and methodology, which need to be incorporated into undergraduate medical education and postgraduate training curricula and then reinforced through continuing medical education. Medical schools need to analyze current practices of teaching–learning and research, and reflect upon possible changes needed to develop a ‘student-focused teaching–learning and research culture’. This article examines the barriers to and benefits of physician participation in clinical research as well as interventions needed to increase their participation, including the specific role of undergraduate medical education. The main challenge is the unwillingness of many physicians and patients to participate in clinical trials. Barriers to participation include lack of time, lack of resources, trial-specific issues, communication difficulties, conflicts between the role of clinician and scientist, inadequate research experience and training for physicians, lack of rewards and recognition for physicians, and sometimes a scientifically uninteresting research question, among others. Strategies to encourage physician participation in clinical research include financial and nonfinancial incentives, adequate training, research questions that are in line with physician interests and have clear potential to improve patient care, and regular feedback. Finally, encouraging research culture and fostering the development of inquiry and research-based learning among medical students is now a high priority in order to develop more and better clinician-researchers. PMID:23745079

Time management strategies for research productivity.

PubMed

Chase, Jo-Ana D; Topp, Robert; Smith, Carol E; Cohen, Marlene Z; Fahrenwald, Nancy; Zerwic, Julie J; Benefield, Lazelle E; Anderson, Cindy M; Conn, Vicki S

2013-02-01

Researchers function in a complex environment and carry multiple role responsibilities. This environment is prone to various distractions that can derail productivity and decrease efficiency. Effective time management allows researchers to maintain focus on their work, contributing to research productivity. Thus, improving time management skills is essential to developing and sustaining a successful program of research. This article presents time management strategies addressing behaviors surrounding time assessment, planning, and monitoring. Herein, the Western Journal of Nursing Research editorial board recommends strategies to enhance time management, including setting realistic goals, prioritizing, and optimizing planning. Involving a team, problem-solving barriers, and early management of potential distractions can facilitate maintaining focus on a research program. Continually evaluating the effectiveness of time management strategies allows researchers to identify areas of improvement and recognize progress.

SSL Pricing and Efficacy Trend Analysis for Utility Program Planning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tuenge, Jason R.

2013-10-01

An LED lamp or luminaire can generally be found that matches or exceeds the efficacy of benchmark technologies in a given product category, and LED products continue to expand into ever-higher lumen output niches. However, the price premium for LED continues to pose a barrier to adoption in many applications, in spite of expected savings from reduced energy use and maintenance. Other factors—such as dimmability and quality of light—can also present challenges. The appropriate type, timing, and magnitude of energy efficiency activities will vary from organization to organization based on local variables and the method of evaluation. A number ofmore » factors merit consideration when prioritizing activities for development. Category-specific projections for pricing and efficacy are provided herein to assist in efficiency program planning efforts.« less

Barriers to effective diabetes management - a survey of people with severe mental illness.

PubMed

Mulligan, Kathleen; McBain, Hayley; Lamontagne-Godwin, Frederique; Chapman, Jacqui; Flood, Chris; Haddad, Mark; Jones, Julia; Simpson, Alan

2018-06-01

People with severe mental illnesses (SMI) such as schizophrenia and bipolar disorder have an increased risk of developing type 2 diabetes and have poorer health outcomes than those with diabetes alone. To maintain good diabetes control, people with diabetes are advised to engage in several self-management behaviours. The aim of this study was to identify barriers or enablers of diabetes self-management experienced by people with SMI. Adults with type 2 diabetes and SMI were recruited through UK National Health Service organisations and mental health and diabetes charities. Participants completed an anonymous survey consisting of: Summary of Diabetes Self-Care Activities (SDSCA); CORE-10 measure of psychological distress; a measure of barriers and enablers of diabetes self-management based on the Theoretical Domains Framework; Diabetes UK care survey on receipt of 14 essential aspects of diabetes healthcare. To identify the strongest explanatory variables of SDSCA outcomes, significant variables (p < .05) identified from univariate analyses were entered into multiple regressions. Most of the 77 participants had bipolar disorder (42%) or schizophrenia (36%). They received a mean of 7.6 (SD 3.0) diabetes healthcare essentials. Only 28.6% had developed a diabetes care plan with their health professional and only 40% reported receiving specialist psychological support. Engagement in self-management activities was variable. Participants reported taking medication on 6.1 (SD 2.0) days in the previous week but other behaviours were less frequent: general diet 4.1 (2.3) days; specific diet 3.6 (1.8) days, taking exercise 2.4 (2.1) days and checking feet on 1.7 (1.8) days. Smoking prevalence was 44%. Participants reported finding regular exercise and following a healthy diet particularly difficult. Factors associated with diabetes self-management included: the level of diabetes healthcare and support received; emotional wellbeing; priority given to diabetes; perceived ability to manage diabetes or establish a routine to do so; and perceived consequences of diabetes self-management. Several aspects of diabetes healthcare and self-management are suboptimal in people with SMI. There is a need to improve diabetes self-management support for this population by integrating diabetes action plans into care planning and providing adequate psychological support to help people with SMI manage their diabetes.

Current situations and future directions for mental health system governance in Nepal: findings from a qualitative study.

PubMed

Upadhaya, Nawaraj; Jordans, Mark J D; Pokhrel, Ruja; Gurung, Dristy; Adhikari, Ramesh P; Petersen, Inge; Komproe, Ivan H

2017-01-01

Assessing and understanding health systems governance is crucial to ensure accountability and transparency, and to improve the performance of mental health systems. There is a lack of systematic procedures to assess governance in mental health systems at a country level. The aim of this study was to appraise mental health systems governance in Nepal, with the view to making recommendations for improvements. In-depth individual interviews were conducted with national-level policymakers (n = 17) and district-level planners (n = 11). The interview checklist was developed using an existing health systems governance framework developed by Siddiqi and colleagues as a guide. Data analysis was done with NVivo 10, using the procedure of framework analysis. The mental health systems governance assessment reveals a few enabling factors and many barriers. Factors enabling good governance include availability of mental health policy, inclusion of mental health in other general health policies and plans, increasing presence of Non-Governmental Organizations (NGOs) and service user organizations in policy forums, and implementation of a few mental health projects through government-NGO collaborations. Legal and policy barriers include the failure to officially revise or fully implement the mental health policy of 1996, the existence of legislation and several laws that have discriminatory provisions for people with mental illness, and lack of a mental health act and associated regulations to protect against this. Other barriers include lack of a mental health unit within the Ministry of Health, absence of district-level mental health planning, inadequate mental health record-keeping systems, inequitable allocation of funding for mental health, very few health workers trained in mental health, and the lack of availability of psychotropic drugs at the primary health care level. In the last few years, some positive developments have emerged in terms of policy recognition for mental health, as well as the increased presence of NGOs, increased presence of service users or caregivers in mental health governance, albeit restricted to only some of its domains. However, the improvements at the policy level have not been translated into implementation due to lack of strong leadership and governance mechanisms.

Barriers and facilitators for breastfeeding among working women in the United States.

PubMed

Johnston, Marina L; Esposito, Noreen

2007-01-01

To review the literature and describe the barriers and facilitators to the continuation of breastfeeding for at least 6 months by working women in the United States. A search of PubMed, CINAHL, Sociological Abstracts, ISI, PsychInfo, and ProQuest. Twenty studies based on the inclusion criteria and published between January 1, 1995, and January 2006. An ecologic framework, which includes the individual (microsystem), social support and relationships (mesosystem), and the workplace environment (exosystem). When working mothers possess certain personal characteristics and develop a strategic plan, breastfeeding is promoted. When social support is available and when support groups are utilized, lactation is also facilitated. Part-time work, lack of long mother-infant separations, supportive work environments and facilities, and child care options facilitate breastfeeding. Health care providers can use the findings of this review to promote breastfeeding among working women by using tactics geared toward the mother, her social network, and the entire community.

Atopic Dermatitis in Children: Clinical Features, Pathophysiology and Treatment

PubMed Central

Lyons, Jonathan J.; Milner, Joshua D.; Stone, Kelly D.

2014-01-01

Atopic dermatitis (AD) is a chronic, relapsing, highly pruritic skin condition resulting from disruption of the epithelial barrier and associated immune dysregulation in the skin of genetically predisposed hosts. AD generally develops in early childhood, has a characteristic age-dependent distribution and is commonly associated with elevated IgE, peripheral eosinophilia and other allergic diseases. Staphylococcus aureus colonization is common and may contribute to disease progression and severity. Targeted therapies to restore both impaired skin barrier and control inflammation are required for optimal outcomes for patients with moderate to severe disease. Pruritus is universal among patients with AD and has a dominant impact on diminishing quality of life. Medications such as anti-histamines have demonstrated poor efficacy in controlling AD-associated itch. Education of patients regarding the primary underlying defects and provision of a comprehensive skin care plan is essential for disease maintenance and management of flares. PMID:25459583

The WHF Roadmap for Reducing CV Morbidity and Mortality Through Prevention and Control of RHD.

PubMed

Palafox, Benjamin; Mocumbi, Ana Olga; Kumar, R Krishna; Ali, Sulafa K M; Kennedy, Elizabeth; Haileamlak, Abraham; Watkins, David; Petricca, Kadia; Wyber, Rosemary; Timeon, Patrick; Mwangi, Jeremiah

2017-03-01

Rheumatic heart disease (RHD) is a preventable non-communicable condition that disproportionately affects the world's poorest and most vulnerable. The World Heart Federation Roadmap for improved RHD control is a resource designed to help a variety of stakeholders raise the profile of RHD nationally and globally, and provide a framework to guide and support the strengthening of national, regional and global RHD control efforts. The Roadmap identifies the barriers that limit access to and uptake of proven interventions for the prevention and control of RHD. It also highlights a variety of established and promising solutions that may be used to overcome these barriers. As a general guide, the Roadmap is meant to serve as the foundation for the development of tailored plans of action to improve RHD control in specific contexts. Copyright © 2016 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

Condom use in China: prevalence, policies, issues and barriers.

PubMed

Zou, Huachun; Xue, Hui; Wang, Xiaofang; Lu, Damien

2012-03-01

In this review, we describe condom use and its influencing factors in China, with a particular focus on the five populations that are at high risk for HIV/sexually transmissible infections (STI) infection: female sex workers, men who have sex with men, migrant workers, young people and sero-discordant couples. The risk for HIV/STI infection is high while condom use rates are low among these five populations. The 100% Condom Use Programme was successful in trial regions in increasing condom use and decreasing HIV/STI prevalence; however, long-term and routine condom promotion strategies should be in place to ensure better awareness of condom use, high availability of condoms and high rate of condom use among populations at high risk of HIV/STI infection in China. Realistic and vigorous condom-related policies and action plans should be developed and implemented to address the issues and barriers facing condom promotion in China.

How do Dutch primary care providers overcome barriers to advance care planning with older people? A qualitative study.

PubMed

Glaudemans, Jolien J; de Jong, Anja E; Onwuteaka Philipsen, Bregje D; Wind, Jan; Willems, Dick L

2018-06-11

Few older people benefit from advance care planning (ACP), due to several barriers related to primary care professionals, such as insufficient knowledge, negative beliefs and a lack of time. Information on overcoming these barriers is limited. We assumed primary care professionals experienced in ACP with older patients are likely to have learned how to overcome these barriers. To investigate how Dutch primary care professionals experienced in ACP with older patients overcome these barriers. A qualitative study, based on semi-structured interviews, among a purposive sample of 14 Dutch primary care professionals experienced in ACP with older people. Transcripts were thematically analysed. We interviewed eight general practitioners (GPs), three nurses and three elderly care physicians, experienced in ACP with older people. Respondents overcame their own insufficient knowledge and skills, as well as their negative attitudes and beliefs by gaining experience through practicing ACP in their daily practices, exchanging and reflecting on those experiences with peers, pursuing continuing education, teaching and participating in research. To overcome patients' and families' lack of initiative and openness to ACP, respondents prepared them for further steps in ACP. To overcome a lack of time, respondents used tools and information communication technology, delegated parts of ACP to other primary care professionals, acquired financing and systematized documentation of ACP. Primary care professionals can overcome barriers to ACP with older patients by practicing, reflecting on experiences and pursuing continuing education, by preparing patients and involving family and by investing in support to approach ACP more efficiently.

Harmonizing disease prevention and police practice in the implementation of HIV prevention programs: Up-stream strategies from Wilmington, Delaware

PubMed Central

2012-01-01

Introduction Improving access to sterile injection equipment is a key component in community-based infectious disease prevention. Implementation of syringe access programs has sometimes been complicated by community opposition and police interference. Case description In 2006, the Delaware legislature authorized a pilot syringe exchange program (SEP). A program designed to prevent, monitor, and respond to possible policing and community barriers before they had a chance to effect program implementation and operation. A program designed to prevent, monitor, and respond to these barriers was planned and implemented by a multidisciplinary team of legal practitioners and public health professionals. Discussion We report on an integrated intervention to address structural barriers to syringe exchange program utilization. This intervention employs community, police and client education combined with systematic surveillance of and rapid response to police interference to preempt the kinds of structural barriers to implementation observed elsewhere. The intervention addresses community concerns and stresses the benefits of syringe exchange programs to officer occupational safety. Conclusions A cohesive effort combining collaboration with and educational outreach to police and community members based on the needs and concerns of these groups as well as SEP clients and potential clients helped establish a supportive street environment for the SEP. Police-driven structural barriers to implementation of public health programs targeting populations engaged in drug use and other illicit behavior can be addressed by up-stream planning, prevention, monitoring and intervention strategies. More research is needed to inform the tailoring of interventions to address police-driven barriers to HIV prevention services, especially among marginalized populations. PMID:22591836

Motivations and Constraints to Family Planning: A Qualitative Study in Rwanda’s Southern Kayonza District

PubMed Central

Farmer, Didi Bertrand; Berman, Leslie; Ryan, Grace; Habumugisha, Lameck; Basinga, Paulin; Nutt, Cameron; Kamali, Francois; Ngizwenayo, Elias; Fleur, Jacklin St; Niyigena, Peter; Ngabo, Fidele; Farmer, Paul E; Rich, Michael L

2015-01-01

Background: While Rwanda has achieved impressive gains in contraceptive coverage, unmet need for family planning is high, and barriers to accessing quality reproductive health services remain. Few studies in Rwanda have qualitatively investigated factors that contribute to family planning use, barriers to care, and quality of services from the community perspective. Methods: We undertook a qualitative study of community perceptions of reproductive health and family planning in Rwanda’s southern Kayonza district, which has the country’s highest total fertility rate. From October 2011 to December 2012, we conducted interviews with randomly selected male and female community members (n = 96), community health workers (n = 48), and health facility nurses (n = 15), representing all 8 health centers’ catchment areas in the overall catchment area of the district’s Rwinkwavu Hospital. We then carried out a directed content analysis to identify key themes and triangulate findings across methods and informant groups. Results: Key themes emerged across interviews surrounding: (1) fertility beliefs: participants recognized the benefits of family planning but often desired larger families for cultural and historical reasons; (2) social pressures and gender roles: young and unmarried women faced significant stigma and husbands exerted decision-making power, but many husbands did not have a good understanding of family planning because they perceived it as a woman’s matter; (3) barriers to accessing high-quality services: out-of-pocket costs, stock-outs, limited method choice, and long waiting times but short consultations at facilities were common complaints; (4) side effects: poor management and rumors and fears of side effects affected contraceptive use. These themes recurred throughout many participant narratives and influenced reproductive health decision making, including enrollment and retention in family planning programs. Conclusions: As Rwanda continues to refine its family planning policies and programs, it will be critical to address community perceptions around fertility and desired family size, health worker shortages, and stock-outs, as well as to engage men and boys, improve training and mentorship of health workers to provide quality services, and clarify and enforce national policies about payment for services at the local level. PMID:26085021

Evidence-based dentistry for planning restorative treatments: barriers and potential solutions.

PubMed

Afrashtehfar, K I; Eimar, H; Yassine, R; Abi-Nader, S; Tamimi, F

2017-11-01

Evidence-based dentistry (EBD) can help provide the best treatment option for every patient, however, its implementation in restorative dentistry is very limited. This study aimed at assessing the barriers preventing the implementation of EBD among dental undergraduate and graduate students in Montreal, and explore possible solutions to overcome these barriers. A cross-sectional survey was conducted by means of a paper format self-administrated questionnaire distributed among dental students. The survey assessed the barriers and potential solutions for implementation of an evidence-based practice. Sixty-one students completed the questionnaire. Forty-one percent of respondents found evidence-based literature to be the most reliable source of information for restorative treatment planning, however, only 16% used it. They considered that finding reliable information was difficult and they sometimes encountered conflicting information when consulting different sources. Dental students had positive attitudes towards the need for better access to evidence-based literature to assist learning and decision making in restorative treatment planning and to improve treatment outcomes. Even for dentists trained in EBD, online searching takes too much time, and even though it can provide information of better quality than personal intuition, it might not be enough to identify the best available evidence. Even though dental students are aware of the importance of EBD in restorative dentistry they rarely apply the concept, mainly due to time constraints. For this reason, implementation of EBD would probably require faster access to evidence-based knowledge. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Creating more effective health plan quality reports for consumers: lessons from a synthesis of qualitative testing.

PubMed Central

Harris-Kojetin, L D; McCormack, L A; Jaël, E F; Sangl, J A; Garfinkel, S A

2001-01-01

OBJECTIVE: Social marketing techniques such as consumer testing have only recently been applied to develop effective consumer health insurance information. This article discusses lessons learned from consumer testing to create consumer plan choice materials. DATA SOURCES/STUDY SETTING: Data were collected from 268 publicly and privately insured consumers in three studies between 1994 and 1999. STUDY DESIGN: Iterative testing and revisions were conducted to design seven booklets to help Medicaid, Medicare, and employed consumers choose a health plan. DATA COLLECTION METHODS: Standardized protocols were used in 11 focus groups and 182 interviews to examine the content, comprehension, navigation, and utility of the booklets. PRINCIPAL FINDINGS: A method is suggested to help consumers narrow their plan choices by breaking down the process into smaller decisions using a set of guided worksheets. CONCLUSION: Implementing these lessons is challenging and not often done well. This article gives examples of evidence-based approaches to address cognitive barriers that designers of consumer health insurance information can adapt to their needs. Images Figure. 3 PMID:11482584

Strategic Priorities for Increasing Physical Activity Among Adults Age 50 and Older: The National Blueprint Consensus Conference Summary Report

PubMed Central

Sheppard, Lisa; Senior, Jane; Park, Chae Hee; Mockenhaupt, Robin; Bazzarre, Terry; Chodzko-Zajko, Wojtek

2003-01-01

On May 1, 2001, a coalition of national organizations released a major planning document designed to develop a national strategy for the promotion of physically active lifestyles among the mid-life and older adult population. The National Blueprint: Increasing Physical Activity Among Adults Age 50 and Older was developed with input from 46 organizations with expertise in health, medicine, social and behavioral sciences, epidemiology, gerontology/geriatrics, clinical science, public policy, marketing, medical systems, community organization, and environmental issues. The Blueprint notes that, despite a wealth of evidence about the benefits of physical activity for mid-life and older persons, there has been little success in convincing age 50+ Americans to adopt physically active lifestyles. The Blueprint identifies barriers in the areas of research, home and community programs, medical systems, public policy and advocacy, and marketing and communications. In addition to identifying barriers, the Blueprint proposes a number of concrete strategies that could be employed in order to overcome the barriers to physical activity in society at large. This report summarizes the outcome of the National Blueprint Consensus Conference that was held in October 2002. In this conference, representatives of more than 50 national organizations convened in Washington, D.C. with the goal of identifying high priority and high feasibility strategies which would advance the National Blueprint and which could be initiated within the next 12 to 24 months. Participants in the consensus conference were assigned to one of five breakout groups: home and community, marketing, medical systems, public policy, and research. Each breakout group was charged with identifying the three highest priority strategies within their area for effectively increasing physical activity levels in the mid-life and older adult population. In addition to the 15 strategies identified by the breakout groups, three "cross-cutting" strategies were added which were considered to be broad-based in scope and which applied to more than one of the breakout themes. A national organization was identified to take the lead in planning and implementing each strategy. A summary of the 18 strategies and lead organizations is presented. The National Blueprint Consensus Conference has identified an ambitious agenda of strategies and tactics that will need to be implemented in order to overcome societal barriers to physical activity among the mid-life and older adult population. More than 50 national organizations have expressed a commitment to work towards the implementation of the Blueprint agenda. Eighteen priority strategies have been identified in the areas of home and community, marketing, medical systems, public policy, and research. The organizations charged with the task of implementing the high priority strategies will use professional networks and established delivery channels and communication systems to translate this plan into action. PMID:24688279

Strategic priorities for increasing physical activity among adults age 50 and older: the national blueprint consensus conference summary report.

PubMed

Sheppard, Lisa; Senior, Jane; Park, Chae Hee; Mockenhaupt, Robin; Bazzarre, Terry; Chodzko-Zajko, Wojtek

2003-12-01

On May 1, 2001, a coalition of national organizations released a major planning document designed to develop a national strategy for the promotion of physically active lifestyles among the mid-life and older adult population. The National Blueprint: Increasing Physical Activity Among Adults Age 50 and Older was developed with input from 46 organizations with expertise in health, medicine, social and behavioral sciences, epidemiology, gerontology/geriatrics, clinical science, public policy, marketing, medical systems, community organization, and environmental issues. The Blueprint notes that, despite a wealth of evidence about the benefits of physical activity for mid-life and older persons, there has been little success in convincing age 50+ Americans to adopt physically active lifestyles. The Blueprint identifies barriers in the areas of research, home and community programs, medical systems, public policy and advocacy, and marketing and communications. In addition to identifying barriers, the Blueprint proposes a number of concrete strategies that could be employed in order to overcome the barriers to physical activity in society at large. This report summarizes the outcome of the National Blueprint Consensus Conference that was held in October 2002. In this conference, representatives of more than 50 national organizations convened in Washington, D.C. with the goal of identifying high priority and high feasibility strategies which would advance the National Blueprint and which could be initiated within the next 12 to 24 months. Participants in the consensus conference were assigned to one of five breakout groups: home and community, marketing, medical systems, public policy, and research. Each breakout group was charged with identifying the three highest priority strategies within their area for effectively increasing physical activity levels in the mid-life and older adult population. In addition to the 15 strategies identified by the breakout groups, three "cross-cutting" strategies were added which were considered to be broad-based in scope and which applied to more than one of the breakout themes. A national organization was identified to take the lead in planning and implementing each strategy. A summary of the 18 strategies and lead organizations is presented. The National Blueprint Consensus Conference has identified an ambitious agenda of strategies and tactics that will need to be implemented in order to overcome societal barriers to physical activity among the mid-life and older adult population. More than 50 national organizations have expressed a commitment to work towards the implementation of the Blueprint agenda. Eighteen priority strategies have been identified in the areas of home and community, marketing, medical systems, public policy, and research. The organizations charged with the task of implementing the high priority strategies will use professional networks and established delivery channels and communication systems to translate this plan into action.

Comparison of selected foreign plans and practices for spent fuel and high-level waste management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schneider, K.J.; Mitchell, S.J.; Lakey, L.T.

1990-04-01

This report describes the major parameters for management of spent nuclear fuel and high-level radioactive wastes in selected foreign countries as of December 1989 and compares them with those in the United States. The foreign countries included in this study are Belgium, Canada, France, the Federal Republic of Germany, Japan, Sweden, Switzerland, and the United Kingdom. All the countries are planning for disposal of spent fuel and/or high-level wastes in deep geologic repositories. Most countries (except Canada and Sweden) plan to reprocess their spent fuel and vitrify the resultant high-level liquid wastes; in comparison, the US plans direct disposal ofmore » spent fuel. The US is planning to use a container for spent fuel as the primary engineered barrier. The US has the most developed repository concept and has one of the earliest scheduled repository startup dates. The repository environment presently being considered in the US is unique, being located in tuff above the water table. The US also has the most prescriptive regulations and performance requirements for the repository system and its components. 135 refs., 8 tabs.« less

Creating Rural Allied Health Leadership Structures Using District Advisors: An Action Research Project Using Program Logic.

PubMed

Schmidt, David; Kurtz, Megan; Davidson, Stuart

2017-01-01

District advisors in five allied health disciplines were introduced in a local health district in rural Australia in 2013. These strategic leadership roles provide support to clinicians and managers. As there is little research exploring allied health leadership models from a strategic and operational perspective, the coordinated commencement of these roles provided opportunity to study the creation of this leadership structure. Four advisors participated in this action research study which used focus groups and program logic processes to explore the inputs, outputs, barriers, outcomes to date, and preferred future outcomes of the leadership model. A purpose-built questionnaire was sent to 134 allied health clinicians or managers with questionnaire responses used by advisors to visualise the leadership model. Advisors prioritised policy development, representing the profession outside the organisation, and supporting department managers, whilst clinicians prioritised communication and connection-building within the organisation. Outcomes of the leadership model included connection, coordination, and advocacy for clinicians. Future preferred outcomes included increased strategic and workforce planning. Barriers included limited time, a widespread workforce and limited resourcing. Instituting a leadership model improved communication, cohesion, and coordination within the organisation. Future increases in workforce planning and coordination are limited by advisor capacity and competing workloads.

Planning the Unplanned Experiment: Towards Assessing the Efficacy of Standards for Safety-Critical Software

NASA Technical Reports Server (NTRS)

Graydon, Patrick J.; Holloway, C. M.

2015-01-01

Safe use of software in safety-critical applications requires well-founded means of determining whether software is fit for such use. While software in industries such as aviation has a good safety record, little is known about whether standards for software in safety-critical applications 'work' (or even what that means). It is often (implicitly) argued that software is fit for safety-critical use because it conforms to an appropriate standard. Without knowing whether a standard works, such reliance is an experiment; without carefully collecting assessment data, that experiment is unplanned. To help plan the experiment, we organized a workshop to develop practical ideas for assessing software safety standards. In this paper, we relate and elaborate on the workshop discussion, which revealed subtle but important study design considerations and practical barriers to collecting appropriate historical data and recruiting appropriate experimental subjects. We discuss assessing standards as written and as applied, several candidate definitions for what it means for a standard to 'work,' and key assessment strategies and study techniques and the pros and cons of each. Finally, we conclude with thoughts about the kinds of research that will be required and how academia, industry, and regulators might collaborate to overcome the noted barriers.

Factors involved in the collaboration between the national comprehensive cancer control programs and tobacco control programs: a qualitative study of 6 States, United States, 2012.

PubMed

Momin, Behnoosh; Neri, Antonio; Goode, Sonya A; Sarris Esquivel, Nikie; Schmitt, Carol L; Kahende, Jennifer; Zhang, Lei; Stewart, Sherri L

2015-05-28

Historically, federal funding streams to address cancer and tobacco use have been provided separately to state health departments. This study aims to document the impact of a recent focus on coordinating chronic disease efforts through collaboration between the 2 programs. Through a case-study approach using semistructured interviews, we collected information on the organizational context, infrastructure, and interaction between cancer and tobacco control programs in 6 states from March through July 2012. Data were analyzed with NVivo software, using a grounded-theory approach. We found between-program activities in the state health department and coordinated implementation of interventions in the community. Factors identified as facilitating integrated interventions in the community included collaboration between programs in the strategic planning process, incorporation of one another's priorities into state strategic plans, co-location, and leadership support for collaboration. Coalitions were used to deliver integrated interventions to the community. Five states perceived high staff turnover as a barrier to collaboration, and all 5 states felt that federal funding requirements were a barrier. Cancer and tobacco programs are beginning to implement integrated interventions to address chronic disease. Findings can inform the development of future efforts to integrate program activities across chronic disease prevention efforts.

Pilot Testing a Web-Based System for the Assessment and Management of Chemotherapy-Induced Peripheral Neuropathy.

PubMed

Knoerl, Robert; Dudley, William N; Smith, Gloria; Bridges, Celia; Kanzawa-Lee, Grace; Lavoie Smith, Ellen M

2017-04-01

Because numerous barriers hinder the assessment and management of chemotherapy-induced peripheral neuropathy in clinical practice, the Carevive Care Planning System, a novel Web-based platform, was developed to address these barriers. It provides patients an opportunity to report their symptoms before their clinic visit and generates customizable care plans composed of evidence-based management strategies. The purpose of this study was to evaluate patient and provider perspectives of feasibility, usability, acceptability, and satisfaction with the Carevive platform. We used a single-arm, pretest/posttest, prospective design and recruited 25 women with breast cancer who were receiving neurotoxic chemotherapy and six advanced practice providers from an academic hospital. At three consecutive clinical visits, patients reported their neuropathy symptoms on a tablet via the Carevive system. The Diffusion of Innovations Theory served as an overarching evaluation framework. The Carevive platform was feasible to use. However, patients had higher ratings of usability, acceptability, and satisfaction with the platform than did the providers, who disliked the amount of time required to use the platform and had difficulty logging into Carevive. If issues regarding provider dissatisfaction can be addressed, the Carevive platform may aid in the screening of neuropathy symptoms and facilitate the use of evidence-based management strategies.

Steps and Tools to Guide Planning and Implementation of a Comprehensive System to Address Barriers to Learning and Teaching

ERIC Educational Resources Information Center

Center for Mental Health in Schools at UCLA, 2007

2007-01-01

The data are clear: Too many students are not doing well in school. Too many are experiencing interfering barriers, most of which are not internal dysfunctions but are associated with neighborhood, family, school, and peer factors. If the situation is to change, schools must play a greater role in providing supports for students experiencing…

STIR: Novel Electronic States by Gating Strongly Correlated Materials

DTIC Science & Technology

2016-03-01

plan built on my group’s recent demonstration of electrolyte gating in Strontium Titanate, using an atomically thin hexagonal Boron Nitride barrier to...demonstration of electrolyte gating in Strontium Titanate, using an atomically thin hexagonal Boron Nitride barrier to prevent disorder and chemical...techniques and learned to apply thin hexagonal Boron Nitride to single crystals of materials expected to show some of the most exciting correlated

Factors That Effect Interagency Collaborations: Lessons During and Following the 2002 Winter Olympics

DTIC Science & Technology

2008-03-01

solving Formal control ( decision making ) Strategic planning (structure or process) Barriers PROBE / Ticklers Were there incentives... making ) Strategic planning (structure or process) 74 PROBE / Ticklers To what extend does interdependence needed for these...aspect Motivation Social capital Trust Leadership Interpersonal communication (people skills) Shared problem solving Formal control ( decision

Research on Physical Activity in the Elderly: Practical Implications for Program Planning.

ERIC Educational Resources Information Center

Myers, Anita M.; Gonda, Gail

1986-01-01

The authors critically examine the research on physical activity in the elderly to assess the elderly's capacity for exercise and the benefits accruing from exercise. Lower-intensity exercise programs attract a more representative group of senior participants and overcome many barriers. Implications for program planning and efforts are discussed.…

Specific Barriers and Drivers in Different Stages of Decision-Making about Energy Efficiency Upgrades in Private Homes

PubMed Central

Klöckner, Christian A.; Nayum, Alim

2016-01-01

Energy efficiency upgrades of privately owned homes like adding to the insulation layers in the walls, roof or floor, or replacing windows with more efficiently insulated versions can contribute significantly to reducing the energy impact of the building sector and thus also the CO2 footprint of a household. However, even in countries like Norway that have a rather high rate of renovation, energy upgrades are not always integrated into such a refurbishment project. This study tests which structural and internal psychological barriers hinder and which drivers foster decision-making to implement such measures, once a renovation project is planned. With a theoretical background in stage-based models of decision-making 24 barriers and drivers were tested for their specific effect in the stages of decision-making. The four stages of decision-making assumed in this study were (1) “not being in a decision mode,” (2) “deciding what to do,” (3) “deciding how to do it,” and (4) “planning implementation.” Based on an online survey of 3787 Norwegian households, it was found that the most important barriers toward deciding to implement energy efficiency upgrades were not owning the dwelling and feeling the right time had not come yet. The most important drivers of starting to decide were higher expected comfort levels, better expected living conditions, and an expected reduction of energy costs. For the transition from deciding what to do to how to do it, not managing to make a decision and feeling the right point in time has not come yet were the strongest barriers, easily accessible information and an expected reduction of energy costs were the most important drivers. The final transition from deciding how to do the upgrades to planning implementation was driven by expecting a payoff within a reasonable time frame and higher expected comfort levels; the most important barriers were time demands for supervising contractors and—again—a feeling that the right point in time has not come yet. Implications for policy-making and marketing are discussed. PMID:27660618

Specific Barriers and Drivers in Different Stages of Decision-Making about Energy Efficiency Upgrades in Private Homes.

PubMed

Klöckner, Christian A; Nayum, Alim

2016-01-01

Energy efficiency upgrades of privately owned homes like adding to the insulation layers in the walls, roof or floor, or replacing windows with more efficiently insulated versions can contribute significantly to reducing the energy impact of the building sector and thus also the CO2 footprint of a household. However, even in countries like Norway that have a rather high rate of renovation, energy upgrades are not always integrated into such a refurbishment project. This study tests which structural and internal psychological barriers hinder and which drivers foster decision-making to implement such measures, once a renovation project is planned. With a theoretical background in stage-based models of decision-making 24 barriers and drivers were tested for their specific effect in the stages of decision-making. The four stages of decision-making assumed in this study were (1) "not being in a decision mode," (2) "deciding what to do," (3) "deciding how to do it," and (4) "planning implementation." Based on an online survey of 3787 Norwegian households, it was found that the most important barriers toward deciding to implement energy efficiency upgrades were not owning the dwelling and feeling the right time had not come yet. The most important drivers of starting to decide were higher expected comfort levels, better expected living conditions, and an expected reduction of energy costs. For the transition from deciding what to do to how to do it, not managing to make a decision and feeling the right point in time has not come yet were the strongest barriers, easily accessible information and an expected reduction of energy costs were the most important drivers. The final transition from deciding how to do the upgrades to planning implementation was driven by expecting a payoff within a reasonable time frame and higher expected comfort levels; the most important barriers were time demands for supervising contractors and-again-a feeling that the right point in time has not come yet. Implications for policy-making and marketing are discussed.

Equity and immunization supply chain in Madagascar.

PubMed

van den Ent, Maya M V X; Yameogo, Andre; Ribaira, Eric; Hanson, Celina M; Ratoto, Ramiandrasoa; Rasolomanana, Saholy; Foncha, Chrysanthus; Gasse, François

2017-04-19

Vaccination rates have improved in many countries, yet immunization inequities persist within countries and the poorest communities often bear the largest burden of vaccine preventable disease. Madagascar has one of the world's largest equity gaps in immunization rates. Barriers to immunization include immunization supply chain, human resources, and service delivery to reflect the health system building blocks, which affect poor rural communities more than affluent communities. The Reaching Every District (RED) approach was revised to address barriers and bottlenecks. This approach focuses on the provision of regular services, including making cold chain functional. This report describes Madagascar's inequities in immunization, its programmatic causes and the country's plans to address barriers to immunization in the poorest regions in the country. Two cross-sectional health facility surveys conducted in November and December 2013 and in March 2015 were performed in four regions of Madagascar to quantify immunization system barriers. Of the four regions studied, 26-33% of the population live beyond 5km (km) of a health center. By 2015, acceptable (fridges stopped working for less than 6days) cold chains were found in 52-80% of health facilities. Only 10-57% of health centers had at least two qualified health workers. Between 65% and 95% of planned fixed vaccination sessions were conducted and 50-88% of planned outreach sessions were conducted. The proportion of planned outreach sessions that were conducted increased between the two surveys. Madagascar's immunization program faces serious challenges and those affected most are the poorest populations. Major inequities in immunization were found at the subnational level and were mainly geographic in nature. Approaches to improve immunization systems need to be equitable. This may include the replacement of supply chain equipment with those powered by sustainable energy sources, monitoring its functionality at health facility level and vaccination services in all communities. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Exploring the knowledge, attitudes and needs of advance care planning in older Chinese Australians.

PubMed

Yap, Sok Shin; Chen, Karren; Detering, Karen M; Fraser, Scott A

2017-05-23

To identify factors that influence the engagement of Chinese Australians with advance care planning. Despite the benefits of advance care planning, there is a low prevalence of advance care planning in the Chinese Australian community. Reasons for this are often cited as cultural considerations and taboos surrounding future medical planning and death; however, other logistical factors may also be important. This qualitative study used a thematic analysis grounded theory approach to explore facilitators and barriers to engagement in advance care planning. Semistructured interviews were conducted in-language (Mandarin or Cantonese) exploring the views of a purposive sample of 30 community-dwelling older Chinese Australians within Victoria, Australia. Three key themes were identified: knowledge of, attitudes towards and needs for undertaking advance care planning amongst the Chinese Australians. There was a low awareness of advance care planning amongst the participants and some confusion regarding the concept. Most participants reported positive attitudes towards advance care planning but acknowledged that others may be uncomfortable discussing death-related topics. Participants would want to know the true status of their health and plan ahead in consultation with family members to reduce the burden on the family and suffering for themselves. Language was identified as the largest barrier to overcome to increase advance care planning awareness. In-language materials and key support networks including GPs, family and Chinese community groups were identified as ideal forums for the promotion of advance care planning. The participants of this study were open to conversations regarding future medical planning and end-of-life care, suggesting the low uptake of advance care planning amongst Chinese Australians is not culturally motivated but may be due a lack of knowledge relating to advance care planning. The results highlight the need to provide access to appropriate in-language advance care planning resources and promotion of advance care planning across the Chinese community. © 2017 John Wiley & Sons Ltd.

Using the ICF to develop the capability-oriented database of persons with disabilities: a case study in Nakornpanom province, Thailand.

PubMed

Tongsiri, Sirinart; Riewpaiboon, Wachara

2013-06-01

This study aims to determine functioning information, rehabilitation needs, and environmental barriers of persons with disabilities (PWDs) using a developed ICF-based questionnaire with community survey approach in Thailand. A systematic review of the use of ICF and disability surveys from January 2000- June 2010 was undertaken. A questionnaire was then developed and tested in two pilot studies before using in a face-to-face interview conducted with legally registered PWDs in Nakornpanom province. Forty-six ICF codes were used in the questionnaire; two second-level codes in body functions, 18 second-level and six third-level codes in activities & participation and 14 second-level and six third-level codes in environmental factors. Each code had 2-6 qualifiers. One thousand and seven PWDs (56.6% male, mean age = 48.4 ± 0.64 years) were interviewed by 16 trained-interviewers. Interview duration was approximately 17 min. The functioning profile could be revealed for both individual and population. These reflected the need for rehabilitation. Several cut-off points to identify "disabled persons" were offered. Regarding participation, PWDs were concerned more about environmental barriers. One-fourth of PWDs needed home environment adaptation, almost 13% were uneducated and 23% had limited chance to participate in social activities. ICF framework and codes can be used to develop a questionnaire to measure population functioning profile and rehabilitation needs of PWDs by community survey. Results can be used to develop a capability-oriented disability database to identify prevalence of disabilities and rehabilitation needs. Policy makers may use this database to plan, monitor and evaluate rehabilitation service programs and removal of environmental barriers.

Canadian 24-Hour Movement Guidelines for Children and Youth: Exploring the perceptions of stakeholders regarding their acceptability, barriers to uptake, and dissemination.

PubMed

Faulkner, Guy; White, Lauren; Riazi, Negin; Latimer-Cheung, Amy E; Tremblay, Mark S

2016-06-01

Engaging stakeholders in the development of guidelines and plans for implementation is vital. The purpose of this study was to examine stakeholders' (parents, teachers, exercise professionals, paediatricians, and youth) perceptions of the Canadian 24-Hour Movement Behaviour Guidelines for Children and Youth ("Movement Guidelines"). Stakeholders (n = 104) engaged in semi-structured focus groups or interviews to discuss the perceived acceptability of the guidelines, potential barriers to implementation, and preferred methods and messengers of dissemination. A thematic analysis was conducted. Overall, there was consistent support across all stakeholder groups, with the exception of youth participants, for the Movement Guidelines. Stakeholders identified a range of barriers to the uptake of the guidelines including concerns with accurately defining key terms such as "recreational" screen time; everyday challenges such as financial and time constraints; and the possibility of the Movement Guidelines becoming just another source of stress and guilt for already busy and overwhelmed parents. Participants identified a range of recommended methods and messengers for future dissemination. School and medical settings were the most commonly recommended settings through which dissemination efforts should be delivered. Overall, participants representing a range of stakeholder groups were receptive to the new Movement Guidelines and endorsed their value. In complementing the Movement Guidelines, messaging and resources will need to be developed that address common concerns participants had regarding their dissemination and implementation.

Starting a new conversation: Engaging Veterans with spinal cord injury in discussions of what function means to them, the barriers/facilitators they encounter, and the adaptations they use to optimize function.

PubMed

Hill, Jennifer N; Balbale, Salva; Lones, Keshonna; LaVela, Sherri L

2017-01-01

Assessments of function in persons with spinal cord injury (SCI) often utilize pre-defined constructs and measures without consideration of patient context, including how patients define function and what matters to them. We utilized photovoice to understand how individuals define function, facilitators and barriers to function, and adaptations to support functioning. Veterans with SCI were provided with cameras and guidelines to take photographs of things that: (1) help with functioning, (2) are barriers to function, and (3) represent adaptations used to support functioning. Interviews to discuss photographs followed and were audio-recorded, transcribed, and analyzed using grounded-thematic coding. Nvivo 8 was used to store and organize data. Participants (n = 9) were male (89%), Caucasian (67%), had paraplegia (75%), averaged 64 years of age, and were injured, on average, for 22 years. Function was described in several ways: the concept of 'normalcy,' aspects of daily living, and ability to be independent. Facilitators included: helpful tools, physical therapy/therapists, transportation, and caregivers. Barriers included: wheelchair-related issues and interior/exterior barriers both in the community and in the hospital. Examples of adaptations included: traditional examples like ramps, and also creative examples like the use of rubber bands on a can to help with grip. Patient-perspectives elicited in-depth information that expanded the common definition of function by highlighting the concept of "normality," facilitators and barriers to function, and adaptations to optimize function. These insights emphasize function within a patient-context, emphasizing a holistic definition of function that can be used to develop personalized, patient-driven care plans. Published by Elsevier Inc.

Environmental Barrier Coating (EBC) Durability Modeling; An Overview and Preliminary Analysis

NASA Technical Reports Server (NTRS)

Abdul-Aziz, A.; Bhatt, R. T.; Grady, J. E.; Zhu, D.

2012-01-01

A study outlining a fracture mechanics based model that is being developed to investigate crack growth and spallation of environmental barrier coating (EBC) under thermal cycling conditions is presented. A description of the current plan and a model to estimate thermal residual stresses in the coating and preliminary fracture mechanics concepts for studying crack growth in the coating are also discussed. A road map for modeling life and durability of the EBC and the results of FEA model(s) developed for predicting thermal residual stresses and the cracking behavior of the coating are generated and described. Further initial assessment and preliminary results showed that developing a comprehensive EBC life prediction model incorporating EBC cracking, degradation and spalling mechanism under stress and temperature gradients typically seen in turbine components is difficult. This is basically due to mismatch in thermal expansion difference between sub-layers of EBC as well as between EBC and substrate, diffusion of moisture and oxygen though the coating, and densification of the coating during operating conditions as well as due to foreign object damage, the EBC can also crack and spall from the substrate causing oxidation and recession and reducing the design life of the EBC coated substrate.

Provider Perspectives on Evidence-Based HIV Prevention Interventions: Barriers and Facilitators to Implementation

PubMed Central

Dickson-Gomez, Julia

2011-01-01

Abstract Since the beginning of the HIV/AIDS epidemic, community-based organizations (CBOs) have been key players in combating this disease through grassroots prevention programs and close ties to at-risk populations. Increasingly, both funding agencies and public health institutions require that CBOs implement evidence-based HIV prevention interventions, most of which are researcher developed. However, after completing training for these evidence-based interventions (EBIs), agencies may either abandon plans to implement them or significantly modify the intervention. Based on 22 semistructured interviews with HIV prevention service providers, this article explores the barriers and facilitators to dissemination and implementation of EBIs included in the Centers for Disease Control and Prevention's (CDC) Diffusion of Effective Behavioral Interventions (DEBI) program. Results suggest that there is a tension between the need to implement interventions with fidelity and the lack of guidance on how to adapt the interventions for their constituencies and organizational contexts. Findings suggest the need for HIV prevention intervention development and dissemination that integrate community partners in all phases of research and dissemination. PMID:21323564

SU-G-206-17: RadShield: Semi-Automated Shielding Design for CT Using NCRP 147 and Isodose Curves

DOE Office of Scientific and Technical Information (OSTI.GOV)

DeLorenzo, M; Rutel, I; Yang, K

2016-06-15

Purpose: Computed tomography (CT) exam rooms are shielded more quickly and accurately compared to manual calculations using RadShield, a semi-automated diagnostic shielding software package. Last year, we presented RadShield’s approach to shielding radiographic and fluoroscopic rooms calculating air kerma rate and barrier thickness at many points on the floor plan and reporting the maximum values for each barrier. RadShield has now been expanded to include CT shielding design using not only NCRP 147 methodology but also by overlaying vendor provided isodose curves onto the floor plan. Methods: The floor plan image is imported onto the RadShield workspace to serve asmore » a template for drawing barriers, occupied regions and CT locations. SubGUIs are used to set design goals, occupancy factors, workload, and overlay isodose curve files. CTDI and DLP methods are solved following NCRP 147. RadShield’s isodose curve method employs radial scanning to extract data point sets to fit kerma to a generalized power law equation of the form K(r) = ar^b. RadShield’s semiautomated shielding recommendations were compared against a board certified medical physicist’s design using dose length product (DLP) and isodose curves. Results: The percentage error found between the physicist’s manual calculation and RadShield’s semi-automated calculation of lead barrier thickness was 3.42% and 21.17% for the DLP and isodose curve methods, respectively. The medical physicist’s selection of calculation points for recommending lead thickness was roughly the same as those found by RadShield for the DLP method but differed greatly using the isodose method. Conclusion: RadShield improves accuracy in calculating air-kerma rate and barrier thickness over manual calculations using isodose curves. Isodose curves were less intuitive and more prone to error for the physicist than inverse square methods. RadShield can now perform shielding design calculations for general scattering bodies for which isodose curves are provided.« less

SU-F-P-53: RadShield: Semi-Automated Shielding Design for CT Using NCRP 147 and Isodose Curves

DOE Office of Scientific and Technical Information (OSTI.GOV)

DeLorenzo, M; Rutel, I; Wu, D

Purpose: Computed tomography (CT) exam rooms are shielded more quickly and accurately compared to manual calculations using RadShield, a semi-automated diagnostic shielding software package. Last year, we presented RadShield’s approach to shielding radiographic and fluoroscopic rooms calculating air kerma rate and barrier thickness at many points on the floor plan and reporting the maximum values for each barrier. RadShield has now been expanded to include CT shielding design using not only NCRP 147 methodology but also by overlaying vendor provided isodose curves onto the floor plan. Methods: The floor plan image is imported onto the RadShield workspace to serve asmore » a template for drawing barriers, occupied regions and CT locations. SubGUIs are used to set design goals, occupancy factors, workload, and overlay isodose curve files. CTDI and DLP methods are solved following NCRP 147. RadShield’s isodose curve method employs radial scanning to extract data point sets to fit kerma to a generalized power law equation of the form K(r) = ar^b. RadShield’s semi-automated shielding recommendations were compared against a board certified medical physicist’s design using dose length product (DLP) and isodose curves. Results: The percentage error found between the physicist’s manual calculation and RadShield’s semi-automated calculation of lead barrier thickness was 3.42% and 21.17% for the DLP and isodose curve methods, respectively. The medical physicist’s selection of calculation points for recommending lead thickness was roughly the same as those found by RadShield for the DLP method but differed greatly using the isodose method. Conclusion: RadShield improves accuracy in calculating air-kerma rate and barrier thickness over manual calculations using isodose curves. Isodose curves were less intuitive and more prone to error for the physicist than inverse square methods. RadShield can now perform shielding design calculations for general scattering bodies for which isodose curves are provided.« less

Limitations of and Barriers to Using Performance Measurement: Purchasers' Perspectives

PubMed Central

Ginsberg, Caren; Sheridan, Samantha

2001-01-01

Although health plan performance data are becoming increasingly more available, many purchasers are still not using these data to make their purchasing decisions. In this article, we review barriers that private purchasers face to using performance data. In addition, we consider the effects of the larger health care purchasing environment and employers' quality improvement activities on their use of the data. We conclude that a variety of factors, including trends, the health care purchasing environment, characteristics of firms, and problems with performance data and their presentation to users create barriers to incorporating this information into health care decisionmaking. PMID:25372184

Beliefs about the use of nonprescribed antibiotics among people in Yogyakarta City, Indonesia: a qualitative study based on the theory of planned behavior.

PubMed

Widayati, Aris; Suryawati, Sri; de Crespigny, Charlotte; Hiller, Janet E

2015-03-01

Although antibiotics are prescription-only medicine in Indonesia, they can be purchased without prescription. This qualitative study elicited beliefs about nonprescribed antibiotics use informed by the theory of planned behavior to develop a questionnaire for an expanded theory of planned behavior survey. Twenty-five (N = 25) adults with experience of using nonprescribed antibiotics were interviewed. Content analysis was applied. Participants reported that the use of nonprescribed antibiotics was advantageous in term of saving time and money and of reducing the number of medicines that need to be purchased, in contrast to a perception of what occurs with medical prescriptions. Potential adverse effects, poor health outcomes, and antimicrobial resistance were the perceived disadvantages. Facilitators of such use were the availability of over-the-counter antibiotics and successful experience in using antibiotics. Medication for children was the perceived barrier to such use. Family members and friends, especially those with health education background, approved of such use. © 2012 APJPH.

Failure of health care reform in the USA.

PubMed

Mechanic, D

1996-01-01

The failure of health reform in the USA reflects the individualism and lack of community responsibility of the American political culture, the power of interest groups, and the extraordinary process President Clinton followed in developing his highly elaborate plan. Despite considerable initial public support and a strong start, the reform effort was damaged by the cumbersome process, the complexity of the plan itself, and the unfamiliarity of key components such as alliances for pooled buying of health insurance. In addition, the alienation of important interest groups and the loss of presidential initiative in framing the public discussion as a result of international, domestic and personal issues contributed to the failure in developing public consensus. This paper considers an alternative strategy that would have built on the extension of the Medicare program as a way of exploring the possibilities and barriers to achieving health care reform. Such an approach would build on already familiar and popular pre-existing components. The massive losses in the most recent election and large budget cuts planned by the Republican majority makes it unlikely that gaps in insurance or comprehensiveness of coverage will be corrected in the foreseeable future.

A computerized faculty time-management system in an academic family medicine department.

PubMed

Daugird, Allen J; Arndt, Jane E; Olson, P Richard

2003-02-01

The authors describe the development, implementation, and evaluation of a computerized faculty time-management system (FTMS) in the Department of Family Medicine at the University of North Carolina-Chapel Hill. The FTMS is presented as an integrated set of computerized spreadsheets used annually to allocate faculty time across all mission activities of the department. It was first implemented in 1996 and has been continuously developed since then. An iterative approach has been used to gain consensus among faculty about time resources needed for various tasks of all missions of the department. These time-resource assumptions are used in the computerized system. Faculty time is allocated annually by the department vice chair in negotiation with individual faculty, making sure that the activities planned do not exceed the work time each faculty member has available for the year. During this process, faculty preferences are balanced against department aggregate needs to meet mission commitments and obligations. The authors describe how the computerized FTMS is used for faculty time management and career development, department planning, budget planning, clinical scheduling, and mission cost accounting. They also describe barriers and potential abuses and the challenge of building an organizational culture willing to discuss faculty time openly and committed to developing a system perceived as fair and accurate. The spreadsheet file is available free from the authors for use in other departments.

[Transition from pediatric to adult health care services for adolescents with chronic diseases: Recommendations from the Adolescent Branch from Sociedad Chilena de Pediatría].

PubMed

Zubarew, Tamara; Correa, Loreto; Bedregal, Paula; Besoain, Carolina; Reinoso, Alejandro; Velarde, Macarena; Valenzuela, María Teresa; Inostroza, Carolina

2017-01-01

The Adolescent Branch from Sociedad Chilena de Pediatría supports the implementation of planned programs for transition from child to adult health centers, oriented to adolescents with chronic diseases, in order to ensure an appropriate follow-up and a high-quality health care. Recommendations for care are set out in the FONIS and VRI PUC project carried out by the Division of Pediatrics of the Universidad Católica de Chile: “Transition process from pediatric to adult services: perspectives of adolescents with chronic diseases, caregivers and health professionals”, whose goal was to describe the experience, barriers, critical points, and facilitators in the transition process. Critical points detected in this study were: existence of a strong bond between adolescents, caregivers and the pediatric team, resistance to transition, difficulty developing autonomy and self-management among adolescents; invisibility of the process of adolescence; and lack of communication between pediatric and adult team during the transfer. According to these needs, barriers and critical points, and based on published international experiences, recommendations are made for implementation of gradual and planned transition processes, with emphasis on the design and implementation of transition policies, establishment of multidisciplinary teams and transition planning. We discuss aspects related to coordination of teams, transfer timing, self-care and autonomy, transition records, adolescent and family participation, need for emotional support, ethical aspects involved, importance of confidentiality, need for professional training, and the need for evaluation and further research on the subject.

Pharmacist prescription of hormonal contraception in Oregon: Baseline knowledge and interest in provision.

PubMed

Rodriguez, Maria I; McConnell, K John; Swartz, Jonas; Edelman, Alison B

2016-01-01

Oregon has implemented legislation expanding the scope of pharmacists to directly prescribe short-acting hormonal contraception (pill and patch) without a medical prescription. Pharmacists are crucial to the success of the new law, but relatively little is known about their intentions to prescribe contraception, or the motivators or barriers in providing this service. With the use of a cross-sectional survey of pharmacists practicing in Oregon before the legislative implementation, we analyzed responses to assess contraceptive knowledge, motivation to participate in direct provision, and perception of barriers to pharmacist prescription of contraception. A logistic regression model was used to examine the association between years in pharmacy practice and intention to provide direct access to contraception. A total of 509 pharmacists responded (17%). If training and reimbursement were offered, more than one-half of pharmacists would potentially be interested in prescribing contraception, managing side-effects, or moving women to a different hormonal method (57%, 61%, and 54%, respectively). However, only 39.1% of pharmacists surveyed planned to actually prescribe hormonal contraception when the legislation took effect. Shortage of pharmacy staff to provide services, concerns about liability, and a need for additional training were the three largest barriers to participation. Pharmacists practicing in urban locations (odds ratio 1.73, 95% CI 1.11-2.70) or currently offering emergency contraception (odds ratio 2.23, 95% CI 1.47-3.40) were significantly more likely to be planning to participate. Preliminary data indicate a need to support pharmacists with education on contraceptive provision and development of interventions to facilitate counseling in the pharmacy setting. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Growth of nurse prescribing competence: facilitators and barriers during education.

PubMed

Hopia, Hanna; Karhunen, Anne; Heikkilä, Johanna

2017-10-01

To describe facilitators and barriers in relation to the growth of nurse prescribing competence from the perspective of the nurses studying in a prescribing programme. The number of nurses enrolled in a nurse prescribing programme is rapidly increasing in Finland. However, few studies on nurse prescribing education are available and therefore research is needed, particularly from the point of view of nurses studying in the programme. The descriptive, qualitative study used the text of student online learning diaries as data during a 14-month prescribing programme. The sample consisted of 31 nurses, public health nurses or midwives enrolled in a prescribing programme at a university of applied sciences. The data were analysed using the inductive analysis method. The growth of nurses' prescribing competence was facilitated by learning clinical examination of the patient, networking with peers, receiving support from the workplace and supervisors, doctors' positive attitude towards nurse prescribing and being able to apply competencies directly to nursing practice. The barriers to the growth of nurses' prescribing competence were unclear job description, incomplete care plans and concerns about how consultation with doctors will be organised and realised. The results show that, for the purpose of developing the new role and position of nurse prescribers, educators and nursing managers must invest more in staff awareness of nurse prescribing education and also offer more support to nurse prescribers in their workplaces. The results of this study can be used especially in countries where nurse prescribing education is only in the process of being planned or has just been started. Heads of nursing and educators in prescribing education will benefit from the results when creating expanded job descriptions for nurses and supporting networking between students during the period of training. © 2016 John Wiley & Sons Ltd.

Advance care planning in the oncology settings.

PubMed

Samara, Juliane; Larkin, David; Chan, Choi Wan; Lopez, Violeta

2013-06-01

Self-determination and patient choice of end-of-life care are emphasised in palliative care. Advance care planning (ACP) is an approach to enabling patients' choices. The use of ACP has not been extensively studied in our current context. Little is known about oncology care nurses' views and the barriers they face in the implementation of ACP. The aims of this study were to assess the uptake of ACP by health professionals and explore nurses' perceived barriers for implementing ACP. This study employed a pre- and post-implementation audit design using the Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System (PACES) and Getting Research into Practice (GRIP) programs. An education programme on ACP was provided between pre-and post-implementation audits. Nurses and medical professionals (pre-audit, n = 32; post-audit, n = 30) working in oncology departments were invited to complete a questionnaire based on the audit criteria. A convenience sample of 25 nurses participated in the focus group interview. Interview data were analysed by content analysis. The post-audit results were lower than the pre-audit results with a range of decreased compliance from 1% for criterion 5 to 14% for criterion 6. Lack of time to implement ACP was the most frequently raised barrier by oncology nurses. The study findings were disappointing, but this first audit is significant to provide insights for future dissemination and implementation of ACP interventions. An ongoing mandatory professional development programme in ACP for healthcare staff is promising to promote the uptake of ACP in healthcare settings. © 2013 The Authors. International Journal of Evidence-Based Healthcare © 2013 The Joanna Briggs Institute.

Mobile Phone Use in Psychiatry Residents in the United States: Multisite Cross-Sectional Survey Study.

PubMed

Gipson, Shih; Torous, John; Boland, Robert; Conrad, Erich

2017-11-01

Mobile technology ownership in the general US population and medical professionals is increasing, leading to increased use in clinical settings. However, data on use of mobile technology by psychiatry residents remain unclear. In this study, our aim was to provide data on how psychiatric residents use mobile phones in their clinical education as well as barriers relating to technology use. An anonymous, multisite survey was given to psychiatry residents in 2 regions in the United States, including New Orleans and Boston, to understand their technology use. All participants owned mobile phones, and 79% (54/68) used them to access patient information. The majority do not use mobile phones to implement pharmacotherapy (62%, 42/68) or psychotherapy plans (90%, 61/68). The top 3 barriers to using mobile technology in clinical care were privacy concerns (56%, 38/68), lack of clinical guidance (40%, 27/68), and lack of evidence (29%, 20/68). We conclude that developing a technology curriculum and engaging in research could address these barriers to using mobile phones in clinical practice. ©Shih Gipson, John Torous, Robert Boland, Erich Conrad. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 01.11.2017.