Evaluation of the in-service safety performance of safety-shape and vertical concrete barriers.

DOT National Transportation Integrated Search

2011-12-16

Roadside concrete barriers have been widely used to protect errant motorists from hitting : roadside hazards or obstacles. Two concrete barrier profiles, vertical and safety-shape, have been used : for this purpose. The safety-shape profile has been ...

Barriers, Obstacles, and Mine Warfare for Joint Operations

DTIC Science & Technology

2007-04-26

separated from the anchor. Mines that separate from their anchors and rise to the surface are known as floaters . These may continue to float until...the 1907 Hague Treaty, these mines have been used on occasion. A drifting mine is classified differently from a moored mine that has become a floater ...as a floater was designed to be anchored, while a drifter was designed to float freely with the tides and currents. (c) The principal advantage of

Thermal activation of dislocations in large scale obstacle bypass

NASA Astrophysics Data System (ADS)

Sobie, Cameron; Capolungo, Laurent; McDowell, David L.; Martinez, Enrique

2017-08-01

Dislocation dynamics simulations have been used extensively to predict hardening caused by dislocation-obstacle interactions, including irradiation defect hardening in the athermal case. Incorporating the role of thermal energy on these interactions is possible with a framework provided by harmonic transition state theory (HTST) enabling direct access to thermally activated reaction rates using the Arrhenius equation, including rates of dislocation-obstacle bypass processes. Moving beyond unit dislocation-defect reactions to a representative environment containing a large number of defects requires coarse-graining the activation energy barriers of a population of obstacles into an effective energy barrier that accurately represents the large scale collective process. The work presented here investigates the relationship between unit dislocation-defect bypass processes and the distribution of activation energy barriers calculated for ensemble bypass processes. A significant difference between these cases is observed, which is attributed to the inherent cooperative nature of dislocation bypass processes. In addition to the dislocation-defect interaction, the morphology of the dislocation segments pinned to the defects play an important role on the activation energies for bypass. A phenomenological model for activation energy stress dependence is shown to describe well the effect of a distribution of activation energies, and a probabilistic activation energy model incorporating the stress distribution in a material is presented.

RNA interference in the clinic: challenges and future directions

PubMed Central

Pecot, Chad V.; Calin, George A.; Coleman, Robert L.; Lopez-Berestein, Gabriel; Sood, Anil K.

2011-01-01

Inherent difficulties with blocking many desirable targets using conventional approaches have prompted many to consider using RNA interference (RNAi) as a therapeutic approach. Although exploitation of RNAi has immense potential as a cancer therapeutic, many physiological obstacles stand in the way of successful and efficient delivery. This Review explores current challenges to the development of synthetic RNAi-based therapies and considers new approaches to circumvent biological barriers, to avoid intolerable side effects and to achieve controlled and sustained release. PMID:21160526

A Cappella: A Report on the Realities, Concerns, Expectations and Barriers Experienced by Adolescent Women in Canada = A Cappella: Rapport sur les realites, preoccupations, attentes et obstacles que connaissent les adolescentes au Canada.

ERIC Educational Resources Information Center

Canadian Teachers' Federation, Ottawa (Ontario).

In the spring of 1990 a project was undertaken in Canada to document the major concerns and perceptions of adolescent women; to supplement the words of adolescent women with brief summaries of current knowledge; to use the words of adolescent women and the additional knowledge gathered to provide information to young women on issues which are of…

Gene therapy: light is finally in the tunnel.

PubMed

Cao, Huibi; Molday, Robert S; Hu, Jim

2011-12-01

After two decades of ups and downs, gene therapy has recently achieved a milestone in treating patients with Leber's congenital amaurosis (LCA). LCA is a group of inherited blinding diseases with retinal degeneration and severe vision loss in early infancy. Mutations in several genes, including RPE65, cause the disease. Using adeno-associated virus as a vector, three independent teams of investigators have recently shown that RPE65 can be delivered to retinal pigment epithelial cells of LCA patients by subretinal injections resulting in clinical benefits without side effects. However, considering the whole field of gene therapy, there are still major obstacles to clinical applications for other diseases. These obstacles include innate and immune barriers to vector delivery, toxicity of vectors and the lack of sustained therapeutic gene expression. Therefore, new strategies are needed to overcome these hurdles for achieving safe and effective gene therapy. In this article, we shall review the major advancements over the past two decades and, using lung gene therapy as an example, discuss the current obstacles and possible solutions to provide a roadmap for future gene therapy research.

Gait Pattern Alterations during Walking, Texting and Walking and Texting during Cognitively Distractive Tasks while Negotiating Common Pedestrian Obstacles

PubMed Central

Licence, Sammy; Smith, Robynne; McGuigan, Miranda P.; Earnest, Conrad P.

2015-01-01

Objectives Mobile phone texting is a common daily occurrence with a paucity of research examining corresponding gait characteristics. To date, most studies have participants walk in a straight line vs. overcoming barriers and obstacles that occur during regular walking. The aim of our study is to examine the effect of mobile phone texting during periods of cognitive distraction while walking and negotiating barriers synonymous with pedestrian traffic. Methods Thirty participants (18-50y) completed three randomized, counter-balanced walking tasks over a course during: (1) normal walking (control), (2) texting and walking, and (3) texting and walking whilst being cognitively distraction via a standard mathematical test performed while negotiating the obstacle course. We analyzed gait characteristics during course negotiation using a 3-dimensional motion analysis system and a general linear model and Dunnet-Hsu post-hoc procedure the normal walking condition to assess gait characteristic differences. Primary outcomes included the overall time to complete the course time and barrier contact. Secondary outcomes included obstacle clearance height, step frequency, step time, double support phase and lateral deviation. Results Participants took significantly longer (mean ± SD) to complete the course while texting (24.96±4.20 sec) and during cognitive distraction COG (24.09±3.36 sec) vs. normal walking (19.32±2.28 sec; all, P<0.001). No significant differences were noted for barrier contacts (P = 0.28). Step frequency, step time, double support phase and lateral deviation all increased in duration during the texting and cognitive distraction trial. Texting and being cognitively distracted also increased obstacle clearance versus the walking condition (all, P<0.02). Conclusions Texting while walking and/or being cognitively distracted significantly affect gait characteristics concordant to mobile phone usage resulting in a more cautious gate pattern. Future research should also examine a similar study in older participants who may be at a greater risk of tripping with such walking deviations. PMID:26222430

Dos Hermanas Chicanas: Overcoming Barriers to Professional Advancement

ERIC Educational Resources Information Center

Prospero, Moises

2007-01-01

Women and ethnic minorities face steep barriers to professional advancement, and those who rise to the executive level typically use a variety of strategies to overcome obstacles in their way. This study first reviewed the literature on barriers to professional advancement for women and ethnic minorities and the strategies that they report using…

The status of live viral vaccination in early life.

PubMed

Gans, Hayley A

2013-05-17

The need for neonatal vaccines is supported by the high disease burden during the first year of life particularly in the first month. Two-thirds of childhood deaths are attributable to infectious diseases of which viruses represent key pathogens. Many infectious diseases have the highest incidence, severity and mortality in the first months of life, and therefore early life vaccination would provide significant protection and life savings. For some childhood viral diseases successful vaccines exist, such as against measles, mumps, rubella, varicella, influenza poliovirus, and rotavirus, but their use in the first year particularly at birth is not yet practiced. Vaccines against other key pathogens continue to elude scientists such as against respiratory syncytial virus. The obstacles for early and neonatal vaccination are complex and include host factors, such as a developing immune system and the interference of passively acquired antibodies, as well vaccine-specific issues, such as optimal route of administration, titer and dosing requirements. Importantly, additional host and infrastructure barriers also present obstacles to neonatal vaccination in the developing world where morbidity and mortality rates are highest. This review will highlight the current live viral vaccines and their use in the first year of life, focusing on efficacy and entertaining the barriers that exist. It is important to understand the successes of current vaccines and use this knowledge to determine strategies that are successful in young infants and for the development of new vaccines for use in early life. Copyright © 2012 Elsevier Ltd. All rights reserved.

Factors influencing behavior guidance: a survey of practicing pediatric dentists.

PubMed

Juntgen, Laura M; Sanders, Brian J; Walker, Laquia A; Jones, James E; Weddell, James A; Tomlin, Angela M; Eckert, George; Maupome, Gerardo

2013-01-01

The purpose of this study was to identify factors influencing behavior guidance technique utilization among practicing pediatric dentists and explore potential barriers to the incorporation of previously unused techniques. The data for this study were obtained from a web-based survey containing 15 multiple choice questions concerning the practitioners' past, current, and anticipated future behavior guidance technique utilization. Most respondents received hands-on training in 10 of the American Academy of Pediatric Dentistry behavior guidance techniques. The type of training was associated with the practitioners' level of comfort using a given technique upon graduation and with the current frequency of technique utilization. Residency type impacted hands-on behavior guidance training, with 39 percent of respondents reporting no intravenous sedation training. The type of practice was associated with the frequency of behavior guidance technique utilization, as was graduation decade. Currently practicing dentists cited legal concerns, parental acceptance to change, and limited resources as perceived obstacles in the incorporation of new techniques. Behavior guidance technique selection and utilization among practicing pediatric dentists was influenced by multiple factors, including advanced education training, residency type, graduation decade, and practice type. Obstacles to the incorporation of previously unused techniques appear to be multifactorial.

Misogyny, Women, and Obstacles to Tertiary Education: A Vile Situation.

ERIC Educational Resources Information Center

Stalker, Joyce

2001-01-01

Interviews with 18 women enrolled in postsecondary education used a framework of misogyny to reinterpret barriers to their participation Resulting themes included women's role in maintaining the home as sanctuary, women needing constraint, and men's role as suppressors. Results suggest how a theory based in misogyny can explain obstacles to…

Obstacles Perceived by Physical Education Teachers to Integrating ICT

ERIC Educational Resources Information Center

Villalba, Ana; González-Rivera, María Dolores; Díaz-Pulido, Belén

2017-01-01

Teachers find difficulties and barriers about integrating technology in the physical education classroom. Therefore, the aim of this study is to analyse the perception of PE teachers regarding obstacles to integrating ICT and its relation with their age. The methodology followed was quantitative and descriptive in nature. The participants were 400…

Breaking down Barriers: Academic Obstacles of First-Generation Students at Research Universities

ERIC Educational Resources Information Center

Stebleton, Michael J.; Soria, Krista M.

2012-01-01

The purpose of this study was to examine the perceived academic obstacles of first-generation students in comparison to non-first-generation students. Using the Student Experience in the Research University (SERU) completed by approximately 58,000 students from six research universities, the researchers used nonparametric bootstrapping to analyze…

Implementing clinical governance in Isfahan hospitals: Barriers and solutions, 2014.

PubMed

Ferdosi, Masoud; Ziyari, Farhad Bahman; Ollahi, Mehran Nemat; Salmani, Amaneh Rahim; Niknam, Noureddin

2016-01-01

In the new approach, all health care providers have been obligated to maintain and improve the quality and have been accountable for it. One of the ways is the implementation of clinical governance (CG). More accurate understanding of its challenges can help to improve its performance. In this study, barriers of CG implementation are investigated from the perspective of the hospitals involved. Besides, some solutions are suggested based on stakeholders' opinions. This study used combined method (qualitative content analysis and questionnaire) in hospitals affiliated to Isfahan University of Medical Sciences in 2014. First, experts, and stakeholders talked about CG implementation obstacles in a semi-structured interview. Interviews were confirmed by the interviewee (double check). After analyzing the interviews using reduction coding the questionnaire was drawn up. The questionnaire "validity was confirmed by Cronbach's alpha (0/891)" and its reliability was obtained using experts confirmation. Data analyzing was performed using SPSS (18) software. According to results staffing and management factors were the main obstacles. After them, were factors related to organizational culture, infrastructure elements, information, sociocultural and then process factors. The learning barriers were in final rank. Thirty-four solutions was proposed by experts and divided into subset of eight major barriers. Most solutions were offered on modifying processes and minimal solutions about modifying of organizational culture, sociocultural, and educational factors. Removing the obstacles, especially management and human resource factors can be effective by facilitating and accelerating CG. Furthermore, use of experts and stakeholders opinions can help to remove CG barriers.

Access and barriers to health care delivery in Arab countries: a review.

PubMed

Kronfol, N M

2012-12-01

This paper reviews some of the main obstacles encountered by the population (or rather by different social groups) in accessing health services in Arab countries. These obstacles can be social and cultural, administrative and organizational or financial and may impact on gender and ethnic groups to different degrees. Governments are urged to address the health inequalities that result from these obstacles and promote equity, solidarity and fairness through social policies that enhance social and national development.

Reading, Listening and Feeling: Audio Feedback as a Component of an Inclusive Learning Culture at Universities

ERIC Educational Resources Information Center

Knauf, Helen

2016-01-01

Feedback on student performance is an important part of university assessment procedures. However, effective feedback is hampered by various obstacles. The growing heterogeneity of the student body increases these barriers, particularly with regard to the reception of feedback. One strategy to overcome these obstacles can be to communicate…

Adaptation and translation of mental health interventions in Middle Eastern Arab countries: a systematic review of barriers to and strategies for effective treatment implementation.

PubMed

Gearing, Robin E; Schwalbe, Craig S; MacKenzie, Michael J; Brewer, Kathryne B; Ibrahim, Rawan W; Olimat, Hmoud S; Al-Makhamreh, Sahar S; Mian, Irfan; Al-Krenawi, Alean

2013-11-01

All too often, efficacious psychosocial evidence-based interventions fail when adapted from one culture to another. International translation requires a deep understanding of the local culture, nuanced differences within a culture, established service practices, and knowledge of obstacles and promoters to treatment implementation. This research investigated the following objectives to better facilitate cultural adaptation and translation of psychosocial and mental health treatments in Arab countries: (1) identify barriers or obstacles; (2) identify promoting strategies; and (3) provide clinical and research recommendations. This systematic review of 22 psychosocial or mental health studies in Middle East Arab countries identified more barriers (68%) than promoters (32%) to effective translation and adaptation of empirically supported psychosocial interventions. Identified barriers include obstacles related to acceptability of the intervention within the cultural context, community and system difficulties, and problems with clinical engagement processes. Whereas identified promoter strategies centre on the importance of partnering and working within the local and cultural context, the need to engage with acceptable and traditional intervention characteristics, and the development of culturally appropriate treatment strategies and techniques. Although Arab cultures across the Middle East are unique, this article provides a series of core clinical and research recommendations to assist effective treatment adaptation and translation within Arab communities in the Middle East.

Obstacles to action in arthritis: a community case-control study.

PubMed

Hutton, Ingrid; Gamble, Greg; McLean, Grant; Butcher, Hugh; Gow, Peter; Dalbeth, Nicola

2009-07-01

Despite the benefits of physical activity, people with arthritis are less active than the general population. The aim of this study was to determine the motivators and obstacles to physical activity for adults with arthritis. Participants were identified from the Obstacles to Action Study, a community based study of 8163 adults, which explored barriers and motivators to physical activity. A 1:1 case-control study was designed; cases were identified as those participants who reported arthritis (n = 1106). Each case was matched with an age, sex and ethnicity-matched non-arthritis control (n = 1106). Cases were less likely to achieve recommended physical activity targets (58.8% vs. 68.1% P = 0.00001). Furthermore, fewer people with arthritis believed that physical activity would help them lead healthy lives (86.7% vs. 91.3% P = 0.006) or viewed physical activity as a priority (53.8% vs. 59.8% P = 0.005). Cases were less confident in their abilities to try a new activity (37.1% vs. 43.7% P = 0.002) or maintain a healthy weight (65.0% vs. 74.3% P = 0.00001). Cases also reported greater negative impact scores for barriers to activity, particularly arthritis, accessibility, cost and discomfort while exercising. Motivators and environmental barriers to activity were similar for cases and controls. These findings persisted after adjusting for educational level, body mass index and comorbidities. People with arthritis are less active and demonstrate different attitudes toward physical activity. Although people with arthritis identify similar environmental barriers, they have different psychosocial barriers. In order to design effective physical activity programs for people with arthritis, these barriers must be specifically addressed.

Understanding barriers to exercise implementation 5-year post-breast cancer diagnosis: a large-scale qualitative study.

PubMed

Hefferon, Kate; Murphy, Helen; McLeod, Janice; Mutrie, Nanette; Campbell, Anna

2013-10-01

Due to the amount of literature supporting exercise participation after cancer diagnosis, there has been recent interest in barriers to exercise engagement among cancer patients. However, little is known regarding reasons why people choose to disengage and how this disengagement occurs over time. This study aimed to qualitatively study the perceived barriers to exercise implementation, 5-year post-breast cancer diagnosis. Eighty-three female breast cancer survivors participated in a one-to-one semi-structured interview, regarding their experience of exercise over the past 5 years following their original participation in a group-based structured exercise intervention after diagnosis (41 from intervention and 42 from original control group). The data were analysed using inductive thematic analysis. The findings included three main themes and several subthemes regarding the women's perceived barriers: psychological barriers (lack of motivation, fears, dislike of gym, not being the 'sporty type'), physical barriers (the ageing process, cancer treatment and other physical co-morbidities, fatigue and weight gain) and contextual and environmental barriers (employment, traditional female care-giving roles, proximity/access to facilities, seasonal weather). The findings add inductive support to the current survivor health research advocating the use of activity immediately after diagnosis, as well as the need for tailored activity programmes in order to overcome potential obstacles.

Connectivity, passability and heterogeneity interact to determine fish population persistence in river networks

PubMed Central

Samia, Yasmine; Lutscher, Frithjof; Hastings, Alan

2015-01-01

The movement of fish in watersheds is frequently inhibited by human-made migration barriers such as dams or culverts. The resulting lack of connectivity of spatial subpopulations is often cited as a cause for observed population decline. We formulate a matrix model for a spatially distributed fish population in a watershed, and we investigate how location and other characteristics of a single movement barrier impact the asymptotic growth rate of the population. We find that while population growth rate often decreases with the introduction of a movement obstacle, it may also increase due to a ‘retention effect’. Furthermore, obstacle mortality greatly affects population growth rate. In practice, different connectivity indices are used to predict population effects of migration barriers, but the relation of these indices to population growth rates in demographic models is often unclear. When comparing our results with the dentritic connectivity index, we see that the index captures neither the retention effect nor the influences of obstacle mortality. We argue that structural indices cannot entirely replace more detailed demographic models to understand questions of persistence and extinction. We advocate the development of novel functional indices and characteristics. PMID:26311313

Connectivity, passability and heterogeneity interact to determine fish population persistence in river networks.

PubMed

Samia, Yasmine; Lutscher, Frithjof; Hastings, Alan

2015-09-06

The movement of fish in watersheds is frequently inhibited by human-made migration barriers such as dams or culverts. The resulting lack of connectivity of spatial subpopulations is often cited as a cause for observed population decline. We formulate a matrix model for a spatially distributed fish population in a watershed, and we investigate how location and other characteristics of a single movement barrier impact the asymptotic growth rate of the population. We find that while population growth rate often decreases with the introduction of a movement obstacle, it may also increase due to a 'retention effect'. Furthermore, obstacle mortality greatly affects population growth rate. In practice, different connectivity indices are used to predict population effects of migration barriers, but the relation of these indices to population growth rates in demographic models is often unclear. When comparing our results with the dentritic connectivity index, we see that the index captures neither the retention effect nor the influences of obstacle mortality. We argue that structural indices cannot entirely replace more detailed demographic models to understand questions of persistence and extinction. We advocate the development of novel functional indices and characteristics. © 2015 The Author(s).

Women Engineers: Factors and Obstacles Related to the Pursuit of a Degree in Engineering

NASA Astrophysics Data System (ADS)

Wentling, Rose Mary; Camacho, Cristina

Research on women in engineering confirms the presence of gender barriers that affect the recruitment and retention of women in engineering. These barriers stop some women from choosing engineering as a field of study, and impede some women from completing a degree in engineering. However, there are some young female students who complete their engineering education despite the presence of obstacles throughout their college years. This study addressed the factors that have hindered, motivated, and assisted women who graduated with a degree in engineering. By studying and understanding the barriers that hinder women in deciding to pursue and in completing a degree in engineering, as well as the factors that assist and encourage them, we can learn how to break down the barriers and how to facilitate the educational journey of female engineering students. This study provides valuable insights and created a framework from which high schools, universities, researchers, and female students can directly benefit.

Transporters at CNS Barrier Sites: Obstacles or Opportunities for Drug Delivery?

PubMed Central

Sanchez-Covarrubias, Lucy; Slosky, Lauren M.; Thompson, Brandon J.; Davis, Thomas P.; Ronaldson, Patrick T.

2014-01-01

The blood-brain barrier (BBB) and blood-cerebrospinal fluid (BCSF) barriers are critical determinants of CNS homeostasis. Additionally, the BBB and BCSF barriers are formidable obstacles to effective CNS drug delivery. These brain barrier sites express putative influx and efflux transporters that precisely control permeation of circulating solutes including drugs. The study of transporters has enabled a shift away from “brute force” approaches to delivering drugs by physically circumventing brain barriers towards chemical approaches that can target specific compounds of the BBB and/or BCSF barrier. However, our understanding of transporters at the BBB and BCSF barriers has primarily focused on understanding efflux transporters that efficiently prevent drugs from attaining therapeutic concentrations in the CNS. Recently, through the characterization of multiple endogenously expressed uptake transporters, this paradigm has shifted to the study of brain transporter targets that can facilitate drug delivery (i.e., influx transporters). Additionally, signaling pathways and trafficking mechanisms have been identified for several endogenous BBB/BCSF transporters, thereby offering even more opportunities to understand how transporters can be exploited for optimization of CNS drug delivery. This review presents an overview of the BBB and BCSF barrier as well as the many families of transporters functionally expressed at these barrier sites. Furthermore, we present an overview of various strategies that have been designed and utilized to deliver therapeutic agents to the brain with a particular emphasis on those approaches that directly target endogenous BBB/BCSF barrier transporters. PMID:23789948

Aggregates: The Fundamental Building Blocks of Planetesimals?

NASA Technical Reports Server (NTRS)

Cuzzi, J. N.; Hartlep, T.; Simon, J. I.; Cato, M. J.

2017-01-01

The initial accretion of primitive asteroids (meteorite parent bodies) from freely-floating nebula particles remains problematic. Traditional growth-by-sticking models in turbulent nebulae encounter a formidable "meter-size barrier" due to both drift and destruction, or even a mmtocmsize "bouncing" barrier. Even if growth by sticking could somehow breach these barriers (perhaps if the actual sticking or strength is larger than current estimates, which are based on pure ice or pure silicate), turbulent nebulae present further obstacles through the 1-10km size range. On the other hand, nonturbulent nebulae form large asteroids too quickly to explain long spreads in formation times, or the dearth of melted asteroids. Thus, the intensity of nebula turbulence (or "alpha ") is critical to the entire process. Theoretical understanding of nebula turbulence continues to evolve; while recent models of MRI (magneticallydriven) turbulence favor lowornoturbulence environments, purely hydrodynamic turbulence is making a comeback with three recently discovered mechanisms generating turbulence of moderate which do not rely on magnetic fields at all.

Working with What We've Got: Perceptions of Barriers and Supports among Small-Metropolitan-Area Same-Sex Adopting Couples

ERIC Educational Resources Information Center

Kinkler, Lori A.; Goldberg, Abbie E.

2011-01-01

In seeking to adopt, lesbians and gay men may confront various barriers and obstacles. Ideally, they have access to a variety of support resources that can help to buffer the negative effects of these barriers. Lesbians and gay men living in small metropolitan communities may have limited access to support resources, however. The current…

Strategies for Overcoming Obstacles in AIDS Education for Preteens.

ERIC Educational Resources Information Center

Rodrick-Athans, Linda; Bhavnagri, Navaz Peshotan

1997-01-01

Points out that every four months the number of reported AIDS cases among adolescents doubles. Describes and evaluates a comprehensive AIDS prevention education program for preteens. Identifies adolescent attitudes as barriers to effective AIDS education. Presents strategies to break down barriers and promote acceptance of AIDS education,…

Bow shock formation in a complex plasma.

PubMed

Saitou, Y; Nakamura, Y; Kamimura, T; Ishihara, O

2012-02-10

A bow shock is observed in a two-dimensional supersonic flow of charged microparticles in a complex plasma. A thin conducting needle is used to make a potential barrier as an obstacle for the particle flow in the complex plasma. The flow is generated and the flow velocity is controlled by changing a tilt angle of the device under the gravitational force. A void, microparticle-free region, is formed around the potential barrier surrounding the obstacle. The flow is bent around the leading edge of the void and forms an arcuate structure when the flow is supersonic. The structure is characterized by the bow shock as confirmed by a polytropic hydrodynamic theory as well as numerical simulation.

Food for thought: obstacles to menu labelling in restaurants and cafeterias.

PubMed

Thomas, Erica

2016-08-01

Menu labelling is recommended as a policy intervention to reduce obesity and diet-related disease. The present commentary considers the many challenges the restaurant industry faces in providing nutrition information on its menus. Barriers include lack of nutrition expertise, time, cost, availability of nutrition information for exotic ingredients, ability to provide accurate nutrition information, libel risk, customer dissatisfaction, limited space on the menu, menu variations, loss of flexibility in changing the menu, staff training and resistance of employees to change current practice. Health promotion specialists and academics involved in fieldwork must help restaurateurs find solutions to these barriers for menu labelling interventions to be widely implemented and successful. Practical support for small independent restaurants such as free or subsidised nutrition analysis, nutrition training for staff and menu design may also be necessary to encourage voluntary participation.

Targeting blood–brain barrier changes during inflammatory pain: an opportunity for optimizing CNS drug delivery

PubMed Central

Ronaldson, Patrick T; Davis, Thomas P

2012-01-01

The blood–brain barrier (BBB) is the most significant obstacle to effective CNS drug delivery. It possesses structural and biochemical features (i.e., tight-junction protein complexes and, influx and efflux transporters) that restrict xenobiotic permeation. Pathophysiological stressors (i.e., peripheral inflammatory pain) can alter BBB tight junctions and transporters, which leads to drug-permeation changes. This is especially critical for opioids, which require precise CNS concentrations to be safe and effective analgesics. Recent studies have identified molecular targets (i.e., endogenous transporters and intracellular signaling systems) that can be exploited for optimization of CNS drug delivery. This article summarizes current knowledge in this area and emphasizes those targets that present the greatest opportunity for controlling drug permeation and/or drug transport across the BBB in an effort to achieve optimal CNS opioid delivery. PMID:22468221

Sociological Factors in Rural Communities That Impact the Entrance and Upward Mobility of Female Administrators and Administrative Aspirants in Public Schools.

ERIC Educational Resources Information Center

Hite, Steven J.; And Others

Research indicates that female teachers who attempt to enter and advance in administrative positions encounter obstacles ranging from sex-role stereotyping to direct prejudice and discrimination. While these obstacles have been researched for a number of years, there has been little focus on the barriers experienced by women in rural districts.…

Strategies for Enhanced Drug Delivery to the Central Nervous System

PubMed Central

Dwibhashyam, V. S. N. M.; Nagappa, A. N.

2008-01-01

Treating central nervous system diseases is very challenging because of the presence of a variety of formidable obstacles that impede drug delivery. Physiological barriers like the blood-brain barrier and blood-cerebrospinal fluid barrier as well as various efflux transporter proteins make the entry of drugs into the central nervous system very difficult. The present review provides a brief account of the blood brain barrier, the P-glycoprotein efflux and various strategies for enhancing drug delivery to the central nervous system. PMID:20046703

Touch and gravitropic set-point angle interact to modulate gravitropic growth in roots

NASA Technical Reports Server (NTRS)

Massa, G. D.; Gilroy, S.

2003-01-01

Plant roots must sense and respond to a variety of environmental stimuli as they grow through the soil. Touch and gravity represent two of the mechanical signals that roots must integrate to elicit the appropriate root growth patterns and root system architecture. Obstacles such as rocks will impede the general downwardly directed gravitropic growth of the root system and so these soil features must be sensed and this information processed for an appropriate alteration in gravitropic growth to allow the root to avoid the obstruction. We show that primary and lateral roots of Arabidopsis do appear to sense and respond to mechanical barriers placed in their path of growth in a qualitatively similar fashion. Both types of roots exhibited a differential growth response upon contacting the obstacle that directed the main axis of elongation parallel to the barrier. This growth habit was maintained until the obstacle was circumvented, at which point normal gravitropic growth was resumed. Thus, the gravitational set-point angle of the primary and lateral roots prior to encountering the barrier were 95 degrees and 136 degrees respectively and after growing off the end of the obstacle identical set-point angles were reinstated. However, whilst tracking across the barrier, quantitative differences in response were observed between these two classes of roots. The root tip of the primary root maintained an angle of 136 degrees to the horizontal as it traversed the barrier whereas the lateral roots adopted an angle of 154 degrees. Thus, this root tip angle appeared dependent on the gravitropic set-point angle of the root type with the difference in tracking angle quantitatively reflecting differences in initial set-point angle. Concave and convex barriers were also used to analyze the response of the root to tracking along a continuously varying surface. The roots maintained the a fairly fixed angle to gravity on the curved surface implying a constant resetting of this tip angle/tracking response as the curve of the surface changed. We propose that the interaction of touch and gravity sensing/response systems combine to strictly control the tropic growth of the root. Such signal integration is likely a critical part of growth control in the stimulus-rich environment of the soil. c2003 COSPAR. Published by Elsevier Ltd. All rights reserved.

Systemic Obstacles to Lifelong Learning: The Influence of the Educational System Design on Learning Attitudes

ERIC Educational Resources Information Center

Lavrijsen, Jeroen; Nicaise, Ides

2017-01-01

Comparative research has often emphasized the importance of external barriers (e.g. enrolment costs) to explain inequalities in lifelong learning participation. However, individuals, in particular the low educated, are often not only prevented from participation by external barriers, but also by negative psychological dispositions about learning.…

Breaking Barriers: Women-Centered Physical Education Programming in Higher Education

ERIC Educational Resources Information Center

Foster, Elaine; Appleby, Karen M.

2015-01-01

In general, physical activity subsides for females after high school. Researchers have found that women experience unique barriers to remaining physically active during their college years. Obstacles such as social anxiety, lack of social support, and life balance have been cited as challenges for women in relation to maintaining consistent…

Harnessing the Barriers That Impact on Students' English Language Learning (ELL)

ERIC Educational Resources Information Center

Liton, Hussain Ahmed

2016-01-01

This study strives to single out the barriers and obstacles in terms of academic, course curriculum system and socio-cultural issues that impact on students' learning English language adversely in the prep year level at Jazan University, Saudi Arabia. This paper especially focuses on the factors affecting EFL ("English as a Foreign…

Living with Anxiety Disorders--Unemployment as a Barrier to Social Inclusion

ERIC Educational Resources Information Center

Anczweski, Julian; Anczewska, Marta

2015-01-01

Individuals living with anxiety disorders often face significant obstacles in their day to day lives. While trying to manage the physical and emotional symptoms associated with these disorders can be a challenge, sufferers also encounter barriers by way of social exclusion from key life domains: family life, relationships, education, employment…

Analysis of the obstacles related to treatment entry, adherence and drop-out among alcoholic patients.

PubMed

Fonsi Elbreder, Márcia; Carvalho De Humerez, Dorisdaia; Laranjeira, Ronaldo

2009-01-01

Alcoholism is a complex syndrome involving social, psychological and individual factors in addition to a series of obstacles regarding treatment entry, adherence, and drop-out. These obstacles contribute negatively to both clinical evolution and prognosis of the patients, affecting their quality of life and raising the social costs. This is a bibliographical study in which we address this theme as well as other experiences observed in our daily practice in the Alcohol and Drug Research Unit (UNIAD) based at the Federal University of São Paulo (UNIFESP). The analysis of the obstacles related to treatment entry, attendance, and drop-out among alcoholic patients shows that systemic, social, cultural, and individual factors are all involved, including the structural ones. Women have more obstacles compared to men, and what is thought to be a barrier to one patient may be a factor motivating another patient to search for help. We conclude that several factors at different levels exist that prevent the patient from overcoming these treatment obstacles.

Overcoming obstacles to implementing methadone maintenance therapy for prisoners: Implications for policy and practice

PubMed Central

McKenzie, Michelle; Nunn, Amy; Zaller, Nickolas D.; Bazazi, Alexander R.; Rich, Josiah D.

2010-01-01

More than 2.4 million people are currently incarcerated in the United States, many as a result of drug-related offenses. In addition, more than 200,000 active heroin addicts pass through the correctional system annually. New evidence suggests that both providing prisoners with referrals for community-based methadone programs and providing methadone prior to release reduces recidivism and adverse health and social consequences associated with drug use. This article reports the programmatic challenges associated with initiating methadone treatment in the Rhode Island correctional system. Significant obstacles to implementing methadone treatment include: stigma associated with pharmacological treatment, misconceptions regarding the nature of opioid addiction, logistics of control and storage of methadone, increased work load for nursing staff, and general safety and control concerns. The authors discuss strategies to address these barriers and conclude that providing methadone prior to inmate release is a feasible intervention with the potential to mitigate drug-related health and social harms. PMID:19736902

Obstacles Facing Veterans in Applied Sciences Programs at the Community College Level

ERIC Educational Resources Information Center

Neeley, Alexander B.

2017-01-01

The purpose of this study was to determine the presence (or absence) of barriers that hindered the ability of veteran student populations in completing degrees in the applied sciences field. Furthermore, in this study, the researcher sought to identify and to understand any detected barriers. The researcher examined the academic performances of…

Biomaterials for the Treatment of Alzheimer's Disease.

PubMed

Hadavi, Darya; Poot, André A

2016-01-01

Alzheimer's disease (AD) as a progressive and fatal neurodegenerative disease represents a huge unmet need for treatment. The low efficacy of current treatment methods is not only due to low drug potency but also due to the presence of various obstacles in the delivery routes. One of the main barriers is the blood-brain barrier. The increasing prevalence of AD and the low efficacy of current therapies have increased the amount of research on unraveling of disease pathways and development of treatment strategies. One of the interesting areas for the latter subject is biomaterials and their applications. This interest originates from the fact that biomaterials are very useful for the delivery of therapeutic agents, such as drugs, proteins, and/or cells, in order to treat diseases and regenerate tissues. Recently, manufacturing of nano-sized delivery systems has increased the efficacy and delivery potential of biomaterials. In this article, we review the latest developments with regard to the use of biomaterials for the treatment of AD, including nanoparticles and liposomes for delivery of therapeutic compounds and scaffolds for cell delivery strategies.

Access to health care for uninsured Latina immigrants in South Carolina.

PubMed

Luque, John S; Soulen, Grace; Davila, Caroline B; Cartmell, Kathleen

2018-05-02

South Carolina is considered a "new destination" state for Latino immigrants. Language barriers, transportation difficulties, low socioeconomic status, inflexible work schedules, different cultural norms, and anxiety and fear related to the current anti-immigrant political climate all negatively impact Latino immigrants' frequency of contact with the health care system, and consequently they suffer poor health outcomes. The study objective was to explore uninsured Latina immigrant women's access to health care and alternative treatment strategies in coastal South Carolina. The study design was a qualitative interview design. Thirty women participated in semi-structured interviews in community sites. Thematic analysis identified salient categories of topics across interview participants. The themes were organized into four primary categories including: 1) Barriers and Facilitators to Healthcare, 2) Health Behaviors and Coping Mechanisms, 3) Disease Management Strategies, and 4) Cultural Factors. Participants demonstrated determination for accessing care but reported that their primary health care access barriers included the high cost of services, lack of health insurance, family and work responsibilities, and language barriers. Coping mechanisms included activating their social networks, visiting family and friends and assisting one another with navigating life challenges. Participants overcame obstacles to obtain healthcare for themselves and their family members despite the multiple barriers presented. Social networks were leveraged to protect against some of the negative effects of financial barriers to health care access.

Barriers to primary care hospital follow-up among older adults in rural or semi-rural communities.

PubMed

Hardman, Bobbi; Newcomb, Patricia

2016-02-01

Failure to follow-up with a primary care provider (PCP) following discharge from an acute care setting is strongly associated with readmission within 90 days among elderly patients. The purpose of this study was to identify barriers to primary care follow-up among older adults in rural communities. This was an explanatory mixed methods study which included scaled survey and interview techniques. Descriptive and inferential statistics were calculated for scaled concepts. Standard content analysis was performed on the qualitative items. Correlation between intention to follow-up with a PCP and actual follow-up was poor (r=0.20). Patients encountered substantial obstacles to the PCP follow-up visit. Obstacles clustered into two groups: 1) healthcare or social system barriers and 2) personal characteristics of patients. Individualized discharge planning that reflects the complexities of post-hospitalization adaptation for elders is most likely to be useful for ensuring PCP follow-up. Copyright © 2015 Elsevier Inc. All rights reserved.

Application of a three-feature dispersed-barrier hardening model to neutron-irradiated Fe-Cr model alloys

NASA Astrophysics Data System (ADS)

Bergner, F.; Pareige, C.; Hernández-Mayoral, M.; Malerba, L.; Heintze, C.

2014-05-01

An attempt is made to quantify the contributions of different types of defect-solute clusters to the total irradiation-induced yield stress increase in neutron-irradiated (300 °C, 0.6 dpa), industrial-purity Fe-Cr model alloys (target Cr contents of 2.5, 5, 9 and 12 at.% Cr). Former work based on the application of transmission electron microscopy, atom probe tomography, and small-angle neutron scattering revealed the formation of dislocation loops, NiSiPCr-enriched clusters and α‧-phase particles, which act as obstacles to dislocation glide. The values of the dimensionless obstacle strength are estimated in the framework of a three-feature dispersed-barrier hardening model. Special attention is paid to the effect of measuring errors, experimental details and model details on the estimates. The three families of obstacles and the hardening model are well capable of reproducing the observed yield stress increase as a function of Cr content, suggesting that the nanostructural features identified experimentally are the main, if not the only, causes of irradiation hardening in these model alloys.

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.

Seeking Help in Domestic Violence Among Muslim Women in Muslim-Majority and Non-Muslim-Majority Countries: A Literature Review.

PubMed

Afrouz, Rojan; Crisp, Beth R; Taket, Ann

2018-01-01

Women from different backgrounds and cultures are at risk of domestic violence. Disclosing the abusive experience and seeking help is not straightforward and easy and might be a complicated and long-term process. Muslim women, like other groups of women, may face various barriers to disclose abusive relationships and for seeking help. Some of the barriers may be common for the majority of Muslim women in different contexts, while others might be related to women's situations and the wider society they live. To identify these barriers and make recommendations for future studies, this article reviews related papers conducted in both Muslim-majority and non-Muslim-majority countries. A critical systematic review of the literature was conducted for identifying Muslim women's barriers in disclosing abuse and seeking help. Twenty-one studies met the inclusion criteria. The main identified barriers are discussed into under four themes: social context, family context, individual factors, and expectations of service providers. Although the researchers tried to investigate various barriers in seeking help, many of them have not focused on structural obstacles. Besides, in many Muslim-majority countries, the issue has not been explored. Therefore, the results of the current article will not apply to those countries. Recommendation for future research comprises more qualitative research compatible with the women's cultures and backgrounds in different societies, focusing more on structural and cultural factors to explore and find women's barriers to seek help.

Barriers to diabetes education in urban patients: perceptions, patterns, and associated factors.

PubMed

Rhee, Mary K; Cook, Curtiss B; El-Kebbi, Imad; Lyles, Robert H; Dunbar, Virginia G; Panayioto, Rita M; Berkowitz, Kathy J; Boyd, Barbara; Broussard, Sandra; George, Christopher D

2005-01-01

This study explored patients' perceptions of barriers to diabetes education among a mostly African American population of adults with diabetes. A survey was conducted among 605 new patients attending an urban outpatient diabetes clinic. The questionnaire gathered information on issues patients believed would adversely affect their ability to learn about diabetes. The type and frequency of education barriers were evaluated, and variables associated with reporting an obstacle were analyzed. Average patient age was 50 years, diabetes duration was 5.6 years, body mass index was 32 kg/m2, and hemoglobin A1C was 9.1%. The majority (56%) were women, 89% were African American, and 95% had type 2 diabetes. Most respondents (96%) had received some prior instruction in diabetes care; however, 53% anticipated future difficulties learning about diabetes. The most commonly cited concerns were poor vision (74%) and reading problems (29%). Patients with a perceived barrier to diabetes education were older (P < .001) than were persons without a barrier, and they differed in both employment and educational status (both P < .001). In adjusted analyses, older age, male gender, being disabled, and having an elementary education or less were associated with a significantly increased likelihood of having a barrier to diabetes education, whereas having a college education decreased the odds. Higher hemoglobin A1C levels also tended to be associated with a greater chance of reporting an education barrier (P = .05). A substantial number of persons anticipated a barrier to diabetes education. Interventions at multiple levels that address the demographic and socioeconomic obstacles to diabetes education are needed to ensure successful self-management training.

Moving toward a universally accessible web: Web accessibility and education.

PubMed

Kurt, Serhat

2017-12-08

The World Wide Web is an extremely powerful source of information, inspiration, ideas, and opportunities. As such, it has become an integral part of daily life for a great majority of people. Yet, for a significant number of others, the internet offers only limited value due to the existence of barriers which make accessing the Web difficult, if not impossible. This article illustrates some of the reasons that achieving equality of access to the online world of education is so critical, explores the current status of Web accessibility, discusses evaluative tools and methods that can help identify accessibility issues in educational websites, and provides practical recommendations and guidelines for resolving some of the obstacles that currently hinder the achievability of the goal of universal Web access.

Are the Walls Really Down? Behavioral and Organizational Barriers to Faculty and Staff Diversity. ASHE Higher Education Report, Volume 33, Number 1

ERIC Educational Resources Information Center

Evans, Alvin, Ed.; Chun, Edna Breinig, Ed.

2007-01-01

This monograph focuses on the subtle behavioral and organizational barriers that hinder the recruitment, retention, and advancement of women and minority faculty and administrators in higher education today. Specifically the monograph explores the obstacles that face women and minorities who serve as full-time, tenure-track faculty and…

Reader's Block: A Systematic Review of Barriers to Adoption, Access and Use in E-Book User Studies

ERIC Educational Resources Information Center

Girard, Adam

2014-01-01

Introduction: This review of barriers to e-book use systematically identifies obstacles to engaging reading experiences. Through the use of an analytical framework, the users being studied, study setting, and methods used in previous work are described in order to identify promising areas for future research. Method: The method used is a…

The role of Sudanese community pharmacists in patients' self-care.

PubMed

Mohamed, Sumia S; Mahmoud, Adil A; Ali, Abdulazim A

2014-04-01

To describe the current and potential roles of Sudanese community pharmacists in responding to symptoms (RTS) and chronic diseases management (CDM) and identify perceived barriers. Community pharmacies in Khartoum State. A structured, self-administered, piloted questionnaire was conducted of pharmacists in charge of 274, randomly selected, community pharmacies. Close ended questions and a 5-point Likert-type scale were used to measure responses. Respondents' demographics, their current activities, attitude and involvement in RTS and CDM and potential barriers. Response rate was 67 %. The majority of respondents (>90 %) reported that they are involved in RTS activities but have negative views regarding practice standards. They lack specific lists of minor conditions and their treatment (87.4 %), recorded counseling procedure (84.7 %), and referral forms (85.8 %). Almost all community pharmacists see an important role for them in CDM (4.54 ± 0.74, 95.3 %) and accept team work with other health care providers (4.46 ± 0.74, 87.5 %). Lack of proper knowledge and training, time, space, patients' acceptance and official recognition of pharmacists' new role, were some of the identified barriers. Sudanese community pharmacists provide RTS and CDM services; however, clinical knowledge and training and well defined national practice standards needs were identified. The current product-focused activities need to be refined to include more patient-focused services. For Improved patients' self-care services, a number of obstacles identified by surveyed pharmacists need to resolved. This requires collaboration of different parties including academics, governmental bodies and professional organizations.

[Barriers to Digitalisation of Healthcare in Germany: A Survey of Experts].

PubMed

Nohl-Deryk, Pascal; Brinkmann, Jesaja Kenneth; Gerlach, Ferdinand Michael; Schreyögg, Jonas; Achelrod, Dmitrij

2018-01-04

Digital health is a growing area in healthcare with a huge potential. Nevertheless, the degree of digitalization in German healthcare is low when compared internationally and with other German industries. Despite political efforts, certain barriers seem to strongly impede the process of digitalization process in healthcare. We surveyed 18 representative healthcare experts from various sectors with semi-structured interviews on barriers and solutions for digital health. Thematic analysis by Braun and Clarke was used for interpretation. The interviewees identified barriers that were stakeholder-specific and across stakeholders. Self-regulatory bodies and the medical profession were found to lack willingness and organizational structure for digitalization. Lack of evidence and missing interoperability represented primary obstacles, while current legislation and financial regulations were rarely mentioned. In particular, infrastructure expansion and interoperability would require a coordinated, state intervention. Positive communication on possibilities and benefits of digital solutions was also considered important. A strong political will, an overarching strategy accompanied by a communication concept seems to be necessary in order for digital health to succeed. Regarding legislation, binding specifications, deadlines and sanctions may be needed for self-regulatory bodies, while also involving users in the development process at an early stage and creating positive incentives for using digital solutions. © Georg Thieme Verlag KG Stuttgart · New York.

Obstacles to Successful Implementation of eHealth Applications into Clinical Practice.

PubMed

Voogt, Marianne P; Opmeer, Brent C; Kastelein, Arnoud W; Jaspers, Monique W M; Peute, Linda W

2018-01-01

eHealth can improve healthcare worldwide, and scientific research should provide evidence on the efficacy, safety and added value of such interventions. For successful implementation of eHealth interventions into clinical practice, barriers need to be anticipated. We identified seven barriers by interviewing health professionals in the Dutch healthcare system. These barriers covered three topics: financing, human factors and organizational factors. This paper discusses their potential impact on eHealth uptake. Bridging the gap between studies to assess effective eHealth interventions and their value-based implementation in healthcare is much needed.

The awareness and attitudes of students of one indian dental school toward information technology and its use to improve patient care.

PubMed

Jathanna, Vinod R; Jathanna, Ramya V; Jathanna, Roopalekha

2014-01-01

Many obstacles need to be overcome if digital and electronic technologies are to be fully integrated in the operation of dental clinics in some countries. These obstacles may be physical, technical, or psychosocial barriers in the form of perceptions and attitudes related to software incompatibilities, patient privacy, and interference with the patient-practitioner relationship. The objectives of the study are to assess the perceptions of Indian dental students of one school toward the usefulness of digital technologies in improving dental practice; their willingness to use digital and electronic technologies; the perceived obstacles to the use of digital and electronic technologies in dental care setups; and their attitudes toward Internet privacy issues. The study population consisted of 186 final year undergraduate dental students from the A. B. Shetty Memorial institute of Dental Sciences, Rajiv Gandhi University of Health Sciences, Mangalore, India. Survey data were analyzed descriptively . Most students indicated that information technology enhances patient satisfaction, the quality of dental record, diagnosis, treatment planning, and doctor-doctor communication. Cost of equipment and need for technical training were regarded as major obstacles by substantial proportions of respondents. Most dental students at our school feel that the information technology will support their decision making in diagnoses and devising effective treatment plans, which in turn increase patient satisfaction and quality of care. Students also perceived that lack of technical knowledge and the high cost of implementation are major barriers to developing information technology in India.

Assessment of anorexia nervosa: an overview of universal issues and contextual challenges

PubMed Central

2013-01-01

Aim Anorexia Nervosa (AN) is a complex and clinically challenging syndrome. Intended for specialist audiences, this narrative review aims to summarise the available literature related to assessment in the adult patient context, synthesising both research evidence and clinical consensus guidelines. Method We provide a review of the available literature on specialist assessment of AN focusing on common trajectories into assessment, obstacles accessing assessment, common presenting issues and barriers to the assessment process, the necessary scope of assessment, and tools and techniques. It describes the further step of synthesising assessment information in ways that can inform resultant care plans. Results In addition to assessment of core behaviours and diagnostic skills, considerations for the expert assessor include the functions of primary care, systemic and personal barriers, knowledge of current assessment tools and research pertaining to comorbid pathology in AN, assessing severity of illness, role of family at assessment, as well as medical, nutritional and compulsory elements of assessment. Conclusion Comprehensive assessment of AN in the current healthcare context still remains largely the remit of the specialist ED clinician. Assessment should remain an on-going process, paying particular attention to available empirical evidence, thereby reducing the gap between research and practice. PMID:24999408

Pharmacomodulation of microRNA Expression in Neurocognitive Diseases: Obstacles and Future Opportunities.

PubMed

Simion, Viorel; Nadim, Wissem Deraredj; Benedetti, Helene; Pichon, Chantal; Morisset-Lopez, Severine; Baril, Patrick

2017-01-01

Given the importance of microRNAs (miRNAs) in modulating brain functions and their implications in neurocognitive disorders there are currently significant efforts devoted in the field of miRNA-based therapeutics to correct and/or to treat these brain diseases. The observation that miRNA 29a/b-1 cluster, miRNA 10b and miRNA 7, for instance, are frequently deregulated in the brains of patients with neurocognitive diseases and in animal models of Alzheimer, Huntington's and Parkinson's diseases, suggest that correction of miRNA expression using agonist or antagonist miRNA oligonucleotides might be a promising approach to correct or even to cure such diseases. The encouraging results from recent clinical trials allow envisioning that pharmacological approaches based on miRNAs might, in a near future, reach the requirements for successful therapeutic outcomes and will improve the healthcare of patients with brain injuries or disorders. This review will focus on the current strategies used to modulate pharmacological function of miRNA using chemically modified oligonucleotides. We will then review the recent literature on strategies to improve nucleic acid delivery across the blood-brain barrier which remains a severe obstacle to the widespread application of miRNA therapeutics to treat brain diseases. Finally, we provide a state-of-art of current preclinical research performed in animal models for the treatment of neurocognitive disorders using miRNA as therapeutic agents and discuss future developments of miRNA therapeutics.

Pharmacomodulation of microRNA Expression in Neurocognitive Diseases: Obstacles and Future Opportunities

PubMed Central

Simion, Viorel; Nadim, Wissem Deraredj; Benedetti, Hélène; Pichon, Chantal; Morisset-Lopez, Severine; Baril, Patrick

2017-01-01

Given the importance of microRNAs (miRNAs) in modulating brain functions and their implications in neurocognitive disorders there are currently significant efforts devoted in the field of miRNA-based therapeutics to correct and/or to treat these brain diseases. The observation that miRNA 29a/b-1 cluster, miRNA 10b and miRNA 7, for instance, are frequently deregulated in the brains of patients with neurocognitive diseases and in animal models of Alzheimer, Huntington’s and Parkinson’s diseases, suggest that correction of miRNA expression using agonist or antagonist miRNA oligonucleotides might be a promising approach to correct or even to cure such diseases. The encouraging results from recent clinical trials allow envisioning that pharmacological approaches based on miRNAs might, in a near future, reach the requirements for successful therapeutic outcomes and will improve the healthcare of patients with brain injuries or disorders. This review will focus on the current strategies used to modulate pharmacological function of miRNA using chemically modified oligonucleotides. We will then review the recent literature on strategies to improve nucleic acid delivery across the blood-brain barrier which remains a severe obstacle to the widespread application of miRNA therapeutics to treat brain diseases. Finally, we provide a state-of-art of current preclinical research performed in animal models for the treatment of neurocognitive disorders using miRNA as therapeutic agents and discuss future developments of miRNA therapeutics. PMID:27397479

Access to Care for Multiple Sclerosis in Times of Economic Crisis in Greece – the HOPE II Study

PubMed Central

Souliotis, Kyriakos; Alexopoulou, Elena; Papageorgiou, Manto; Politi, Anastasia; Litsa, Panagiota; Contiades, Xenophon

2016-01-01

Background: While there is currently no cure for multiple sclerosis (MS), treatment with biologic disease-modifying drugs (bDMDs) can reduce the impact of the condition on the lives of patients. In Greece, the regulatory change in the distribution system of bDMDs, limited their administration through the designated pharmacies of the National Organization for Healthcare Services Provision (EOPYY) or the National Health System (ESY) hospitals, thus potentially impacting access to MS treatment. In this context, the aim of this paper was to assess the barriers to bDMDs, by recording MS patients’ experiences. Methods: A survey research was conducted between January and February 2014 in Athens and 5 other major Greek cities with the methods of personal and telephone interview. A structured questionnaire was used to elicit socio-economic and medical information, information related to obstacles in accessing bDMDs and medical treatment, from MS patients that visited EOPYY pharmacies during the study period. Results: During the last year 69% of 179 participants reported that the distribution system of bDMDs has improved. Thirteen percent of participants encountered problems in accessing their medication, and 16.9% of participants in accessing their physician, with the obstacles being more pronounced for non-Athens residents. Frequent obstacles to bDMDs were the distance from EOPYY pharmacies and difficulties in obtaining a diagnosis from an EOPYY/ESY physician, while obstacles to medical care were delays in appointment booking and travel difficulties. Conclusion: Even though the major weaknesses of the distribution system of bDMDs have improved, further amelioration of the system could be achieved through the home delivery of medicines to patients living in remote areas, and through the development of a national MS registry. PMID:26927393

Covalent nano delivery systems for selective imaging and treatment of brain tumors.

PubMed

Ljubimova, Julia Y; Sun, Tao; Mashouf, Leila; Ljubimov, Alexander V; Israel, Liron L; Ljubimov, Vladimir A; Falahatian, Vida; Holler, Eggehard

2017-04-01

Nanomedicine is a rapidly evolving form of therapy that holds a great promise for superior drug delivery efficiency and therapeutic efficacy than conventional cancer treatment. In this review, we attempt to cover the benefits and the limitations of current nanomedicines with special attention to covalent nano conjugates for imaging and drug delivery in the brain. The improvement in brain tumor treatment remains dismal despite decades of efforts in drug development and patient care. One of the major obstacles in brain cancer treatment is the poor drug delivery efficiency owing to the unique blood-brain barrier (BBB) in the CNS. Although various anti-cancer agents are available to treat tumors outside of the CNS, the majority fails to cross the BBB. In this regard, nanomedicines have increasingly drawn attention due to their multi-functionality and versatility. Nano drugs can penetrate BBB and other biological barriers, and selectively accumulate in tumor cells, while concurrently decreasing systemic toxicity. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Interventional Nanotheranostics of Pancreatic Ductal Adenocarcinoma

PubMed Central

Li, Junjie; Liu, Fengyong; Gupta, Sanjay; Li, Chun

2016-01-01

Pancreatic ductal adenocarcinoma (PDAC) accounts for over 90% of all pancreatic cancer. Nanoparticles (NPs) offer new opportunities for image-guided therapy owing to the unique physicochemical properties of the nanoscale effect and the multifunctional capabilities of NPs. However, major obstacles exist for NP-mediated cancer theranostics, especially in PDAC. The hypovascular nature of PDAC may impede the deposition of NPs into the tumor after systemic administration, and most NPs localize predominantly in the mononuclear phagocytic system, leading to a relatively poor tumor-to-surrounding-organ uptake ratio. Image guidance combined with minimally invasive interventional procedures may help circumvent these barriers to poor drug delivery of NPs in PDAC. Interventional treatments allow regional drug delivery, targeted vascular embolization, direct tumor ablation, and the possibility of disrupting the stromal barrier of PDAC. Interventional treatments also have potentially fewer complications, faster recovery, and lower cost compared with conventional therapies. This work is an overview of current image-guided interventional cancer nanotheranostics with specific attention given to their applications for the management of PDAC. PMID:27375787

Barriers to Liposomal Gene Delivery: from Application Site to the Target.

PubMed

Saffari, Mostafa; Moghimi, Hamid Reza; Dass, Crispin R

2016-01-01

Gene therapy is a therapeutic approach to deliver genetic material into cells to alter their function in entire organism. One promising form of gene delivery system (DDS) is liposomes. The success of liposome-mediated gene delivery is a multifactorial issue and well-designed liposomal systems might lead to optimized gene transfection particularly in vivo. Liposomal gene delivery systems face different barriers from their site of application to their target, which is inside the cells. These barriers include presystemic obstacles (epithelial barriers), systemic barriers in blood circulation and cellular barriers. Epithelial barriers differ depending on the route of administration. Systemic barriers include enzymatic degradation, binding and opsonisation. Both of these barriers can act as limiting hurdles that genetic material and their vector should overcome before reaching the cells. Finally liposomes should overcome cellular barriers that include cell entrance, endosomal escape and nuclear uptake. These barriers and their impact on liposomal gene delivery will be discussed in this review.

Use of Online Machine Translation for Nursing Literature: A Questionnaire-Based Survey

PubMed Central

Anazawa, Ryoko; Ishikawa, Hirono; Takahiro, Kiuchi

2013-01-01

Background: The language barrier is a significant obstacle for nurses who are not native English speakers to obtain information from international journals. Freely accessible online machine translation (MT) offers a possible solution to this problem. Aim: To explore how Japanese nursing professionals use online MT and perceive its usability in reading English articles and to discuss what should be considered for better utilisation of online MT lessening the language barrier. Method: In total, 250 randomly selected assistants and research associates at nursing colleges across Japan answered a questionnaire examining the current use of online MT and perceived usability among Japanese nurses, along with the number of articles read in English and the perceived language barrier. The items were rated on Likert scales, and t-test, ANOVA, chi-square test, and Spearman’s correlation were used for analyses. Results: Of the participants, 73.8% had used online MT. More than half of them felt it was usable. The language barrier was strongly felt, and academic degrees and English proficiency level were associated factors. The perceived language barrier was related to the frequency of online MT use. No associated factor was found for the perceived usability of online MT. Conclusion: Language proficiency is an important factor for optimum utilisation of MT. A need for education in the English language, reading scientific papers, and online MT training was indicated. Cooperation with developers and providers of MT for the improvement of their systems is required. PMID:23459140

Numerical modeling of the destruction of steel plates with a gradient substrate

NASA Astrophysics Data System (ADS)

Orlov, M. Yu.; Glazyrin, V. P.; Orlov, Yu. N.

2017-10-01

The paper presents the results of numerical simulation of the shock loading process of steel barriers with a gradient substrate. In an elastic plastic axisymmetric statement, a shock is simulated along the normal in the range of initial velocities up to 300 m / s. A range of initial velocities was revealed, in which the presence of a substrate "saved" the obstacle from spallation. New tasks were announced to deepen scientific knowledge about the behavior of unidirectional gradient barriers at impact. The results of calculations are obtained in the form of graphs, calculated configurations of the "impact - barrier" and tables.

Barriers to health care for people with hearing loss: a review of the literature.

PubMed

Scheier, Donna B

2009-01-01

Deaf individuals face many barriers when trying to access health care. The reasons why barriers are encountered, difficulties met as a result of the barriers, and ways that health professionals and others working with deaf people can overcome obstacles are included in this review of the literature. A brief summary of Deaf culture and history gives background information to better understand the problems. Misunderstandings by d/Deaf patients and hearing health professionals are addressed, as well as issues related to medical interpreters. This paper aims to make health professionals more aware of the needs and cultural differences that must be considered when providing care to the d/Deaf population.

The solar cycle dependence of the location and shape of the Venus bow shock

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

Zhang, T.L.; Luhmann, J.G.; Russell, C.T.

1990-09-01

From initial Pioneer Venus observations during the maximum of solar cycle 21 it was evident that the position of the Venus bow shock varies with solar activity. The bow shock radius in the terminator plane changed from 2.4 R{sub v} to 2.1 R{sub v} as solar activity went from maximum to minimum and, as activity has increased in cycle 22, it has increased again. The recent studies of the subsolar region show that the altitude of the nose of the bow shock varies from 1,600 km at solar minimum to 2,200 km at intermediate solar activity in concert with themore » terminator altitude so that the shape remains constant and only the size varies during the solar cycle. Using a gas dynamic model and the observed bow shock location, the authors infer the variation in the size of the effective obstacle during the solar cycle. At solar maximum, the effective obstacle is larger than the ionopause as if a magnetic barrier exists in the inner magnetosheath. This magnetic barrier acts as the effective obstacle deflecting the magnetosheath plasma about 500 km above the surface of Venus. However, at solar minimum the effective obstacle is well below the subsolar ionopause, and some absorption of the solar wind plasma by the Venus neutral atmosphere is suggested by these observations. The dependence of the solar cycle variation of the shock position on the orientation of the interplanetary magnetic field reinforces the idea that planetary ion pickup is important in the interaction of the solar wind with Venus.« less

INTEREST IN AND OBSTACLES TO PURSUING WORK AMONG UNEMPLOYED DUALLY DIAGNOSED INDIVIDUALS

PubMed Central

Laudet, Alexandre B.; Magura, Stephen; Vogel, Howard S.; Knight, Edward L.

2007-01-01

Employment status is commonly used as a sign of stability in recovery and an outcome variable for substance abuse treatment and research. However, there has been little attention in the literature on the topic of work for the dually diagnosed (i.e., persons diagnosed with both substance use and mental health disorders). Data collected in 1999 are presented on expressed interest in and perceived barriers to pursuing work and on the utilization of vocational rehabilitation (voc-rehab) services among unemployed members of a dual recovery self-help fellowship (N = 130). While members generally expressed high interest in working, they also cited multiple obstacles to attaining and maintaining employment. A path model was specified and tested. Significant contributors to interest in working were substance use status and physical health rating. Consistent with our hypotheses, mental health symptoms and greater perceived obstacles (e.g., stigma, fear of failure, and insufficient skills) were significant contributors to perceived difficulty in pursuing work, whereas substance use, physical health, and recency of employment were not. Finally, those who perceived less difficulty in pursuing work were more likely to utilize voc-rehab services, and men were more likely than women to use these facilities; interest in work was not significantly associated with utilizing voc-rehab services. The roles of mental health disorders and substance use in relation to pursuit of employment are discussed, as well as that of perceived obstacles such as stigma. The paper addresses the setting of realistic vocational goals and possible strategies to mitigate barriers to increased employment of dually diagnosed individuals. PMID:11863273

Interest in and obstacles to pursuing work among unemployed dually diagnosed individuals.

PubMed

Laudet, Alexandre B; Magura, Stephen; Vogel, Howard S; Knight, Edward L

2002-01-01

Employment status is commonly used as a sign of stability in recovery and an outcome variable for substance abuse treatment and research. However, there has been little attention in the literature on the topic of work for the dually diagnosed (i.e., persons diagnosed with both substance use and mental health disorders). Data collected in 1999 are presented on expressed interest in and perceived barriers to pursuing work and on the utilization of vocational rehabilitation (voc-rehab) services among unemployed members of a dual recovery self-help fellowship (N= 130). While members generally expressed high interest in working, they also cited multiple obstacles to attaining and maintaining employment. A path model was specified and tested. Significant contributors to interest in working were substance use status and physical health rating. Consistent with our hypotheses, mental health symptoms and greater perceived obstacles (e.g., stigma, fear of failure, and insufficient skills) were significant contributors to perceived difficulty in pursuing work, whereas substance use, physical health, and recency of employment were not. Finally, those who perceived less difficulty in pursuing work were more likely to utilize voc-rehab services, and men were more likely than women to use these facilities; interest in work was not significantly associated with utilizing voc-rehab services. The roles of mental health disorders and substance use in relation to pursuit of employment are discussed, as well as that of perceived obstacles such as stigma. The paper addresses the setting of realistic vocational goals and possible strategies to mitigate barriers to increased employment of dually diagnosed individuals.

Electromagnetic Navigational Bronchoscopy

PubMed Central

Port, Jeffrey; Harrison, Sebron

2013-01-01

Despite advances in technology and treatment options, lung cancer remains a deadly disease. National screening programs are being instituted in an attempt to discover lung cancer in high-risk individuals at an earlier stage. Such screening programs invariably discover small peripheral nodules that previously would not have been clinically apparent; the management of such lesions can be challenging. Current diagnostic options such as percutaneous biopsy are effective; however, they are hindered by their risk of morbidity such as pneumothorax. Electromagnetic bronchoscopy (ENB) is an emerging technology that allows the practitioner the ability to both sample and treat small peripheral pulmonary lesions. In experienced centers, ENB provides high rates of diagnostic yield for small lesions and a complication rate significantly lower than that of more conventional diagnostic modalities. Although there are current barriers to its widespread utilization (cost, specialized imaging, technical training), these obstacles will handled similarly to any other emerging technology and will likely not be long-term impediments to its use. PMID:24436528

Development of a Nebraska culvert aquatic organism passage screening tool.

DOT National Transportation Integrated Search

2012-12-01

Culverts channelize water relative to natural stream reaches, which can increase the velocity of water passing through them. Increased water velocities can alter stream morphology and create a possible barrier or obstacle to fish passage, which may a...

Provision of mental healthcare for children and adolescents: a worldwide view.

PubMed

Rocha, Thiago Botter-Maio; Graeff-Martins, Ana Soledade; Kieling, Christian; Rohde, Luis Augusto

2015-07-01

There has been increased attention towards the burden imposed by mental disorders on children and adolescents. The present overview explores the current state of child and adolescent mental healthcare provision around the globe. Current research indicates a concerning gap in the provision of care for the child and adolescent population. The disparities between need, demand and access to youth mental healthcare are likely to be even greater in low and- middle-income countries (LAMIC), where the proportion of children and adolescents in the population is higher. The scarcity of available resources for youth mental healthcare, especially in LAMIC, represents a major obstacle to decreasing the impact of mental disorders across the lifespan. Our review highlights the discrepancy between demands and availability of mental healthcare for youth populations throughout the world. We describe some of the potential contributors to the current state of youth mental healthcare, such as problematic access to services, implementation deficiencies and inadequacy of policies. Recent innovative strategies to reduce these barriers are also presented.

Aviation obstacle auto-extraction using remote sensing information

NASA Astrophysics Data System (ADS)

Zimmer, N.; Lugsch, W.; Ravenscroft, D.; Schiefele, J.

2008-10-01

An Obstacle, in the aviation context, may be any natural, man-made, fixed or movable object, permanent or temporary. Currently, the most common way to detect relevant aviation obstacles from an aircraft or helicopter for navigation purposes and collision avoidance is the use of merged infrared and synthetic information of obstacle data. Several algorithms have been established to utilize synthetic and infrared images to generate obstacle information. There might be a situation however where the system is error-prone and may not be able to consistently determine the current environment. This situation can be avoided when the system knows the true position of the obstacle. The quality characteristics of the obstacle data strongly depends on the quality of the source data such as maps and official publications. In some countries such as newly industrializing and developing countries, quality and quantity of obstacle information is not available. The aviation world has two specifications - RTCA DO-276A and ICAO ANNEX 15 Ch. 10 - which describe the requirements for aviation obstacles. It is essential to meet these requirements to be compliant with the specifications and to support systems based on these specifications, e.g. 3D obstacle warning systems where accurate coordinates based on WGS-84 is a necessity. Existing aerial and satellite or soon to exist high quality remote sensing data makes it feasible to think about automated aviation obstacle data origination. This paper will describe the feasibility to auto-extract aviation obstacles from remote sensing data considering limitations of image and extraction technologies. Quality parameters and possible resolution of auto-extracted obstacle data will be discussed and presented.

Does the Israeli Security Fence Actually Increase Security

DTIC Science & Technology

2011-04-01

obstacles in the path—land, orchards , farms, even houses. Finally, where the barrier is constructed, the route the barrier takes as it winds through...the wall. This impacted farmers who could no longer access their farmland, patients that couldn’t reach their doctors, and even children that couldn’t...tell is the story of the farmer who must ask for permission to access his farmlands, now placed off-limits in the seam zone. They don’t fully speak of

Overcoming ocular drug delivery barriers through the use of physical forces.

PubMed

Huang, Di; Chen, Ying-Shan; Rupenthal, Ilva D

2018-02-15

Overcoming the physiological barriers in the eye remains a key obstacle in the field of ocular drug delivery. While ocular barriers naturally have a protective function, they also limit drug entry into the eye. Various pharmaceutical strategies, such as novel formulations and physical force-based techniques, have been investigated to weaken these barriers and transport therapeutic agents effectively to both the anterior and the posterior segments of the eye. This review summarizes and discusses the recent research progress in the field of ocular drug delivery with a focus on the application of physical methods, including electrical fields, sonophoresis, and microneedles, which can enhance penetration efficiency by transiently disrupting the ocular barriers in a minimally or non-invasive manner. Copyright © 2017 Elsevier B.V. All rights reserved.

Legal Barriers to the Growth of Health Information Exchange-Boulders or Pebbles?

PubMed

Mello, Michelle M; Adler-Milstein, Julia; Ding, Karen L; Savage, Lucia

2018-03-01

Policy Points: Historically, in addition to economic and technical hurdles, state and federal health information privacy laws have been cited as a significant obstacle to expanding electronic health information exchange (HIE) in the United States. Our review finds that over the past decade, several helpful developments have ameliorated the legal barriers to HIE, although variation in states' patient consent requirements remains a challenge. Today, health care providers' complaints about legal obstacles to HIE may be better understood as reflecting concerns about the economic and competitive risks of information sharing. Although the clinical benefits of exchanging patients' health information electronically across providers have long been recognized, participation in health information exchange (HIE) has lagged behind adoption of electronic health records. Barriers erected by federal and state health information privacy law have been cited as a leading reason for the slow progress. A comprehensive assessment of these issues has not been undertaken for nearly a decade, despite a number of salient legal developments. Analysis of federal and state health information privacy statutes and regulations and secondary materials. Although some legal barriers to HIE persist, many have been ameliorated-in some cases, simply through improved understanding of what the law actually requires. It is now clear that the Health Insurance Portability and Accountability Act presents no obstacles to electronically sharing protected health information for treatment purposes and does not hold providers who properly disclose information liable for privacy breaches by recipients. The failure of federal efforts to establish a unique patient identifier number does slow HIE by inhibiting optimal matching of patient records, but other action to facilitate matching will be taken under the 21st Century Cures Act. The Cures Act also creates the legal architecture to begin to combat "information blocking." Varying patient consent requirements under federal and state law are the most important remaining legal barrier to HIE progress. However, federal rules relating to disclosure of substance-abuse treatment information were recently liberalized, and development of a technical standard, Data Segmentation for Privacy, or DS4P, now permits sensitive data requiring special handling to be segmented within a patient's record. Even with these developments, state-law requirements for patient consent remain daunting to navigate. Although patient consent requirements make HIE challenging, providers' expressed worries about legal barriers to participating in HIE likely primarily reflect concerns that are economically motivated. Lowering the cost of HIE or increasing financial incentives may boost provider participation more than further reducing legal barriers. © 2018 Milbank Memorial Fund.

Didactical Design Material Units of Distance and Speed to Developed Mathematical Connection in Elementary School

NASA Astrophysics Data System (ADS)

Jannah, R. R.; Apriliya, S.; Karlimah

2017-03-01

This study aims to develop alternative instructional design based of barriers learning which identified by developing mathematical connection capabilities to the material unit of distance and speed. The research was conducted in the fifth grade elementary school Instructional design is complemented with a hypothetical learning trajectory in the form of a pedagogical didactic anticipation. The method used is descriptive method with qualitative approach. Techniques data collection used were observation, interviews, and documentation. The instrument used the researchers themselves are equipped with an instrument written test. The data were analyzed qualitatively to determine the student learning obstacles, then arrange hypothetical learning trajectory and pedagogical didactic anticipation. Learning obstacle are identified, it is learning obstacle related the connections between mathematical topics, learning obstacle related with other disciplines, and learning obstacle related with everyday life. The results of this research are improvement and development of didactic design in mathematics which has activities mathematical connection to the material unit of distance and speed in elementary school. The learning activities are carried out is using varied methods include method lectures, demonstrations, practice and exercise, as well as using the modified instructional media.

Load sharing in the growth of bundled biopolymers

PubMed Central

Wang, Ruizhe; Carlsson, A. E.

2014-01-01

To elucidate the nature of load sharing in the growth of multiple biopolymers, we perform stochastic simulations of the growth of biopolymer bundles against obstacles under a broad range of conditions and varying assumptions. The obstacle motion due to thermal fluctuations is treated explicitly. We assume the “Perfect Brownian Ratchet” (PBR) model, in which the polymerization rate equals the free-filament rate as soon as the filament-obstacle distance exceeds the monomer size. Accurate closed-form formulas are obtained for the case of a rapidly moving obstacle. We find the following: (1) load sharing is usually sub-perfect in the sense that polymerization is slower than for a single filament carrying the same average force; (2) the sub-perfect behavior becomes significant at a total force proportional to the logarithm or the square root of the number of filaments, depending on the alignment of the filaments; (3) for the special case of slow barrier diffusion and low opposing force, an enhanced obstacle velocity for an increasing number of filaments is possible; (4) the obstacle velocity is very sensitive to the alignment of the filaments in the bundle, with a staggered alignment being an order of magnitude faster than an unstaggered one at forces of only 0.5 pN per filament for 20 filaments; (5) for large numbers of filaments, the power is maximized at a force well below 1 pN per filament; (6) for intermediate values of the obstacle diffusion coefficient, the shape of the force velocity relation is very similar to that for rapid obstacle diffusion. PMID:25489273

Load sharing in the growth of bundled biopolymers.

PubMed

Wang, Ruizhe; Carlsson, A E

2014-11-01

To elucidate the nature of load sharing in the growth of multiple biopolymers, we perform stochastic simulations of the growth of biopolymer bundles against obstacles under a broad range of conditions and varying assumptions. The obstacle motion due to thermal fluctuations is treated explicitly. We assume the "Perfect Brownian Ratchet" (PBR) model, in which the polymerization rate equals the free-filament rate as soon as the filament-obstacle distance exceeds the monomer size. Accurate closed-form formulas are obtained for the case of a rapidly moving obstacle. We find the following: (1) load sharing is usually sub-perfect in the sense that polymerization is slower than for a single filament carrying the same average force; (2) the sub-perfect behavior becomes significant at a total force proportional to the logarithm or the square root of the number of filaments, depending on the alignment of the filaments; (3) for the special case of slow barrier diffusion and low opposing force, an enhanced obstacle velocity for an increasing number of filaments is possible; (4) the obstacle velocity is very sensitive to the alignment of the filaments in the bundle, with a staggered alignment being an order of magnitude faster than an unstaggered one at forces of only 0.5 pN per filament for 20 filaments; (5) for large numbers of filaments, the power is maximized at a force well below 1 pN per filament; (6) for intermediate values of the obstacle diffusion coefficient, the shape of the force velocity relation is very similar to that for rapid obstacle diffusion.

[Diagnosis of dementia in non-western elderly migrants in memory clinics: obstacles and solutions].

PubMed

Goudsmit, M; Parlevliet, J L; van Campen, J P C M; Schmand, B

2011-10-01

In the next decade the number of non-western elderly immigrants will double in the Netherlands. Because of specific risk factors (hypertension, diabetes), the number of elderly immigrants with dementia will probably increase. Memory clinics are not well prepared for these patients, because health professionals lack knowledge about important obstacles in intercultural dementia diagnostics. They should consider language barriers, cultural differences, low level of education and illiteracy, as well as ignorance about dementia, shame and special care expectations of patients and their families. We give recommendations to improve communication, (neuropsychological) testing and counseling in clinical practice.

LNG vapor barrier and obstacle evaluation: Wind-tunnel simulation of 1987 Falcon Spill Series. Final report, July 1987-February 1991

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

Shin, S.H.; Meroney, R.N.; Neff, D.E.

1991-03-01

Measurements of the behavior of simulated liquefied natural gas clouds dispersing over small-scale model placed in environmental wind tunnels permits evaluations of the fluid physics of dense cloud movement and dispersion in a controlled environment. A large data base on the interaction of simulated LNG plumes with the Falcon test configuration of vapor barrier fences and vortex generators was obtained. The purpose of the reported test program is to provide post-field-spill wind tunnel experiments to augment the LNG Vapor Fence Field Program data obtained during the Falcon Test Series in 1987. The goal of the program is to determine themore » probable response of a dense LNG Vapor cloud to vortex inducer obstacles and fences, examine the sensitivity of results to various scaling arguments which might augment limit, or extend the value of the field and wind-tunnel tests, and identify important details of the spill behavior which were not predicted during the pretest planning phase.« less

It isn't all about language: communication barriers for Latinas using contraceptives.

PubMed

Campo, Shelly; Kohler, Connie; Askelson, Natoshia M; Ortiz, Cristina; Losch, Mary

2015-11-01

Little is known about barriers that Latinas in the United States face in preventing unintended pregnancies beyond those of language and cost. This study examined factors inhibiting contraceptive use among 18- to 30-year-old Latinas in the Midwest. Individual interviews (N = 31) were conducted in Spanish with Latinas residing across the state. The interview protocol included questions about contraceptives and unintended pregnancies. Interviews were recorded, transcribed, translated, and coded for themes related to barriers. The majority of the barriers were related to communication but not English proficiency. Respondents talked about specific situations and experiences in which communication presented obstacles to using contraceptives. While language and cost are important barriers, attention needs to be paid to the other communication issues that women face related to culture, religion, partners, family, and spontaneity. Health care providers need to address the range of communication barriers that affect Latinas' contraceptive use. © The Author(s) 2014.

How Obstacles Perturb Population Fronts and Alter Their Genetic Structure.

PubMed

Möbius, Wolfram; Murray, Andrew W; Nelson, David R

2015-12-01

As populations spread into new territory, environmental heterogeneities can shape the population front and genetic composition. We focus here on the effects of an important building block of heterogeneous environments, isolated obstacles. With a combination of experiments, theory, and simulation, we show how isolated obstacles both create long-lived distortions of the front shape and amplify the effect of genetic drift. A system of bacteriophage T7 spreading on a spatially heterogeneous Escherichia coli lawn serves as an experimental model system to study population expansions. Using an inkjet printer, we create well-defined replicates of the lawn and quantitatively study the population expansion of phage T7. The transient perturbations of the population front found in the experiments are well described by a model in which the front moves with constant speed. Independent of the precise details of the expansion, we show that obstacles create a kink in the front that persists over large distances and is insensitive to the details of the obstacle's shape. The small deviations between experimental findings and the predictions of the constant speed model can be understood with a more general reaction-diffusion model, which reduces to the constant speed model when the obstacle size is large compared to the front width. Using this framework, we demonstrate that frontier genotypes just grazing the side of an isolated obstacle increase in abundance, a phenomenon we call 'geometry-enhanced genetic drift', complementary to the founder effect associated with spatial bottlenecks. Bacterial range expansions around nutrient-poor barriers and stochastic simulations confirm this prediction. The effect of the obstacle on the genealogy of individuals at the front is characterized by simulations and rationalized using the constant speed model. Lastly, we consider the effect of two obstacles on front shape and genetic composition of the population illuminating the effects expected from complex environments with many obstacles.

Experimental study of a wake behind a barrier

NASA Astrophysics Data System (ADS)

Tomáš, Dufek; Katarína, Ratkovská

2017-09-01

This article describes in detail an experiment which was carried out on a wind tunnel in the Laboratory of the Department of Power Machines, Faculty of Mechanical Engineering, at the University of West Bohemia (UWB), using Particle Image Velocimetry and Stereo Particle Image Velocimetry. PIV is a non-invasive method that allows you to simultaneously measure the flow velocity across the entire field under investigation. In the experiment, the field was located behind the exit of the wind tunnel. The experiment dealt with the measurement of the wake behind a barrier. Measurement with Stereo PIV was carried out in several vertical parallel planes perpendicular to the axis of the tunnel. Conventional PIV method was then used for a horizontal plane passing through the axis of the tunnel at half the height of the barrier. The velocities in the measured plane are expressed by a vector map. In areas not affected by the wake, the speed in the w direction is about 16 m / s. The wake is formed behind the barrier. A shear layer is formed at the boundary between the flowing air and the braked air. A backflow occurs in the area just behind the barrier. The highest speed in the area is achieved in places just behind the exit of the tunnel, where the current is not affected by the barrier. In the direction from the axis and the obstacle, the speed gradually rises from the negative values of the return flow through the zero speed. In addition to the velocity fields, the output from the experimental measurement was also the distribution of the sum of variances, standard deviation and correlation coefficient in the measured planes.

Survey on public awareness, attitudes, and barriers for herpes zoster vaccination in South Korea.

PubMed

Yang, Tae Un; Cheong, Hee Jin; Song, Joon Young; Noh, Ji Yun; Kim, Woo Joo

2015-01-01

A cross-sectional study was performed to assess current public awareness of herpes zoster (HZ) and its vaccine, determine the factors that influence people's intention regarding HZ vaccination, and investigate the barriers for vaccination by changing decisions with sequential questions regarding knowledge, cost, and physician's recommendation in the Department of Infectious Diseases, Korea University Guro Hospital, in South Korea, between August 23 and September 15 of 2013. Among 603 subjects who completed the survey, 85.7% and 43.6% subjects were aware of HZ and HZ vaccination, respectively. Women, younger age group, those with higher income or higher education levels were more likely to be aware of HZ. Overall, 85.8% of subjects aware of HZ were willing to be vaccinated or vaccinate their parents. The main obstacles for the increased acceptance toward vaccination were the high cost and low perceived risk, which decreased acceptance to 60.2%. However, physician's recommendation reversed 69.5% of the refusal to accept HZ vaccine. These results indicate that expanding public education and physician's recommendations are important factors aimed at increasing HZ vaccine coverage rate.

Whole Exome Sequencing in Pediatric Neurology Patients: Clinical Implications and Estimated Cost Analysis.

PubMed

Nolan, Danielle; Carlson, Martha

2016-06-01

Genetic heterogeneity in neurologic disorders has been an obstacle to phenotype-based diagnostic testing. The authors hypothesized that information compiled via whole exome sequencing will improve clinical diagnosis and management of pediatric neurology patients. The authors performed a retrospective chart review of patients evaluated in the University of Michigan Pediatric Neurology clinic between 6/2011 and 6/2015. The authors recorded previous diagnostic testing, indications for whole exome sequencing, and whole exome sequencing results. Whole exome sequencing was recommended for 135 patients and obtained in 53 patients. Insurance barriers often precluded whole exome sequencing. The most common indication for whole exome sequencing was neurodevelopmental disorders. Whole exome sequencing improved the presumptive diagnostic rate in the patient cohort from 25% to 48%. Clinical implications included family planning, medication selection, and systemic investigation. Compared to current second tier testing, whole exome sequencing can result in lower long-term charges and more timely diagnosis. Overcoming barriers related to whole exome sequencing insurance authorization could allow for more efficient and fruitful diagnostic neurological evaluations. © The Author(s) 2016.

Obstacle traversal and self-righting of bio-inspired robots reveal the physics of multi-modal locomotion

NASA Astrophysics Data System (ADS)

Li, Chen; Fearing, Ronald; Full, Robert

Most animals move in nature in a variety of locomotor modes. For example, to traverse obstacles like dense vegetation, cockroaches can climb over, push across, reorient their bodies to maneuver through slits, or even transition among these modes forming diverse locomotor pathways; if flipped over, they can also self-right using wings or legs to generate body pitch or roll. By contrast, most locomotion studies have focused on a single mode such as running, walking, or jumping, and robots are still far from capable of life-like, robust, multi-modal locomotion in the real world. Here, we present two recent studies using bio-inspired robots, together with new locomotion energy landscapes derived from locomotor-environment interaction physics, to begin to understand the physics of multi-modal locomotion. (1) Our experiment of a cockroach-inspired legged robot traversing grass-like beam obstacles reveals that, with a terradynamically ``streamlined'' rounded body like that of the insect, robot traversal becomes more probable by accessing locomotor pathways that overcome lower potential energy barriers. (2) Our experiment of a cockroach-inspired self-righting robot further suggests that body vibrations are crucial for exploring locomotion energy landscapes and reaching lower barrier pathways. Finally, we posit that our new framework of locomotion energy landscapes holds promise to better understand and predict multi-modal biological and robotic movement.

Planetesimal Initial Mass Functions and Creation Rates Under Turbulent Concentration Using Scale-Dependent Cascades

NASA Technical Reports Server (NTRS)

Cuzzi, J. N.; Hartlep, T.; Estrada, P.

2016-01-01

The initial accretion of primitive bodies from freely-floating nebula particles remains problematic. Traditional growth-by-sticking models in turbulent nebulae encounter a "meter-size barrier" due to both drift and destruction, or even a millimeter-to-centimeter-size "bouncing" barrier. Recent suggestions have been made that some "lucky" particles might be able to outgrow the collision and/or drift barriers, and lead to so-called "streaming instabilities" or SI. However, new full models of growth by sticking in the presence of radial drift show that lucky particles (the largest particles, at the tail of the size distribution, that grow beyond the nominal fragmentation and drift barriers) are far too rare to lead to any collective effects such as streaming or gravitational instabilities. Thus we need to focus on typical radii gamma(sub M) which contain most of the mass. Our models of disks with weak-to-moderate turbulence, which include all the most recent experimental constraints on collisional growth, erosion, bouncing, and fragmentation, as well as radial drift, find that growth stalls quite generally at sizes gamma(sub M) which are too small to settle into layers which are dense enough for any collective effects (streaming or gravitational instabilities) to arise. Even if growth by sticking could somehow breach the nominal barriers (perhaps if the actual sticking or strength is larger than current estimates for pure ice or pure silicate, with specific grain sizes), turbulent nebulae present subsequent formidable obstacles to incremental growth through the 1-10km size range. On the other hand, non-turbulent nebulae alpha is less than 10(Sup -4).

Business Ownership: A New Career Option for Women.

ERIC Educational Resources Information Center

McNamara, Patricia P.

1979-01-01

The status and barriers faced by women business owners is examined, and ways in which higher education institutions can assist women to overcome these obstacles are suggested. The Women Entrepreneurs (WE) Project is described, and a survey of women-owned businesses in California is discussed. (Author/MLW)

Obstacles to preventive care for individuals with disability: Implications for nurse practitioners.

PubMed

Marrocco, Anna; Krouse, Helene J

2017-05-01

Individuals with disabilities have been identified as a population with a significantly lower usage of preventive services. Nurse practitioners (NPs) provide a key access point in the healthcare delivery system for preventive services for vulnerable populations such as those with disabilities. It is essential to understand existing barriers that prohibit access to effective preventive care for this vulnerable population. Systematic search and review of Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, PubMed, Google Scholar, and government reports and World Health Organizations reports. Twenty-six articles were included in the review. This literature review confirmed previous notions that people with disabilities are receiving much fewer preventive services than the general population. The studies reviewed identified four major barriers that contributed to the lack of preventive care. These barriers included physical environment and system, transportation, provider knowledge and attitude, and financial. Recognition of the obstacles that this subpopulation faces in accessing preventive care services is the first step to effectively remedying this problem. Preventive services have been identified as one of the cornerstones to improving health and quality of life. By understanding the circumstances that restrict those with disabilities from accessing preventive services, NPs can provide meaningful and effective solutions. ©2017 American Association of Nurse Practitioners.

Emergency Physician and Stroke Specialist Beliefs and Expectations Regarding Telestroke

PubMed Central

Moskowitz, Ari; Chan, Yu-Feng Yvonne; Bruns, John; Levine, Steven R.

2010-01-01

Background Telestroke has been effective in the management of acute ischemic stroke (AIS). This study characterizes and compares Stroke Specialist (SS) and Emergency Physician (EP) perceptions of telestroke and identifies barriers preventing increased implementation. Methods A survey was developed and distributed nationwide to 382 SSs via an online survey-system and in paper form to 226 EPs attending the 2008 American College of Emergency Physicians (ACEP) national conference. Results Stroke specialists perceived themselves to be more knowledgeable about telemedicine and telestroke (p<0.001 and p=0.010). A large majority of physicians in both specialties either strongly agreed or agreed that telestroke will reduce geographical differences in stroke management and that it is superior to telephone consultation. EPs perceived patient preference (p<0.001), rt-PA side effects (p<0.001), level of technology (p=0.005), and rt-PA not the standard of care (p<0.001) to be more significant obstacles to increased implementation of telestroke than SSs. However, SSs found increased personal work to be a greater barrier than EPs (p<0.001). Conclusion SSs and EPs report positive beliefs regarding telestroke, however perceived obstacles exist to implementation. Differences between barriers perceived by EPs and SSs need to be addressed to enhance AIS treatment. PMID:20167910

Emergency physician and stroke specialist beliefs and expectations regarding telestroke.

PubMed

Moskowitz, Ari; Chan, Yu-Feng Yvonne; Bruns, John; Levine, Steven R

2010-04-01

Telestroke has been effective in the management of acute ischemic stroke. This study characterizes and compares stroke specialist (SS) and emergency physician (EP) perceptions of telestroke and identifies barriers preventing increased implementation. A survey was developed and distributed nationwide to 382 SSs through an online survey system and in paper form to 226 EPs attending the 2008 American College of Emergency Physicians national conference. Stroke specialists perceived themselves to be more knowledgeable about telemedicine and telestroke (P<0.001 and P=0.010, respectively). A large majority of physicians in both specialties either strongly agreed or agreed that telestroke will reduce geographical differences in stroke management and that it is superior to telephone consultation. EPs perceived patient preference (P<0.001), recombinant tissue plasminogen activator side effects (P<0.001), level of technology (P=0.005), and recombinant tissue plasminogen activator not the standard of care (P<0.001) to be more significant obstacles to increased implementation of telestroke than SSs. However, SSs found increased personal work to be a greater barrier than EPs (P<0.001). SSs and EPs report positive beliefs regarding telestroke; however, perceived obstacles exist to implementation. Differences between barriers perceived by EPs and SSs need to be addressed to enhance acute ischemic stroke treatment.

Turbidity current flow over an erodible obstacle and phases of sediment wave generation

NASA Astrophysics Data System (ADS)

Strauss, Moshe; Glinsky, Michael E.

2012-06-01

We study the flow of particle-laden turbidity currents down a slope and over an obstacle. A high-resolution 2-D computer simulation model is used, based on the Navier-Stokes equations. It includes poly-disperse particle grain sizes in the current and substrate. Particular attention is paid to the erosion and deposition of the substrate particles, including application of an active layer model. Multiple flows are modeled from a lock release that can show the development of sediment waves (SW). These are stream-wise waves that are triggered by the increasing slope on the downstream side of the obstacle. The initial obstacle is completely erased by the resuspension after a few flows leading to self consistent and self generated SW that are weakly dependant on the initial obstacle. The growth of these waves is directly related to the turbidity current being self sustaining, that is, the net erosion is more than the net deposition. Four system parameters are found to influence the SW growth: (1) slope, (2) current lock height, (3) grain lock concentration, and (4) particle diameters. Three phases are discovered for the system: (1) "no SW," (2) "SW buildup," and (3) "SW growth". The second phase consists of a soliton-like SW structure with a preserved shape. The phase diagram of the system is defined by isolating regions divided by critical slope angles as functions of current lock height, grain lock concentration, and particle diameters.

Obstacles to nutrition labeling in restaurants.

PubMed

Almanza, B A; Nelson, D; Chai, S

1997-02-01

This study determined the major obstacles that foodservices face regarding nutrition labeling. Survey questionnaire was conducted in May 1994. In addition to demographic questions, the directors were asked questions addressing willingness, current practices, and perceived obstacles related to nutrition labeling. Sixty-eight research and development directors of the largest foodservice corporations as shown in Restaurants & Institutions magazine's list of the top 400 largest foodservices (July 1993). P tests were used to determine significance within a group for the number of foodservices that were currently using nutrition labeling, perceived impact of nutrition labeling on sales, and perceived responsibility to add nutrition labels. Regression analysis was used to determine the importance of factors on willingness to label. Response rate was 45.3%. Most companies were neutral about their willingness to use nutrition labeling. Two thirds of the respondents were not currently using nutrition labels. Only one third thought that it was the foodservice's responsibility to provide such information. Several companies perceived that nutrition labeling would have a potentially negative effect on annual sales volume. Major obstacles were identified as menu or personnel related, rather than cost related. Menu-related obstacles included too many menu variations, limited space on the menu for labeling, and loss of flexibility in changing the menu. Personnel-related obstacles included difficulty in training employees to implement nutrition labeling, and not enough time for foodservice personnel to implement nutrition labeling. Numerous opportunities will be created for dietetics professionals in helping foodservices overcome these menu- or personnel-related obstacles.

[Female migrants in the health care system. Health care utilisation, access barriers and health promotion strategies].

PubMed

Wimmer-Puchinger, B; Wolf, H; Engleder, A

2006-09-01

Due to the evident interaction between social factors and health, migrants are exposed to specific risk factors and access barriers to health services. Some examples are the lower education level, the low social position and/or the insufficient language skills. This concept is further elaborated in the multi-factorial impacts of health literacy. Female migrants often experience additional discrimination because of their gender. Despite the lack of representative data, consistent studies show that female migrants do not regularly take advantage of health care prevention and present themselves with higher degrees of stress. The current "inadequate health care" manifests itself in a lack of care in the areas of prevention and health education and an abundance in the context of medication and diagnostic procedures. To meet these demands and to further reduce barriers, in particular language barriers, specific strategies for this target group involving both politics and the health care system have to be developed. Besides the employment of interpreters with a native cultural background and the distribution of information booklets, it is an important strategy to reduce structural obstacles such as cultural diversity. To contact these women in their living environment should help to increase their self-determined health promotion. Selected models of good practice in Austria with regard to the themes of FGM (female genital mutilation), violence, heart disease and breast cancer are presented to highlight the specific health situation and risk factors of female migrants as well as successful strategies to confront them.

Strategies, barriers, and motivation for weight loss among veterans living with schizophrenia.

PubMed

Klingaman, Elizabeth A; Viverito, Kristen M; Medoff, Deborah R; Hoffmann, Rebecca M; Goldberg, Richard W

2014-12-01

Weight loss programs for veterans living with schizophrenia have demonstrated mixed efficacy, highlighting unique obstacles faced by this population. Data from a large national sample provide an opportunity to characterize the unique factors related to weight loss for veterans with schizophrenia. The present study compared veterans living with schizophrenia (n = 5,388) to veterans with no mental health diagnoses (n = 81,422) on responses to the MOVE!23, a multidimensional assessment of factors related to weight management. Responses to the MOVE!23 between August, 2005 and May, 2013 by veterans with a body mass index in the overweight or obese range were used to describe clinical characteristics, current strategies, perceived barriers, stages of readiness, and importance of and confidence to change behaviors related to their weight management. Both groups reported similar stages of readiness and high ratings of importance and confidence regarding weight loss behaviors. Compared with veterans with no mental health diagnoses, over 5 times as many veterans living with schizophrenia reported smoking to control weight, and a greater number endorsed 18 of the 21 barriers to modifying eating and physical activity. RESULTS highlight the necessity of addressing healthy lifestyles from a holistic perspective for all veterans. Adding regular physical activity as part of daily treatment may address the accessibility, safety concerns, and lack of social support reported as physical activity barriers. Increased access to healthier food choices and addressing smoking in conjunction with weight loss are also warranted. (c) 2014 APA, all rights reserved.

Counseling Gifted Women: Becoming the Heroes of Our Own Stories.

ERIC Educational Resources Information Center

Noble, Kathleen D.

1989-01-01

Many gifted women are unaware of or ambivalent about their potential, due to interpersonal obstacles, socio-cultural barriers, and intrapersonal factors. Guidelines and resources are offered for counseling gifted women to recognize and externalize cultural and familial devaluation and to envision new possibilities for personal fulfillment.…

76 FR 21221 - National Equal Pay Day, 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-15

... America A Proclamation Generations of women have fought for the advancement of their sisters, daughters, and themselves in acts of great courage--reaching for and winning the right to vote, breaking barriers.... While our Nation has come far, obstacles continue to exist for working women, who still earn less on...

Obstacles and Successes in Implementing the ASCA National Model in Schools

ERIC Educational Resources Information Center

Studer, Jeannine R.; Diambra, Joel F.; Breckner, John A.; Heidel, R. Eric

2011-01-01

Researchers surveyed CACREP school counseling program graduates from a southeastern university to explore successes and barriers in implementing a comprehensive, developmental school counseling program. Findings included significant differences across school levels in programmatic change (p less than 0.001) and responsive services (p = 0.041).…

Creating Schools as Learning Communities: Obstacles and Processes

ERIC Educational Resources Information Center

Voulalas, Zafiris D.; Sharpe, Fenton G.

2005-01-01

Purpose: The paper sought to clarify the concept of learning organisation/community; to identify the barriers that are perceived to obstruct the creation of learning communities out of traditional schools; to identify how principals go about the task of converting their schools; and the special characteristics of leadership required to transform…

Tenure Trap: Number of Obstacles Stand in Way of Tenure for Women.

ERIC Educational Resources Information Center

Phillip, Mary-Christine

1993-01-01

Barriers to tenure for women faculty are examined, including different role perceptions for men and women, lack of mentors or professional support, lack of access to prestigious journals for publishing, and male expectations that all faculty will have similar formative experiences and training. (MSE)

Lawyers and Legal Advocacy in Juvenile Courts: An Assessment.

ERIC Educational Resources Information Center

Puritz, Patricia; Burrell, Sue; Schwartz, Robert; Soler, Mark; Warboys, Loren

2000-01-01

Evaluates the juvenile justice system focusing on the barriers children encounter when seeking appropriate counsel and the quality of representation. Includes an assessment of the appointment of counsel, pretrial preparation and trial performance, post-trial maneuvers, and appeals. Finds that the most common obstacle is the overwhelming caseloads…

Digital Exclusion: Coming out from behind Closed Doors

ERIC Educational Resources Information Center

Watling, Sue

2011-01-01

Government visions of a digital future show little indication of how disabled people, reliant on access technology, will participate. Access technology has the potential to offer independent use of the Internet but many disabled people already face barriers that prevent them having equitable digital experiences. Multiple obstacles include high…

The Communication Barriers between Teachers and Parents in Primary Schools

ERIC Educational Resources Information Center

Ozmen, Fatma; Akuzum, Cemal; Zincirli, Muhammed; Selcuk, Gulenaz

2016-01-01

Problem Statement: In educational institutions, the effectiveness of communication between teachers and parents, in terms of student achievement and attendance, has a great importance. Parent-teacher communication provides multi-faceted benefits to teachers, the school, and parents as well. However, various obstacles hinder the realization of…

Circuit design advances for ultra-low power sensing platforms

NASA Astrophysics Data System (ADS)

Wieckowski, Michael; Dreslinski, Ronald G.; Mudge, Trevor; Blaauw, David; Sylvester, Dennis

2010-04-01

This paper explores the recent advances in circuit structures and design methodologies that have enabled ultra-low power sensing platforms and opened up a host of new applications. Central to this theme is the development of Near Threshold Computing (NTC) as a viable design space for low power sensing platforms. In this paradigm, the system's supply voltage is approximately equal to the threshold voltage of its transistors. Operating in this "near-threshold" region provides much of the energy savings previously demonstrated for subthreshold operation while offering more favorable performance and variability characteristics. This makes NTC applicable to a broad range of power-constrained computing segments including energy constrained sensing platforms. This paper explores the barriers to the adoption of NTC and describes current work aimed at overcoming these obstacles in the circuit design space.

Biomarker Testing for Personalized Therapy in Lung Cancer in Low- and Middle-Income Countries.

PubMed

Hirsch, Fred R; Zaric, Bojan; Rabea, Ahmed; Thongprasert, Sumitra; Lertprasertsuke, Nirush; Dalurzo, Mercedes Liliana; Varella-Garcia, Marileila

2017-01-01

There have been many important advances in personalized therapy for patients with lung cancer, particularly for those with advanced disease. Molecular testing is crucial for implementation of personalized therapy. Although the United States and many Western countries have come far in the implementation of personalized therapy for lung cancer, there are substantial challenges for low- and middle-income countries (LMICs). Globally, the LMICs display great heterogeneity in the pattern of implementation of molecular testing and targeted therapy. The current review presents an attempt to identify the challenges and obstacles for the implementation of molecular testing and the use of targeted therapies in these areas. Lack of infrastructure, lack of technical expertise, economic factors, and lack of access to new drugs are among the substantial barriers.

[Indicators, variables and obstacles to the life cycle of scientific and technical information in health. Experiences of the Centro Nacional de Información y Documentación en Salud in Mexico].

PubMed

Macías-Chapula, C A

1987-01-01

Indicators, variables and barriers to scientific and technical health information have been detected and described by CENIDS in Mexico within the life cycle of the information production model, covering the phases of: a) generation; b) institutionalization; c) maintenance/development; and d) distribution/dissemination. Emphasis is placed on the important role that play social, economic, demographic, and political factors of each developing country to conform their ideal information life cycle. After an analysis of the existing Mexican situation, and a short description of CENIDS' structure, organization, functions and services, CENIDS' short-term and mid-term projects, and suggestions for further research lines to improve the current situation in Mexico are also given.

DNA repair goes hip-hop: SMARCA and CHD chromatin remodellers join the break dance.

PubMed

Rother, Magdalena B; van Attikum, Haico

2017-10-05

Proper signalling and repair of DNA double-strand breaks (DSB) is critical to prevent genome instability and diseases such as cancer. The packaging of DNA into chromatin, however, has evolved as a mere obstacle to these DSB responses. Posttranslational modifications and ATP-dependent chromatin remodelling help to overcome this barrier by modulating nucleosome structures and allow signalling and repair machineries access to DSBs in chromatin. Here we recap our current knowledge on how ATP-dependent SMARCA- and CHD-type chromatin remodellers alter chromatin structure during the signalling and repair of DSBs and discuss how their dysfunction impacts genome stability and human disease.This article is part of the themed issue 'Chromatin modifiers and remodellers in DNA repair and signalling'. © 2017 The Authors.

Beijing fifteen years on: the persistence of barriers to gender mainstreaming in health policy.

PubMed

Payne, Sarah

2011-01-01

In 2010, fifteen years after the Beijing declaration on women's rights, the UN Commission on the Status of Women met to review progress in gender mainstreaming. Reports on gender equality by member states revealed differences in the degree of change achieved in this period, while highlighting common barriers to gender mainstreaming. The same barriers have long been identified by academics and activists, but prove remarkably resistant to strategies to address gender inequalities. This paper reviews approaches to gender mainstreaming in the context of health policy, and suggests that a model of the obstacles to gender mainstreaming, which identifies barriers as essentially pragmatic, conceptual, or political in origin, might enable a more explicit discussion of the factors underlying this resistance and the ways in which they might be challenged.

Principles of nanoparticle design for overcoming biological barriers to drug delivery

PubMed Central

Blanco, Elvin; Shen, Haifa; Ferrari, Mauro

2016-01-01

Biological barriers to drug transport prevent successful accumulation of nanotherapeutics specifically at diseased sites, limiting efficacious responses in disease processes ranging from cancer to inflammation. Although substantial research efforts have aimed to incorporate multiple functionalities and moieties within the overall nanoparticle design, many of these strategies fail to adequately address these barriers. Obstacles, such as nonspecific distribution and inadequate accumulation of therapeutics, remain formidable challenges to drug developers. A reimagining of conventional nanoparticles is needed to successfully negotiate these impediments to drug delivery. Site-specific delivery of therapeutics will remain a distant reality unless nanocarrier design takes into account the majority, if not all, of the biological barriers that a particle encounters upon intravenous administration. By successively addressing each of these barriers, innovative design features can be rationally incorporated that will create a new generation of nanotherapeutics, realizing a paradigmatic shift in nanoparticle-based drug delivery. PMID:26348965

How Obstacles Perturb Population Fronts and Alter Their Genetic Structure

PubMed Central

Möbius, Wolfram; Murray, Andrew W.; Nelson, David R.

2015-01-01

As populations spread into new territory, environmental heterogeneities can shape the population front and genetic composition. We focus here on the effects of an important building block of heterogeneous environments, isolated obstacles. With a combination of experiments, theory, and simulation, we show how isolated obstacles both create long-lived distortions of the front shape and amplify the effect of genetic drift. A system of bacteriophage T7 spreading on a spatially heterogeneous Escherichia coli lawn serves as an experimental model system to study population expansions. Using an inkjet printer, we create well-defined replicates of the lawn and quantitatively study the population expansion of phage T7. The transient perturbations of the population front found in the experiments are well described by a model in which the front moves with constant speed. Independent of the precise details of the expansion, we show that obstacles create a kink in the front that persists over large distances and is insensitive to the details of the obstacle’s shape. The small deviations between experimental findings and the predictions of the constant speed model can be understood with a more general reaction-diffusion model, which reduces to the constant speed model when the obstacle size is large compared to the front width. Using this framework, we demonstrate that frontier genotypes just grazing the side of an isolated obstacle increase in abundance, a phenomenon we call ‘geometry-enhanced genetic drift’, complementary to the founder effect associated with spatial bottlenecks. Bacterial range expansions around nutrient-poor barriers and stochastic simulations confirm this prediction. The effect of the obstacle on the genealogy of individuals at the front is characterized by simulations and rationalized using the constant speed model. Lastly, we consider the effect of two obstacles on front shape and genetic composition of the population illuminating the effects expected from complex environments with many obstacles. PMID:26696601

Streamlined Islands in Ares Valles

NASA Technical Reports Server (NTRS)

2002-01-01

(Released 10 June 2002) The Science Although liquid water is not stable on the surface of Mars today, there is substantial geologic evidence that large quantities of water once flowed across the surface in the distant past. Streamlined islands, shown here, are one piece of evidence for this ancient water. The tremendous force of moving water, possibly from a catastrophic flood, carved these teardrop-shaped islands within a much larger channel called Ares Valles. The orientation of the islands can be used as an indicator of the direction the water flowed. The islands have a blunt end that is usually associated with an obstacle, commonly an impact crater. The crater is resistant to erosion and creates a geologic barrier around which the water must flow. As the water flows past the obstacle, its erosive power is directed outward, leaving the area in the lee of the obstacle relatively uneroded. However, some scientists have also argued that the area in the lee of the obstacle might be a depositional zone, where material is dropped out of the water as it briefly slows. The ridges observed on the high-standing terrain in the leeward parts of the islands may be benches carved into the rock that mark the height of the water at various times during the flood, or they might be indicative of layering in the leeward rock. As the water makes its way downstream, the interference of the water flow by the obstacle is reduced, and the water that was diverted around the obstacle rejoins itself at the narrow end of the island. Therefore, the direction of the water flow is parallel to the orientation of the island, and the narrow end of the island points downstream. In addition to the streamlined islands, the channel floor exhibits fluting that is also suggestive of flowing water. The flutes (also known as longitudinal grooves) are also parallel to the direction of flow, indicating that the water flow was turbulent and probably quite fast, which is consistent with the hypothesized catastrophic floods that came through Ares Valles. The Story In symbolism only, these guppy-shaped islands and current-like flutes of land beside them may conjure up a mental image of a flowing Martian river. This picture would only be half-right. Scientifically, no fish ever swam this channel, but these landforms do reveal that catastrophic floods of rushing water probably patterned the land in just this way. Geologists who study flood areas believe that a tremendous force of moving water probably carved both the islands and the small, parallel, 'current-like' ridges around them. The blunt end of the islands (the 'heads' of the 'fish') are probably ancient impact craters that posed obstacles to the water as it rushed down the channel in torrents. Because a crater is resistant to erosion, it creates a geologic barrier around which the water must flow. As the water makes its way downstream, the crater's interference with the water flow is reduced, so the water that was diverted around the obstacle rejoins at the narrow end of the island (the 'tail' of the 'fish'). Therefore, from this information, you can tell that the water flowed from the southeast to the northwest. As a rule of thumb for the future, you can say that the narrow end of the island points downstream. The result may be the island behind the crater, but geologists disagree about the exact process by which the island forms. Some scientists argue that the erosive power of the water is directed outward, leaving the area behind, or in the lee of, the obstacle relatively untouched. Other scientists argue that the water slows when it encounters the crater obstacle, and small particles of sand and 'dirt' drop out of the water and are deposited in the lee. There's another small associated uncertainty too. Look closely at the edges of the islands and notice how the land is terraced. These ledges might mark the height of the water at various times during the flood . . . or they might be an indication that layering occurred. It all depends on your hypothesis. Like the streamlined islands, the current-like flutes are parallel to the direction of flow, indicating that the water flow was turbulent and probably quite fast, which is consistent with the hypothesis that catastrophic floods broke forth in this region, known as Ares Vallis. Ares Vallis is the region where Pathfinder landed to help understand the possible history of water on Mars. Geologists want to understand not only if there was a catastrophic flood, but why it happened. Both orbiters and landers can add to the information on hand, but some Earth examples might provide clues as well. On our planet, some glacial valleys have had major catastrophic floods that were caused by the sudden outburst and drainage of glacial lakes. The Channeled Scabland in Washington state is great Earthly example of a place where the sudden failure of a glacier ice dam spewed out water, leaving a system of large, dry channels with flutes similar to the ones seen in this image. Did something similar happen to cause this outburst on Mars? Hopefully, future studies of THEMIS and other images will help us understand the answer.

Clinical Management of the Breast-Feeding Mother-Infant Dyad in Recovery From Opioid Dependence.

PubMed

Busch, Deborah W

2016-01-01

Human milk is one of the most health-promoting and cost-effective nutritional substances known to humankind. Breastmilk provides substantial and remarkable physiological and psychological health benefits. Within the last decade, there has been a resurgence of breast-feeding in the United States and worldwide and an increased awareness of the immense health benefits for mothers, infants, and societies that support it. Each mother-baby dyad is a unique pair, with distinct relationships, biases, barriers, and obstacles. This article aims to address clinical management for the opioid-recovering breast-feeding dyad and to translate current evidenced-based practice findings, recommendations, and resources to best support this unique population. The recovering breast-feeding mother and newborn with opioid dependence deserve special consideration and expert care to foster their recovery and breast-feeding efforts. It is our moral and ethical responsibility as healthcare professionals to enable, foster, and promote breast-feeding among all families, especially those who stand to benefit the greatest. Substance recovery cannot be treated in isolation, nor can breast-feeding efforts; an interdisciplinary professional team effort promises the greatest chances for recovery success. With appropriate evidence-based practice support, training, and intervention by knowledgeable professionals, many women can overcome the biases and obstacles associated with opioid recovery to successfully breast-feed their babies.

Robustness of free and pinned spiral waves against breakup by electrical forcing in excitable chemical media.

PubMed

Phantu, Metinee; Sutthiopad, Malee; Luengviriya, Jiraporn; Müller, Stefan C; Luengviriya, Chaiya

2017-04-01

We present an investigation on the breakup of free and pinned spiral waves under an applied electrical current in the Belousov-Zhabotinsky reaction. Spiral fronts propagating towards the negative electrode are decelerated. A breakup of the spiral waves occurs when some segments of the fronts are stopped by a sufficiently strong electrical current. In the absence of obstacles (i.e., free spiral waves), the critical value of the electrical current for the wave breakup increases with the excitability of the medium. For spiral waves pinned to circular obstacles, the critical electrical current increases with the obstacle diameter. Analysis of spiral dynamics shows that the enhancement of the robustness against the breakup of both free and pinned spiral waves is originated by the increment of wave speed when either the excitability is strengthened or the obstacle size is enlarged. The experimental findings are reproduced by numerical simulations using the Oregonator model. In addition, the simulations reveal that the robustness against the forced breakup increases with the activator level in both cases of free and pinned spiral waves.

The economics of biosimilars.

PubMed

Blackstone, Erwin A; Joseph, P Fuhr

2013-09-01

The high cost of pharmaceuticals, especially biologics, has become an important issue in the battle to control healthcare costs. The Hatch-Waxman Act encourages generic competition but still provides incentives for pioneers to develop new drugs. The Biologics Price Competition and Innovation Act is intended to do the same for biologics and biosimilars. To examine information related to biosimilars to determine their potential impact on competition in the biologic market. Using information concerning the European Union (EU) and the pharmaceutical industry, this article reviews and analyzes the experience of biosimilars in the EU, as well as the obstacles and opportunities that biosimilars face in the United States. Much of the analysis is based on examining current trends in biologic drugs and the potential implications on the future of biosimilars. This article reviews the mixed success of biosimilars in the EU and the implications for the United States. Because biologics are produced from living organisms, manufacturing issues are more important than in the chemical drug market. The barriers to biosimilar entry into the marketplace are much more difficult to overcome than challenges generic manufacturers typically face and are similar to obstacles specialty injectable producers encounter. The competitive responses by pioneers are also likely to be more important. The capital costs and risk issues with biosimilars make alliances and partnering arrangements very likely. Biosimilars often enter emerging markets, where the barriers to entry are easier to overcome. Nevertheless, the United States represents the greatest opportunity for biosimilar producers, in part because it is the largest biologics market and has high prices for biologics. As the United States enters the biosimilar market, the pharmaceutical industry is likely to grow at an accelerated pace. Automatic substitution is likely to be slow to develop, because of safety and quality concerns. The beneficial impact of biosimilars is likely to take a long time to be realized and to be fraught with more difficulties than was the case for small-molecule generics. Various factors, such as safety, pricing, manufacturing, entry barriers, physician acceptance, and marketing, will make the biosimilar market develop different from the generic market. The high cost to enter the market and the size of the biologic drug market make entry attractive but risky.

The Future Workforce in Cancer Prevention: Advancing Discovery, Research, and Technology

PubMed Central

Newhauser, Wayne. D.; Scheurer, Michael. E.; Faupel-Badger, Jessica. M.; Clague, Jessica.; Weitzel, Jeffrey.; Woods, Kendra. V.

2012-01-01

As part of a 2 day conference on October 15 and 16, 2009, a nine-member task force composed of scientists, clinicians, educators, administrators, and students from across the United States was formed to discuss research, discovery, and technology obstacles to progress in cancer prevention and control, specifically those related to the cancer prevention workforce. This article summarizes the task force’s findings on the current state of the cancer prevention workforce in this area and its needs for the future. The task force identified two types of barriers impeding the current cancer prevention workforce in research, discovery, and technology from reaching its fullest potential: 1) limited cross-disciplinary research opportunities with underutilization of some disciplines is hampering discovery and research in cancer prevention, and 2) new research avenues are not being investigated because technology development and implementation are lagging. Examples of impediments and desired outcomes are provided in each of these areas. Recommended solutions to these problems are based on the goals of enhancing the current cancer prevention workforce and accelerating the pace of discovery and clinical translation. PMID:22314794

The future workforce in cancer prevention: advancing discovery, research, and technology.

PubMed

Newhauser, Wayne D; Scheurer, Michael E; Faupel-Badger, Jessica M; Clague, Jessica; Weitzel, Jeffrey; Woods, Kendra V

2012-05-01

As part of a 2-day conference on October 15 and 16, 2009, a nine-member task force composed of scientists, clinicians, educators, administrators, and students from across the USA was formed to discuss research, discovery, and technology obstacles to progress in cancer prevention and control, specifically those related to the cancer prevention workforce. This article summarizes the task force's findings on the current state of the cancer prevention workforce in this area and its needs for the future. The task force identified two types of barriers impeding the current cancer prevention workforce in research, discovery, and technology from reaching its fullest potential: (1) limited cross-disciplinary research opportunities with underutilization of some disciplines is hampering discovery and research in cancer prevention, and (2) new research avenues are not being investigated because technology development and implementation are lagging. Examples of impediments and desired outcomes are provided in each of these areas. Recommended solutions to these problems are based on the goals of enhancing the current cancer prevention workforce and accelerating the pace of discovery and clinical translation.

Kidney transplantation, bioengineering and regeneration: an originally immunology-based discipline destined to transition towards ad hoc organ manufacturing and repair.

PubMed

Rogers, Jeffrey; Katari, Ravi; Gifford, Sheyna; Tamburrini, Riccardo; Edgar, Lauren; Voigt, Marcia R; Murphy, Sean V; Igel, Daniel; Mancone, Sara; Callese, Tyler; Colucci, Nicola; Mirzazadeh, Majid; Peloso, Andrea; Zambon, Joao Paulo; Farney, Alan C; Stratta, Robert J; Orlando, Giuseppe

2016-01-01

Kidney transplantation (KT), as a modality of renal replacement therapy (RRT), has been shown to be both economically and functionally superior to dialysis for the treatment of end-stage renal disease (ESRD). Progress in KT is limited by two major barriers: a) a chronic and burgeoning shortage of transplantable organs and b) the need for chronic immunosuppression following transplantation. Although ground-breaking advances in transplant immunology have improved patient survival and graft durability, a new pathway of innovation is needed in order to overcome current obstacles. Regenerative medicine (RM) holds the potential to shift the paradigm in RRT, through organ bioengineering. Manufactured organs represent a potentially inexhaustible source of transplantable grafts that would bypass the need for immunosuppressive drugs by using autologous cells to repopulate extracellular matrix (ECM) scaffolds. This overview discusses the current status of renal transplantation while reviewing the most promising innovations in RM therapy as applied to RRT.

Gene delivery with viral vectors for cerebrovascular diseases

PubMed Central

Gan, Yu; Jing, Zheng; Stetler, R. Anne; Cao, Guodong

2017-01-01

Recent achievements in the understanding of molecular events involved in the pathogenesis of central nervous system (CNS) injury have made gene transfer a promising approach for various neurological disorders, including cerebrovascular diseases. However, special obstacles, including the post-mitotic nature of neurons and the blood-brain barrier (BBB), constitute key challenges for gene delivery to the CNS. Despite the various limitations in current gene delivery systems, a spectrum of viral vectors has been successfully used to deliver genes to the CNS. Furthermore, recent advancements in vector engineering have improved the safety and delivery of viral vectors. Numerous viral vector-based clinical trials for neurological disorders have been initiated. This review will summarize the current implementation of viral gene delivery in the context of cerebrovascular diseases including ischemic stroke, hemorrhagic stroke and subarachnoid hemorrhage (SAH). In particular, we will discuss the potentially feasible ways in which viral vectors can be manipulated and exploited for use in neural delivery and therapy. PMID:23276981

Sleep Medicine in Saudi Arabia.

PubMed

Almeneessier, Aljohara S; BaHammam, Ahmed S

2017-04-15

The practice of sleep medicine in Saudi Arabia began in the mid to late 1990s. Since its establishment, this specialty has grown, and the number of specialists has increased. Based on the available data, sleep disorders are prevalent among the Saudi population, and the demand for sleep medicine services is expected to increase significantly. Currently, two training programs are providing structured training and certification in sleep medicine in this country. Recently, clear guidelines for accrediting sleep medicine specialists and technologists were approved. Nevertheless, numerous obstacles hamper the progress of this specialty, including the lack of trained technicians, specialists, and funding. Increasing the awareness of sleep disorders and their serious consequences among health care workers, health care authorities, and insurance companies is another challenge. Future plans should address the medical educational system at all levels to demonstrate the importance of early detection and the treatment of sleep disorders. This review discusses the current position of and barriers to sleep medicine practice and education in Saudi Arabia. © 2017 American Academy of Sleep Medicine

Comparison of the effects of artificial and natural barriers on large African carnivores: implications for interspecific relationships and connectivity.

PubMed

Cozzi, Gabriele; Broekhuis, Femke; McNutt, J Weldon; Schmid, Bernhard

2013-05-01

1. Physical barriers contribute to habitat fragmentation, influence species distribution and ranging behaviour, and impact long-term population viability. Barrier permeability varies among species and can potentially impact the competitive balance within animal communities by differentially affecting co-occurring species. The influence of barriers on the spatial distribution of species within whole communities has nonetheless received little attention. 2. During a 4-year period, we studied the influence of a fence and rivers, two landscape features that potentially act as barriers on space use and ranging behaviour of lions Panthera leo, spotted hyenas Crocuta crocuta, African wild dogs Lycaon pictus and cheetahs Acinonyx jubatus in Northern Botswana. We compared the tendencies of these species to cross the barriers using data generated from GPS-radio collars fitted to a total of 35 individuals. Barrier permeability was inferred by calculating the number of times animals crossed a barrier vs. the number of times they did not cross. Finally, based on our results, we produced a map of connectivity for the broader landscape system. 3. Permeability varied significantly between fence and rivers and among species. The fence represented an obstacle for lions (permeability = 7.2%), while it was considerably more permeable for hyenas (35.6%) and wild dogs and cheetahs (≥ 50%). In contrast, the rivers and associated floodplains were relatively permeable to lions (14.4%) while they represented a nearly impassable obstacle for the other species (<2%). 4. The aversion of lions to cross the fence resulted in a relatively lion-free habitat patch on one side of the fence, which might provide a potential refuge for other species. For instance, the competitively inferior wild dogs used this refuge significantly more intensively than the side of the fence with a high presence of lions. 5. We showed that the influence of a barrier on the distribution of animals could potentially result in a broad-scale modification of community structure and ecology within a guild of co-occurring species. As habitat fragmentation increases, understanding the impact of barriers on species distributions is thus essential for the implementation of landscape-scale management strategies, the development and maintenance of corridors and the enhancement of connectivity. © 2013 The Authors. Journal of Animal Ecology © 2013 British Ecological Society.

Hospital-Based Outpatient Direct Access to Physical Therapist Services: Current Status in Wisconsin.

PubMed

Boissonnault, William G; Lovely, Karen

2016-11-01

Direct access to physical therapist services is available in all 50 states, with reported benefits including reduced health care costs, enhanced patient satisfaction, and no apparent compromised patient safety. Despite the benefits and legality of direct access, few data exist regarding the degree of model adoption, implementation, and utilization. The purposes of the study were: (1) to investigate the extent of implementation and utilization of direct access to outpatient physical therapist services in Wisconsin hospitals and medical centers, (2) to identify barriers to and facilitators for the provisioning of such services, and (3) to identify potential differences between facilities that do and do not provide direct access services. A descriptive survey was conducted. Eighty-nine survey questionnaires were distributed via email to the directors of rehabilitation services at Wisconsin hospitals and medical centers. The survey investigated facility adoption of the direct access model, challenges to and resources utilized during model implementation, and current barriers affecting model utilization. Forty-seven (52.8%) of the 89 survey questionnaires were completed and returned. Forty-two percent of the survey respondents (20 of 47) reported that their facility offered direct access to physical therapist services, but fewer than 10% of patients were seen via direct access at 95% of the facilities offering such services. The most frequently reported obstacles to model implementation and utilization were lack of health care provider, administrator, and patient knowledge of direct access; its legality in Wisconsin; and physical therapists' differential diagnosis and medical screening abilities. Potential respondent bias and limited generalizability of the results are limitations of the study. These findings apply to hospitals and medical centers located in Wisconsin, not to facilities located in other geographic regions. Respondents representing direct access organizations reported more timely access to physical therapist services, enhanced patient satisfaction, decreased organizational health care costs, and improved efficiency of resource utilization as benefits of model implementation. For organizations without direct access, not being an organizational priority, concerns from referral sources, and concerns that the physician-patient relationship would be negatively affected were noted as obstacles to model adoption. © 2016 American Physical Therapy Association.

Barriers to advancement in academic surgery: views of senior residents and early career faculty.

PubMed

Cochran, Amalia; Elder, William B; Crandall, Marie; Brasel, Karen; Hauschild, Tricia; Neumayer, Leigh

2013-11-01

A significant faculty attrition rate exists in academic surgery. The authors hypothesized that senior residents and early-career faculty members have different perceptions of advancement barriers in academic surgery. A modified version of the Career Barriers Inventory-Revised was administered electronically to surgical residents and early-career surgical faculty members at 8 academic medical centers. Residents identified a lack of mentorship as a career barrier about half as often as faculty members. Residents were twice as likely as faculty members to view childbearing as a career barrier. Many early-career faculty members cite a lack of mentors as a limitation to their career development in academic surgery. Childbearing remains a complex perceived influence for female faculty members in particular. Female faculty members commonly perceive differential treatment and barriers on the basis of their sex. Faculty development programs should address both systemic and sex-specific obstacles if academic surgery is to remain a vibrant field. Copyright © 2013 Elsevier Inc. All rights reserved.

Educating the Hip Hop Generation: Communication Barriers Offset Efforts to Reach Young Minds.

ERIC Educational Resources Information Center

Hayes, Dianne Williams

1993-01-01

An examination of trends among youth in the 1990s finds that changes in family structure, peer pressure, and outside influences are stronger in this generation. Racial factors, music, and sophistication about the media are seen as important elements, and intergenerational communication difficulties as an obstacle. Students demand relevance in…

Technology as an Instrument to Improve Quality, Accountability, and Reflection in Academic Medicine

ERIC Educational Resources Information Center

Wilkes, Michael S.; Howell, Lydia

2006-01-01

Objective: This article describes two complementary technology systems used in academic medicine to 1) improve the quality of learning and teaching, and 2) describe the barriers and obstacles encountered in implementing these systems. Method: The literature was integrated with in-depth, case-based experience with technology related to student…

The Lived Experience of Students with an Invisible Disability at a Canadian University

ERIC Educational Resources Information Center

Mullins, Laura; Preyde, Michele

2013-01-01

University institutions are required by law to make their services accessible to students with disabilities. Canadian universities have gone a long way to eliminate the physical obstacles that present barriers for students. Many students with disabilities have invisible disabilities that require different types of adjustments. Although some…

Interrupting the Mindset of Educational Neocolonialism: Critical Deliberations from East and West International Adult Educators

ERIC Educational Resources Information Center

Sun, Qi; Roumell, Elizabeth A. L.

2017-01-01

Applying international and comparative education and cultural perspectives, through critical comparative reflection, this paper examines issues and challenges of adult learning, teaching, and research endeavors between the East and the West. First, a brief literature review illuminating the obstacles and barriers for a two-way exchange between…

Ambiguity and Alignment in Academic Policies: Course Substitutions, Learning Disabilities, and Universal Design

ERIC Educational Resources Information Center

Galilee-Belfer, Mika

2012-01-01

While research on barriers to full participation for those with learning and other disabilities has focused largely on structural and institutional obstacles to work and education (Swain, French, & Cameron, 2005; Jones, 1996; Watson, 2002), the recognition of disability as a social justice issue is gaining currency (Kraus, 2008). Expensive,…

The Barriers to Achieving the Wider Goals of General Education and Their Implications for the British Educational Research Association.

ERIC Educational Resources Information Center

Raven, John

1990-01-01

Advocates revamping the British educational system from technical-rational content model to student-centered process programs designed to promote critical thinking, individual initiative, and communication skills. Discusses obstacles to this educational reform, emphasizing research orientation. Urges the British Educational Research Association to…

Empowering the Parent-Child Relationship in Homeless and Other High-Risk Parents and Families

ERIC Educational Resources Information Center

Swick, Kevin J.

2008-01-01

High quality parent-child relations are essential to healthy development and learning in children. Homeless families experience many barriers to realizing the needed bonding and nurturance for having healthy relationships. This article explores the obstacles to the development of nurturing parent-child relations and offers strategies for…

Primary and Secondary Virtual Learning in New Zealand: Examining Barriers to Achieving Maturity

ERIC Educational Resources Information Center

Barbour, Michael; Davis, Niki; Wenmoth, Derek

2016-01-01

This paper describes the organisational development of virtual learning in networked rural schools in New Zealand, specifically the obstacles that e-learning clusters of rural schools face in their journey to sustainability and maturity through the lens of the Ministry's Learning Communities Online Handbook. Analysis of a nationwide purposeful…

Meeting Needs of Young Children at Risk for or Having a Disability

ERIC Educational Resources Information Center

Peterson, Carla A.; Mayer, Lynn Milgram; Summers, Jean Ann; Luze, Gayle J.

2010-01-01

Poverty-related factors place children at higher risk for disabilities and also serve as barriers to families accessing services for their children and themselves. Early childhood practitioners can play a critical role in supporting families by providing services to overcome these obstacles and by working in partnership with specialized early…

Lived History of a Transformative Leader with a Disability: An Evocative Autoethnography for Social Justice

ERIC Educational Resources Information Center

Vergara, Sofia

2017-01-01

Despite legal advancements recognizing the rights of individuals with disabilities, societal barriers are still arising from the medical model of disability. These obstacles have resulted in marginalizing and isolating practices, in turn leading to the underrepresentation of individuals with disabilities in the workforce and, by extension, in…

Early Exposure to & Preparation for College: A Guide for Educators

ERIC Educational Resources Information Center

Laing, Tony; Villavicencio, Adriana

2016-01-01

Black and Latino young men may face a number of barriers on their pathway to college, including a belief that college is not for them, difficulty navigating the college search and application process, financial obstacles, and insufficient academic preparation. Expanded Success Initiative (ESI) schools are working to prepare students for college…

Stepping around the Brick Wall: Overcoming Student Obstacles in Methods Courses

ERIC Educational Resources Information Center

Bos, Angela L.; Schneider, Monica C.

2009-01-01

Many political science departments offer, and increasing numbers of them require, undergraduate research methods courses. At the same time, studies cite high levels of student anxiety about such courses. Utilizing survey data from both students who take and faculty who teach methods, we conduct an analysis that compares the barriers students and…

Health Information System in Primary Health Care: The Challenges and Barriers from Local Providers’ Perspective of an Area in Iran

PubMed Central

Yazdi-Feyzabadi, Vahid; Emami, Mozhgan; Mehrolhassani, Mohammad Hossein

2015-01-01

Background: Health information system (HIS) has been utilized for collecting, processing, storing, and transferring the required information for planning and decision-making at different levels of health sector to provide quality services. In this study, in order to provide high-quality HIS, primary health care (PHC) providers’ perspective on current challenges and barriers were investigated. Methods: This study was carried out with a qualitative approach using semi-structured audiotaped focus group discussions (FGDs). One FGD was conducted with 13 Behvarz and health technicians as front-line workers and the other with 16 personnel including physicians, statisticians, and health professionals working in health centers of the PHC network in KUMS. The discussions were transcribed and then analyzed using the framework analysis method. Results: The identified organizational challenges were categorized into two groups: HIS structure and the current model of PHC in urban areas. Furthermore, the structural challenges were classified into HIS management structure (information systems resources, including human, supplies, and organizational rules) and information process. Conclusions: The HIS works effectively and efficiently when there are a consistency and integrity between the human, supplies, and process aspects. Hence, multifaceted interventions including strengthening the organizational culture to use the information in decisions, eliminating infrastructural obstacles, appointing qualified staff and more investment for service delivery at urban areas are the most fundamental requirements of high-quality HIS in PHC. PMID:26236444

Real-Time Occupancy Change Analyzer

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

2005-03-30

The Real-Time Occupancy Change Analyzer (ROCA) produces an occupancy grid map of an environment around the robot, scans the environment to generate a current obstacle map relative to a current robot position, and converts the current obstacle map to a current occupancy grid map. Changes in the occupancy grid can be reported in real time to support a number of tracking capabilities. The benefit of ROCA is that rather than only providing a vector to the detected change, it provides the actual x,y position of the change.

Touch modulates gravity sensing to regulate the growth of primary roots of Arabidopsis thaliana

NASA Technical Reports Server (NTRS)

Massa, Gioia D.; Gilroy, Simon

2003-01-01

Plants must sense and respond to diverse stimuli to optimize the architecture of their root system for water and nutrient scavenging and anchorage. We have therefore analyzed how information from two of these stimuli, touch and gravity, are integrated to direct root growth. In Arabidopsis thaliana, touch stimulation provided by a glass barrier placed across the direction of growth caused the root to form a step-like growth habit with bends forming in the central and later the distal elongation zones. This response led to the main root axis growing parallel to, but not touching the obstacle, whilst the root cap maintained contact with the barrier. Removal of the graviperceptive columella cells of the root cap using laser ablation reduced the bending response of the distal elongation zone. Similarly, although the roots of the gravisensing impaired pgm1-1 mutant grew along the barrier at the same average angle as wild-type, this angle became more variable with time. These observations imply a constant gravitropic re-setting of the root tip response to touch stimulation from the barrier. In wild-type plants, transient touch stimulation of root cap cells, but not other regions of the root, inhibited both subsequent gravitropic growth and amyloplast sedimentation in the columella. Taken together, these results suggest that the cells of the root cap sense touch stimuli and their subsequent signaling acts on the columella cells to modulate their graviresponse. This interaction of touch and gravity signaling would then direct root growth to avoid obstacles in the soil while generally maintaining downward growth.

Perception of community pharmacists towards the barriers to enhanced pharmacy services in the healthcare system of Dubai: a quantitative approach.

PubMed

Rayes, Ibrahim K; Hassali, Mohamed A; Abduelkarem, Abduelmula R

2015-01-01

In many developing countries, pharmacists are facing many challenges while they try to enhance the quality of services provided to patients approaching community pharmacies. To explore perception of community pharmacists in Dubai regarding the obstacles to enhanced pharmacy services using a part of the results from a nation-wide quantitative survey. A questionnaire was distributed to 281 full-time licensed community pharmacists in Dubai. The questionnaire had 5 inter-linked sections: demographic information, information about the pharmacy, interaction with physicians, pharmacists' current professional role, and barriers to enhanced pharmacy services. About half of the respondents (45.4%, n=90) agreed that pharmacy clients under-estimate them and 52.5% (n=104) felt the same by physicians. About 47.5% (n=94) of the respondents felt that they are legally unprotected against profession's malpractice. Moreover, 64.7% (n=128) stated that pharmacy practice in Dubai turned to be business-focused. In addition, 76.8% (n=252) found that one of the major barriers to enhanced pharmacy services is the high business running cost. Pharmacists screened tried to prove that they are not one of the barriers to optimized pharmacy services as 62.7% (n=124) disagreed that they lack appropriate knowledge needed to serve community and 67.7% (n=134) gave the same response when asked whether pharmacy staff lack confidence when treating consumers or not. Although being well established within the community, pharmacists in Dubai negatively perceived their own professional role. They stated that there are number of barriers which hinder optimized delivery of pharmacy services like under-estimation by pharmacy clients and other healthcare professionals, pressure to make sales, and high running cost.

Perception of community pharmacists towards the barriers to enhanced pharmacy services in the healthcare system of Dubai: a quantitative approach

PubMed Central

Rayes, Ibrahim K.; Hassali, Mohamed A.; Abduelkarem, Abduelmula R.

2014-01-01

Background: In many developing countries, pharmacists are facing many challenges while they try to enhance the quality of services provided to patients approaching community pharmacies. Objective: To explore perception of community pharmacists in Dubai regarding the obstacles to enhanced pharmacy services using a part of the results from a nation-wide quantitative survey. Methods: A questionnaire was distributed to 281 full-time licensed community pharmacists in Dubai. The questionnaire had 5 inter-linked sections: demographic information, information about the pharmacy, interaction with physicians, pharmacists’ current professional role, and barriers to enhanced pharmacy services. Results: About half of the respondents (45.4%, n=90) agreed that pharmacy clients under-estimate them and 52.5% (n=104) felt the same by physicians. About 47.5% (n=94) of the respondents felt that they are legally unprotected against profession’s malpractice. Moreover, 64.7% (n=128) stated that pharmacy practice in Dubai turned to be business-focused. In addition, 76.8% (n=252) found that one of the major barriers to enhanced pharmacy services is the high business running cost. Pharmacists screened tried to prove that they are not one of the barriers to optimized pharmacy services as 62.7% (n=124) disagreed that they lack appropriate knowledge needed to serve community and 67.7% (n=134) gave the same response when asked whether pharmacy staff lack confidence when treating consumers or not. Conclusions: Although being well established within the community, pharmacists in Dubai negatively perceived their own professional role. They stated that there are number of barriers which hinder optimized delivery of pharmacy services like under-estimation by pharmacy clients and other healthcare professionals, pressure to make sales, and high running cost. PMID:26131039

Biomechanical risk factors for tripping during obstacle--Crossing with the trailing limb in patients with type II diabetes mellitus.

PubMed

Hsu, Wei-Chun; Liu, Ming-Wei; Lu, Tung-Wu

2016-03-01

People with type II diabetes mellitus (DM) are at a high risk of falling especially during more challenging locomotor tasks such as obstacle-crossing. The current study aimed to identify the risk factors for tripping in these patients during trailing-limb obstacle-crossing. Fourteen patients with type II DM with or without mild peripheral neuropathy (PN) and 14 healthy controls walked and crossed obstacles of three different heights while their motion data were measured using a motion capture system and two forceplates. The DM group was found to cross obstacles with significantly reduced trailing toe clearance (p<0.05), increasing the probability of the foot hitting the obstacle, and thus the risk of tripping. This altered end-point control was associated with significantly reduced knee flexion and hip adduction of the trailing swing limb (p<0.05), as well as significantly increased ankle plantarflexor moments in the leading stance limb (p<0.05). Therefore, reduced knee flexion and hip adduction of the swing limb are identified as risk factors for tripping during obstacle-crossing. Increased mechanical demands on the ankle plantarflexors suggest that weakness of these muscles may further reduce the already compromised performance of obstacle-crossing in these patients. The current results showed that obstacle-crossing can be used to detect gait deviations and to identify the associated risk of tripping in patients with type II DM without or at an early stage of PN. Copyright © 2016 Elsevier B.V. All rights reserved.

Space Mechanisms Technology Workshop Proceedings

NASA Technical Reports Server (NTRS)

Fusaro, Robert L. (Editor)

1999-01-01

Over the years, NASA has experienced a number of troublesome mechanism anomalies. Because of this, the NASA Office of Safety and Mission Assurance initiated a workshop to evaluate the current space mechanism state-of-the-art and to determine the obstacles that will have to be met in order to achieve NASA's future missions goals. Seventy experts in the field attended the workshop. The experts identified current and perceived future space mechanisms obstacles. For each obstacle, the participants identified technology deficiencies, the current state-of-the-art, and applicable NASA, DOD, and industry missions. In addition, the participants at the workshop looked at technology needs for current missions, technology needs for future missions, what new technology is needed to improve the reliability of mechanisms, what can be done to improve technology development and the dissemination of information, and what do we do next.

Blood-Brain Barrier Integrity and Glial Support: Mechanisms that can be targeted for Novel Therapeutic Approaches in Stroke

PubMed Central

Ronaldson, Patrick T.; Davis, Thomas P.

2014-01-01

The blood-brain barrier (BBB) is a critical regulator of CNS homeostasis. Additionally, the BBB is the most significant obstacle to effective CNS drug delivery. It possesses specific charcteristics (i.e., tight junction protein complexes, influx and efflux transporters) that control permeation of circulating solutes including therapeutic agents. In order to form this “barrier,” brain microvascular endothelial cells require support of adjacent astrocytes and microglia. This intricate relationship also occurs between endothelial cells and other cell types and structures of the CNS (i.e., pericytes, neurons, extracellular matrix), which implies existence of a “neurovascular unit.” Ischemic stroke can disrupt the neurovascular unit at both the structural and functional level, which leads to an increase in leak across the BBB. Recent studies have identified several pathophysiological mechanisms (i.e., oxidative stress, activation of cytokine-mediated intracellular signaling systems) that mediate changes in the neurovascular unit during ischemic stroke. This review summarizes current knowledge in this area and emphasizes pathways (i.e., oxidative stress, cytokine-mediated intracellular signaling, glial-expressed receptors/targets) that can be manipulated pharmacologically for i) preservation of BBB and glial integrity during ischemic stroke and ii) control of drug permeation and/or transport across the BBB in an effort to identify novel targets for optimization of CNS delivery of therapeutics in the setting of ischemic stroke. PMID:22574987

Why won't they listen: Negotiating the technological and social context for science teaching

NASA Astrophysics Data System (ADS)

Liuzzo, Anna M.

The purpose of this study was to gather information to identify the obstacles and the impact an implementation of technology had in a middle school science classroom. This study explored a teaching environment where the teacher planned on using a variety of technology tools including laptops, probeware, hardware and software to promote scientific study. This study took place in two phases consisting of three consecutive years. In phase one the teacher reported great success. In phase two a shift in the school implementation created a significant impact on the learning taking place. This study identified the obstacles faced by a teacher providing an environment that combined her pedagogy with technology implementation. This teacher's pedagogy included research-based practices such a authentic problem-based learning, scientific inquiry, conceptual understanding of problem solving, connections to real-life situations and the use of metacognition in her practice. This study looked to determined if this implementation had an effect on student engagement and achievement; how the nature of technical and professional development impacted the implementation; and the barriers that were faced in creating a student-centered, technology rich approach to science. This qualitative study was conducted meeting the criteria of a case study of one teacher. The participant teacher's accounts of events through interviews were the primary source of data. In addition, multiple sources of information were also gathered. These included the teacher's reflective journal, student interviews, student focus groups, student artifacts, classroom observations, field notes, e-mail correspondences and students' test scores. This study proposes to contribute to the growing research evidence of implementation in the classroom and to identify specific obstacles that hinder success. The current state of education is calling for reform.

Obstacle detectors for automated transit vehicles: A technoeconomic and market analysis

NASA Technical Reports Server (NTRS)

Lockerby, C. E.

1979-01-01

A search was conducted to identify the technical and economic characteristics of both NASA and nonNASA obstacle detectors. The findings, along with market information were compiled and analyzed for consideration by DOT and NASA in decisions about any future automated transit vehicle obstacle detector research, development, or applications project. Currently available obstacle detectors and systems under development are identified by type (sonic, capacitance, infrared/optical, guided radar, and probe contact) and compared with the three NASA devices selected as possible improvements or solutions to the problems in existing obstacle detection systems. Cost analyses and market forecasts individually for the AGT and AMTV markets are included.

Is It Because of Partners or Partnerships?: An Investigation into the Main Obstacles of Developing International Partnerships in Four UK Universities

ERIC Educational Resources Information Center

Ayoubi, Rami M.; Massoud, Hiba

2012-01-01

Purpose: The main aim of the current study is to explore and model the major obstacles that UK universities encounter when developing international partnerships with overseas universities. Design/methodology/approach: Focusing on the obstacles to developing international partnerships, the study results are developed from 24 interviews with senior…

Vision Based Obstacle Detection in Uav Imaging

NASA Astrophysics Data System (ADS)

Badrloo, S.; Varshosaz, M.

2017-08-01

Detecting and preventing incidence with obstacles is crucial in UAV navigation and control. Most of the common obstacle detection techniques are currently sensor-based. Small UAVs are not able to carry obstacle detection sensors such as radar; therefore, vision-based methods are considered, which can be divided into stereo-based and mono-based techniques. Mono-based methods are classified into two groups: Foreground-background separation, and brain-inspired methods. Brain-inspired methods are highly efficient in obstacle detection; hence, this research aims to detect obstacles using brain-inspired techniques, which try to enlarge the obstacle by approaching it. A recent research in this field, has concentrated on matching the SIFT points along with, SIFT size-ratio factor and area-ratio of convex hulls in two consecutive frames to detect obstacles. This method is not able to distinguish between near and far obstacles or the obstacles in complex environment, and is sensitive to wrong matched points. In order to solve the above mentioned problems, this research calculates the dist-ratio of matched points. Then, each and every point is investigated for Distinguishing between far and close obstacles. The results demonstrated the high efficiency of the proposed method in complex environments.

Demand and Financial Constraints in Eliminating Architectural and Technical Barriers for People with Disabilities in Poland

PubMed Central

Przybyła, Katarzyna

2018-01-01

The purpose of the study is to analyse the availability of financial resources for people with disabilities and to assess the needs satisfaction level of the disabled in order to eliminate architectural and technical barriers in Poland. The research conducted among the disabled affected by physical disability indicates that mobility barriers and obstacles remain among the most important problems encountered by people with disabilities. The research has shown that the problem of barriers increases with age. The elimination of architectural barriers requires, each time, higher financial expenditure, whereas the elimination of technical barriers improves the life quality of people with disabilities at low financial outlays. The average funding in Poland amounted to PLN 827.53 in 2016, including the funding of EUR 1453.60 for the elimination of architectural barriers and approx. EUR 582 for the removal of technical barriers. The financial resources allocated for this purpose do not cover the actual needs of the people with disabilities. The analysis revealed that the demand for investment in the elimination of barriers is increasing with age, whereas the expenditure of the Polish state is decreasing. PMID:29670742

New frontiers in translational research in neuro-oncology and the blood-brain barrier: report of the tenth annual Blood-Brain Barrier Disruption Consortium Meeting.

PubMed

Doolittle, Nancy D; Abrey, Lauren E; Bleyer, W Archie; Brem, Steven; Davis, Thomas P; Dore-Duffy, Paula; Drewes, Lester R; Hall, Walter A; Hoffman, John M; Korfel, Agnieszka; Martuza, Robert; Muldoon, Leslie L; Peereboom, David; Peterson, Darryl R; Rabkin, Samuel D; Smith, Quentin; Stevens, Glen H J; Neuwelt, Edward A

2005-01-15

The blood-brain barrier (BBB) presents a major obstacle to the treatment of malignant brain tumors and other central nervous system (CNS) diseases. For this reason, a meeting partially funded by an NIH R13 grant was convened to discuss recent advances and future directions in translational research in neuro-oncology and the BBB. Cell biology and transport across the BBB, delivery of agents to the CNS, neuroimaging, angiogenesis, immunotherapy, and gene therapy, as well as glioma, primary CNS lymphoma, and metastases to the CNS were discussed. Transport across the BBB relates to the neurovascular unit, which consists not only of endothelial cells but also of pericyte, glia, and neuronal elements.

Autonomous navigation system and method

DOEpatents

Bruemmer, David J [Idaho Falls, ID; Few, Douglas A [Idaho Falls, ID

2009-09-08

A robot platform includes perceptors, locomotors, and a system controller, which executes instructions for autonomously navigating a robot. The instructions repeat, on each iteration through an event timing loop, the acts of defining an event horizon based on the robot's current velocity, detecting a range to obstacles around the robot, testing for an event horizon intrusion by determining if any range to the obstacles is within the event horizon, and adjusting rotational and translational velocity of the robot accordingly. If the event horizon intrusion occurs, rotational velocity is modified by a proportion of the current rotational velocity reduced by a proportion of the range to the nearest obstacle and translational velocity is modified by a proportion of the range to the nearest obstacle. If no event horizon intrusion occurs, translational velocity is set as a ratio of a speed factor relative to a maximum speed.

Recent progress and perspectives in the photocatalytic CO2 reduction of Ti-oxide-based nanomaterials

NASA Astrophysics Data System (ADS)

Sohn, Youngku; Huang, Weixin; Taghipour, Fariborz

2017-02-01

The conversion of CO2 with H2O to valuable chemicals and fuels is a new solution to current environmental and energy problems, and the high energy barrier of these reactions can be overcome by the input of solar and electrical energy. However, the reduction efficiencies and selectivities of these reactions are insufficient for practical use, and significant effort and strategy are required to overcome the many obstacles preventing the large-scale application of photocatalytic CO2 reduction. This article reviews recent progress in CO2 reduction using titanium oxide-based materials and various strategic factors for increasing photocatalytic efficiency. This article also highlights non-titanium-oxide catalysts, the photoelectrocatalytic reduction of CO2, and other recent review articles concerning the recycling of CO2 to value-added carbon compounds.

The dynamical oscillation and propulsion of magnetic fields in the convective zone of a star. II - Thermal shadows. III - Accumulation of heat and the onset of the Rayleigh-Taylor instability

NASA Technical Reports Server (NTRS)

Parker, E. N.

1987-01-01

The dynamics of thermal shadows which develop in the convective zone of a star around an insulating obstacle such as a horizontal band in intense magnetic field are studied. The depth of the shadow on the cool side of the obstacle is found to depend largely on the width of the obstacle multiplied by the temperature gradient. Thermal shadows pressing fields up to 10,000 G downward against the bottom of the convective zone are produced by the broad bands of the azimuthal field in the sun's convective zone. In the third part, the time-dependent accumulation of heat beneath a thermal barrier simulating such a band in the lower convective zone of the sun is considered. The resulting Rayleigh-Taylor instability is shown to cause tongues of heated gas to penetrate upward through the field, providing the emerging magnetic fields that give rise to the activity of the sun.

Perception of family caregivers about barriers of leisure in care of individuals with chronic psychiatric disorders: a qualitative study

PubMed Central

Mandani, Batool; Hosseini, Mohammad Ali; Noori, Ashraf Karbalaie; Ardakani, Mohammad Reza Khodaie

2018-01-01

Background Family caregivers of individuals with chronic psychiatric disorders play an important role in the management of the patient’s conditions, which interferes with other activities of daily living, work, social and leisure activities. Objective This study was conducted in an Iranian context to explore the perception of family caregivers about barriers of leisure in care of individuals with chronic psychiatric disorders. Methods The current qualitative study was conducted on the basis of conventional content analysis. Participants were 15 family caregivers of individuals with chronic psychiatric disorders who were selected by Purposeful sampling method between July 2016 and March 2017 in Tehran, Iran. The data was collected via in-depth semi-structured interviews. The interviews were tape recorded, written and transcribed. Then, data were analyzed by inductive content analysis method. Results Data analysis led to extraction of 3 main categories and 10 sub categories. Obstacles to leisure-time of family caregivers have been placed in three main categories which are patient-related factors (Resentment from psychological problems, Resentment from behavioral problems, Need for continuous monitoring and access), caregiver-related factors (Physical harm, Psychosocial harm, Temporal stress, Accumulation of responsibilities, Concerns), and community-related factors (Feeling of sympathy and rejection, Social stigma). Conclusion Understanding the barriers of leisure in this group of family caregivers has contributed to understanding the family caregivers’ perception in this area and regarding their leisure, it can provide a broader perspective to mental health therapists, rehabilitation managers and policy makers for understanding the needs, addressing the challenges and barriers of this group of family caregivers. PMID:29765577

Perception of family caregivers about barriers of leisure in care of individuals with chronic psychiatric disorders: a qualitative study.

PubMed

Mandani, Batool; Hosseini, Seyed Ali; Hosseini, Mohammad Ali; Noori, Ashraf Karbalaie; Ardakani, Mohammad Reza Khodaie

2018-03-01

Family caregivers of individuals with chronic psychiatric disorders play an important role in the management of the patient's conditions, which interferes with other activities of daily living, work, social and leisure activities. This study was conducted in an Iranian context to explore the perception of family caregivers about barriers of leisure in care of individuals with chronic psychiatric disorders. The current qualitative study was conducted on the basis of conventional content analysis. Participants were 15 family caregivers of individuals with chronic psychiatric disorders who were selected by Purposeful sampling method between July 2016 and March 2017 in Tehran, Iran. The data was collected via in-depth semi-structured interviews. The interviews were tape recorded, written and transcribed. Then, data were analyzed by inductive content analysis method. Data analysis led to extraction of 3 main categories and 10 sub categories. Obstacles to leisure-time of family caregivers have been placed in three main categories which are patient-related factors (Resentment from psychological problems, Resentment from behavioral problems, Need for continuous monitoring and access), caregiver-related factors (Physical harm, Psychosocial harm, Temporal stress, Accumulation of responsibilities, Concerns), and community-related factors (Feeling of sympathy and rejection, Social stigma). Understanding the barriers of leisure in this group of family caregivers has contributed to understanding the family caregivers' perception in this area and regarding their leisure, it can provide a broader perspective to mental health therapists, rehabilitation managers and policy makers for understanding the needs, addressing the challenges and barriers of this group of family caregivers.

Tracked robot controllers for climbing obstacles autonomously

NASA Astrophysics Data System (ADS)

Vincent, Isabelle

2009-05-01

Research in mobile robot navigation has demonstrated some success in navigating flat indoor environments while avoiding obstacles. However, the challenge of analyzing complex environments to climb obstacles autonomously has had very little success due to the complexity of the task. Unmanned ground vehicles currently exhibit simple autonomous behaviours compared to the human ability to move in the world. This paper presents the control algorithms designed for a tracked mobile robot to autonomously climb obstacles by varying its tracks configuration. Two control algorithms are proposed to solve the autonomous locomotion problem for climbing obstacles. First, a reactive controller evaluates the appropriate geometric configuration based on terrain and vehicle geometric considerations. Then, a reinforcement learning algorithm finds alternative solutions when the reactive controller gets stuck while climbing an obstacle. The methodology combines reactivity to learning. The controllers have been demonstrated in box and stair climbing simulations. The experiments illustrate the effectiveness of the proposed approach for crossing obstacles.

Telemedicine: the invisible legal barriers to the health care of the future.

PubMed

Daly, H L

2000-01-01

Telemedicine has the potential to transform the world of health care just as the Internet transformed the world of commerce. Ms. Daly examines two legal obstacles to expanding the use of telemedicine: licensure and liability. She defines telemedicine and discusses its common applications and significant benefits. Licensure laws and liability rules result in formidable barriers to the expanded use of telemedicine, while also failing to provide sufficient protection for consumers. Ms. Daly argues that for the benefits of telemedicine to reach those most in need, mutual recognition of licensing laws coupled with a universal standard of care is necessary.

Polycation-based gene therapy: current knowledge and new perspectives.

PubMed

Tiera, Marcio J; Shi, Qin; Winnik, Françoise M; Fernandes, Julio C

2011-08-01

At present, gene transfection insufficient efficiency is a major drawback of non-viral gene therapy. The 2 main types of delivery systems deployed in gene therapy are based on viral or non-viral gene carriers. Several non-viral modalities can transfer foreign genetic material into the human body. To do so, polycation-based gene delivery methods must achieve sufficient efficiency in the transportation of therapeutic genes across various extracellular and intracellular barriers. These barriers include interactions with blood components, vascular endothelial cells and uptake by the reticuloendothelial system. Furthermore, the degradation of therapeutic DNA by serum nucleases is a potential obstacle for functional delivery to target cells. Cationic polymers constitute one of the most promising approaches to the use of viral vectors for gene therapy. A better understanding of the mechanisms by which DNA can escape from endosomes and traffic to enter the nucleus has triggered new strategies of synthesis and has revitalized research into new polycation-based systems. The objective of this review is to address the state of the art in gene therapy with synthetic and natural polycations and the latest advances to improve gene transfer efficiency in cells.

Bioavailability and transport of peptides and peptide drugs into the brain.

PubMed

Egleton, R D; Davis, T P

1997-01-01

Rational drug design and the targeting of specific organs has become a reality in modern drug development, with the emergence of molecular biology and receptor chemistry as powerful tools for the pharmacologist. A greater understanding of peptide function as one of the major extracellular message systems has made neuropeptides an important target in neuropharmaceutical drug design. The major obstacle to targeting the brain with therapeutics is the presence of the blood-brain barrier (BBB), which controls the concentration and entry of solutes into the central nervous system. Peptides are generally polar in nature, do not easily cross the blood-brain barrier by diffusion, and except for a small number do not have specific transport systems. Peptides can also undergo metabolic deactivation by peptidases of the blood, brain and the endothelial cells that comprise the BBB. In this review, we discuss a number of the recent strategies which have been used to promote peptide stability and peptide entry into the brain. In addition, we approach the subject of targeting specific transport systems that can be found on the brain endothelial cells, and describe the limitations of the methodologies that are currently used to study brain entry of neuropharmaceuticals.

Barriers to the Entry of Biofield Healing Into “Mainstream” Healthcare

PubMed Central

Sprengel, Meredith; Ives, John A.; Jonas, Wayne

2015-01-01

In this article, we describe barriers to the entry of biofield healing into mainstream contemporary science and clinical practice. We focus on obstacles that arise from the social nature of the scientific enterprise, an aspect of science highlighted by the influential work of Thomas Kuhn (1922-1996), one of the most important— and controversial—philosophers of science in the 20th century. Kuhn analyzed science and its revolutionary changes in terms of the dynamics within scientific communities. Kuhn's approach helps us understand unconventional medical theories and practices such as biofield healing. For many years, these were called “complementary and alternative medicine” (CAM). However, because most people use nonmainstream approaches in conjunction with conventional treatments, the National Institutes of Health and many practitioners now prefer “Complementary and Integrative Medicine” (CIM) where integrative implies “bringing conventional and complementary approaches together in a coordinated way.”1 Biofield healing fits the integrative model well, provides a novel approach to therapeutic intervention, and is developing in a manner that can integrate with current medical science in simple ways. Yet, it still remains outside the conventional framework because of its conceptual bases, which contrast sharply with conventional assumptions regarding the nature of reality. PMID:26665046

Discussing Ethical Issues in the Classroom: Leveraging Pedagogical Moments that May Otherwise Undermine Important Discussions

ERIC Educational Resources Information Center

Simpson, Douglas J.; Hull, William J., Jr.

2011-01-01

The authors identify, examine, and clarify three kinds of hindrances (dismissive/evasive tactics, logical stoppers, and ad hominem arguments) to teaching about ethical issues in P-12 schools. In discussing these three types of obstacles, they stress that the barriers themselves provide both challenges and opportunities for teachers. Indeed, they…

The Broadband Quandary for Rural America. The Main Street Economist: Commentary on the Rural Economy.

ERIC Educational Resources Information Center

Staihr, Brian

High speed data services known as broadband have the potential to make rural areas less isolated and improve the rural quality of life, but physical barriers, sparse population density, and few markets present significant obstacles to their deployment in rural areas. Broadband applications such as e-commerce, distance education, and telemedicine…

Academic Bullying: A Barrier to Tenure and Promotion for African-American Faculty

ERIC Educational Resources Information Center

Frazier, Kimberly N.

2011-01-01

The author discusses the problem of retention of African American faculty due to tenure and promotion issues. The author outlines obstacles that African American face in the workplace while seeking tenure and promotion in academia. A case example is presented that illuminates how these stressors manifest in the academic setting and recommendations…

Effects of a Culturally Relevant Educational Intervention on Retention among American Indian Tribal College Students

ERIC Educational Resources Information Center

Keith, Jill F.; Stastny, Sherri; Agnew, Wanda; Brunt, Adrith

2017-01-01

American Indian and Alaska Native students experience the lowest rates of college retention and graduation at four-year institutions in the United States. They often face a variety of barriers to completing their education that may be similar to other ethnic groups while also overcoming obstacles that are culturally specific. However, AIAN…

How to Develop Children as Researchers: A Step-by-Step Guide to Teaching the Research Process

ERIC Educational Resources Information Center

Kellett, Mary

2005-01-01

The importance of research in professional and personal development is increasingly being acknowledged. So why should children not benefit in a similar way? Traditionally, children have been excluded from this learning process because research methodology is considered too difficult for them. Principal obstacles focus around three key barriers:…

A Review of Research Literature on Obstacles That Prevent Use of ICT in Pre-Service Teachers' Educational Courses

ERIC Educational Resources Information Center

Mirzajani, Hassan; Mahmud, Rosnaini; Ayub, Ahmad Fauzi Mohd; Luan, Wong Su

2015-01-01

In spite of growing amount of technologies, tools and information communication and technology (ICT) by providing pre-service teacher education courses, pre-service teachers' ICT utilization is not still as predicted. Research shows many barriers influencing pre-service teachers' utilization of ICT. Many researchers have identified a number of…

Strategies to Enhance Student Success: A Discourse Analysis of Academic Advice in International Student Handbooks

ERIC Educational Resources Information Center

Romerhausen, Nick J.

2013-01-01

As the population of international students continues to rise at U.S. colleges and universities, multiple academic obstacles pose barriers to success. Research on strategies of intervention has primarily included face-to-face interactions while an exploration of other assistance approaches is minimal in comparison. This study explored the role…

Melting the Plastic Ceiling: Overcoming Obstacles to Foster Leadership in Women Plastic Surgeons.

PubMed

Silva, Amanda K; Preminger, Aviva; Slezak, Sheri; Phillips, Linda G; Johnson, Debra J

2016-09-01

The underrepresentation of women leaders in plastic surgery echoes a phenomenon throughout society. The importance of female leadership is presented, and barriers to gender equality in plastic surgery, both intrinsic and extrinsic, are discussed. Strategies for fostering women in leadership on an individual level and for the specialty of plastic surgery are presented.

First-Generation Female College Students' Financial Literacy: Real and Perceived Barriers to Degree Completion

ERIC Educational Resources Information Center

Eitel, Susan J.; Martin, Jennifer

2009-01-01

First-generation female college students (FGFCS) make up a large portion of the diversity in higher education. Unfortunately "access" to education does not translate to success. Persistence and degree completion for these students is often undermined by seemingly insurmountable obstacles. The purposes of this study were to identify the financial…

Iraqi Prisoners in Norway: Educational Background, Participation, Preferences and Barriers to Education

ERIC Educational Resources Information Center

Westrheim, Kariane; Manger, Terje

2014-01-01

The article aimed to develop knowledge of the educational background, participation and preferences of Iraqi prisoners in Norwegian prisons and obstacles to participating in education. The study is based on interviews with 17 prisoners in three prisons. An important finding is that war and political unrest appear to have been significant causes…

START! The Successful Transitions and Retention Track Program: A Comprehensive Approach to Supporting GED Holders Entering College

ERIC Educational Resources Information Center

Nix, J. Vincent; Michalak, Megan B.

2012-01-01

Students entering college face many obstacles to success. Students who received a General Education Development (GED) face additional barriers that must be addressed in order for success in higher education. The Successful Transitions and Retention Track Program employs a holistic approach to addressing the needs of GED holders entering college.

Barriers and Facilitators to Deaf Trauma Survivors' Help-Seeking Behavior: Lessons for Behavioral Clinical Trials Research

ERIC Educational Resources Information Center

Anderson, Melissa L.; Wolf Craig, Kelly S.; Ziedonis, Douglas M.

2017-01-01

Deaf individuals experience significant obstacles to participating in behavioral health research when careful consideration is not given to accessibility during the design of study methodology. To inform such considerations, we conducted an exploratory secondary analysis of a mixed-methods study that originally explored 16 Deaf trauma survivors'…

Supporting Parents and Children Where They Live: Improving Federal and State Policy for Home Visiting

ERIC Educational Resources Information Center

DiLauro, Elizabeth

2010-01-01

As part of a comprehensive system of support for families with young children, home visiting programs help to ensure that families facing obstacles--such as those caused by stress, language barriers, geographic and social isolation, and poverty--receive the support they need to nurture their child's healthy development. Efforts to support home…

Female Education as a Determinant of Economic Growth: The Case Study of Pakistan

ERIC Educational Resources Information Center

Fatima, Goher

2011-01-01

The contribution of female education has been very important in the GDP growth of the country, but this very sector has been ignored by the Government. This paper focuses on the importance of female education and highlights its significance for national development. It also brings out some impediments, obstacles and barriers confronting female…

Math Avoidance: A Barrier to American Indian Science Education and Science Careers.

ERIC Educational Resources Information Center

Green, Rayna

1978-01-01

For American Indian students, math anxiety and math avoidance are the most serious obstacles to general education and to the choice of scientific careers. Indian students interviewed generally exhibited fear and loathing of mathematics and a major lack of basic skills which were caused by a missing or negative impression of the mathematics…

Women Being Coached to Advance Their Careers to Positions of Power and Influence: A Narrative Inquiry

ERIC Educational Resources Information Center

Theune, Doris P.

2010-01-01

This study presents the discipline of executive coaching as a form of contemporary adult education informed by transformative learning theory appropriate for the education, support, and empowerment of adult women seeking to identify, understand, and break through the obstacles and barriers to career advancement to achieve positions of power and…

An In-Depth Analysis of Exemplary Female Superintendents: A Qualitative Inquiry

ERIC Educational Resources Information Center

Kay, Patricia L.

2012-01-01

The number of women who serve as public school district superintendents is inversely proportionate to the number of women who work in public schools. Men continue to dominate the occupancy of this position. Barriers that women encounter in their career journey and obstacles faced by women who serve in the role of superintendent have been…

Beyond Obstacles and Problems: Women Principals in Spain Leading Change in Their Schools

ERIC Educational Resources Information Center

Coronel, Jose M.; Moreno, Emilia; Carrasco, Maria J.

2010-01-01

In Spain, the presence of women in decision-making positions and in positions of power is not proportional to the total number of women within the field of education. Women have encountered personal and professional barriers in their advancement to the principalship; however, significant and substantive changes to school policy are revealed when…

Moving Forward: Early Findings from the Performance-Based Scholarship Demonstration in Arizona. The Performance-Based Scholarship Demonstration

ERIC Educational Resources Information Center

Patel, Reshma; Valenzuela, Ireri

2013-01-01

While postsecondary completion rates are a concern among many student populations across the country, college graduation rates for Latino students, especially Latino male students, are even lower than the national average. Low-income Latino men face many barriers to postsecondary success, including both financial and personal obstacles. This…

Principals' Approaches to Cultivating Teacher Effectiveness: Constraints and Opportunities in Hiring, Assigning, Evaluating, and Developing Teachers

ERIC Educational Resources Information Center

Donaldson, Morgaen L.

2013-01-01

Purpose: How principals hire, assign, evaluate, and provide growth opportunities to teachers likely have major ramifications for teacher effectiveness and student learning. This article reports on the barriers principals encountered when carrying out these functions and variations in the degree to which they identified obstacles and problem-solved…

The Need to Practice What We Teach: The Sticky Floor Effect in Colleges of Business in Southern U.S. Universities

ERIC Educational Resources Information Center

Johnson, Cooper; Long, Jamye; Faught, Sam

2014-01-01

The Sticky Floor Effect, a relatively new career advancement barrier concept, theorizes there exist obstacles for women preventing them from advancing to first level management positions. Of significant importance to institutions of higher learning's colleges of business, the Sticky Floor Effect highlights issues of consistency, moral…

Virtual obstacle crossing: Reliability and differences in stroke survivors who prospectively experienced falls or no falls.

PubMed

Punt, Michiel; Bruijn, Sjoerd M; Wittink, Harriet; van de Port, Ingrid G; Wubbels, Gijs; van Dieën, Jaap H

2017-10-01

Stroke survivors often fall during walking. To reduce fall risk, gait testing and training with avoidance of virtual obstacles is gaining popularity. However, it is unknown whether and how virtual obstacle crossing is associated with fall risk. The present study assessed whether obstacle crossing characteristics are reliable and assessed differences in stroke survivors who prospectively experienced falls or no falls. We recruited twenty-nine community dwelling chronic stroke survivors. Participants crossed five virtual obstacles with increasing lengths. After a break, the test was repeated to assess test-retest reliability. For each obstacle length and trial, we determined; success rate, leading limb preference, pre and post obstacle distance, margins of stability, toe clearance, and crossing step length and speed. Subsequently, fall incidence was monitored using a fall calendar and monthly phone calls over a six-month period. Test-retest reliability was poor, but improved with increasing obstacle-length. Twelve participants reported at least one fall. No association of fall incidence with any of the obstacle crossing characteristics was found. Given the absence of height of the virtual obstacles, obstacle avoidance may have been relatively easy, allowing participants to cross obstacles in multiple ways, increasing variability of crossing characteristics and reducing the association with fall risk. These finding cast some doubt on current protocols for testing and training of obstacle avoidance in stroke rehabilitation. Copyright © 2017 Elsevier B.V. All rights reserved.

Development and Validation of the Elder Learning Barriers Scale Among Older Chinese Adults.

PubMed

Wang, Renfeng; De Donder, Liesbeth; De Backer, Free; He, Tao; Van Regenmortel, Sofie; Li, Shihua; Lombaerts, Koen

2017-12-01

This study describes the development and validation of the Elder Learning Barriers (ELB) scale, which seeks to identify the obstacles that affect the level of educational participation of older adults. The process of item pool design and scale development is presented, as well as the testing and scale refinement procedure. The data were collected from a sample of 579 older Chinese adults (aged over 55) in the Xi'an region of China. After randomly splitting the sample for cross-validation purposes, the construct validity of the ELB scale was confirmed containing five dimensions: dispositional, informational, physical, situational, and institutional barriers. Furthermore, developmental differences in factor structure have been examined among older age groups. The results indicated that the scale demonstrated good reliability and validity. We conclude in general that the ELB scale appears to be a valuable instrument for examining the learning barriers that older Chinese citizens experience for participating in organized educational activities.

Barriers to the use of genetic information for the development of new epilepsy treatments.

PubMed

Ferraro, Thomas N

2016-01-01

Genetic analysis is providing new information on the biological basis of epilepsy at a rapid pace; this article identifies factors acting as major barriers to use of these data for therapy development. Disease heterogeneity is a primary obstacle since so many genes can cause or predispose to epilepsy and the clinical presentation of epilepsy is so diverse, thus making it difficult to define the most therapeutically relevant targets. Further, many epilepsy genes affect brain development, an observation that represents a barrier unto itself given the challenge of reversing or preventing genetically mediated alterations of brain pathway formation. Finally, the lack of appropriate models for testing new therapies is also recognized as a fundamental limitation. Overcoming these barriers will be aided by full characterization of the genetic landscape of epilepsy, elucidation of key pathway points for therapeutic intervention and creation of unique experimental models to validate results.

Barriers to genuine consumer and carer participation from the perspectives of Australian systemic mental health advocates.

PubMed

Gee, Alison; McGarty, Craig; Banfield, Michelle

2016-06-01

Consumer and carer participation in mental health service development and evaluation has widespread nominal support. However, genuine and consistent participation remains elusive due to systemic barriers. This paper explores barriers to reform for mental health services from the perspectives of consumers and carers actively engaged in advocating for improvements in the mental health system. Qualitative research with two mental health systemic advocacy organisations analysed 17 strategic communication documents and nine interviews to examine barriers to reform and participation identified by consumer and carer advocates and staff. A number of individual-level barriers were described, however advocates gave more focus to systemic barriers, for which five themes emerged. These reflected lack of awareness, limited participation opportunities, slow progress for change, policy issues and mental health culture including stigma. Findings highlight systemic barriers to participation for consumer and carer advocates as a whole and the influence of these barriers on the individual experiences of those engaged in advocacy and representation work. Participants also emphasised the need for leadership to overcome some of these obstacles and move towards genuine consumer and carer participation and reform. Findings are discussed in the context of power within mental health systems.

Barriers to and Facilitators of Antiretroviral Therapy Adherence in Nepal: A Qualitative Study

PubMed Central

Simkhada, Padam; Randall, Julian; Freeman, Jennifer V; van Teijlingen, Edwin

2012-01-01

Patient's adherence is crucial to get the best out of antiretroviral therapy (ART). This study explores in-depth the barriers to and facilitators of ART adherence among Nepalese patients and service providers prescribing ART. Face-to-face semi-structured interviews were conducted with 34 participants. Interviews were audio-taped, transcribed, and translated into English before being analyzed thematically. ART-prescribed patients described a range of barriers for failing to adhere to ART. Financial difficulties, access to healthcare services, frequent transport blockades, religious/ritual obstacles, stigma and discrimination, and side-effects were the most-frequently discussed barriers whereas trustworthy health workers, perceived health benefits, and family support were the most-reported facilitators. Understanding barriers and facilitators can help in the design of an appropriate and targeted intervention. Healthcare providers should address some of the practical and cultural issues around ART whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients. PMID:23304907

Barriers to and facilitators of HIV-positive patients' adherence to antiretroviral treatment regimens.

PubMed

Roberts, K J

2000-03-01

HIV-positive patients must strictly adhere to antiretroviral regimens for the medications to work properly. Little, however, is known about the obstacles that patients face in adhering to the regimens or what, if anything, helps patients to adhere. The goals of the project were to describe, from HIV-positive patients' own perspectives, the barriers they face in adhering to antiretroviral regimens and the strategies they use to maximize their adherence. Five main barriers (forgetfulness, social/physical environment, complexity of the regimens, medication side effects, and inadequate patient knowledge) to adherence and six main facilitators (mechanical devices, "making a commitment," "routinizing," health beliefs, social support, and professional support) emerged from the data. Patients may overcome some of these barriers by receiving better health education about the need for adherence, professional and lay support for their efforts, and mechanical devices such as alarm clocks and medi-sets. Other barriers, however, such as the complexity of the medications, highlight the need for simplified antiretroviral regimens.

Paving the Way to Successful Implementation: Identifying Key Barriers to Use of Technology-Based Therapeutic Tools for Behavioral Health Care.

PubMed

Ramsey, Alex; Lord, Sarah; Torrey, John; Marsch, Lisa; Lardiere, Michael

2016-01-01

This study aimed to identify barriers to use of technology for behavioral health care from the perspective of care decision makers at community behavioral health organizations. As part of a larger survey of technology readiness, 260 care decision makers completed an open-ended question about perceived barriers to use of technology. Using the Consolidated Framework for Implementation Research (CFIR), qualitative analyses yielded barrier themes related to characteristics of technology (e.g., cost and privacy), potential end users (e.g., technology literacy and attitudes about technology), organization structure and climate (e.g., budget and infrastructure), and factors external to organizations (e.g., broadband accessibility and reimbursement policies). Number of reported barriers was higher among respondents representing agencies with lower annual budgets and smaller client bases relative to higher budget, larger clientele organizations. Individual barriers were differentially associated with budget, size of client base, and geographic location. Results are discussed in light of implementation science frameworks and proactive strategies to address perceived obstacles to adoption and use of technology-based behavioral health tools.

Paving the Way to Successful Implementation: Identifying Key Barriers to Use of Technology-Based Therapeutic Tools for Behavioral Health Care

PubMed Central

Ramsey, Alex; Lord, Sarah; Torrey, John; Marsch, Lisa; Lardiere, Michael

2014-01-01

This study aimed to identify barriers to use of technology for behavioral health care from the perspective of care decision-makers at community behavioral health organizations. As part of a larger survey of technology readiness, 260 care decision-makers completed an open-ended question about perceived barriers to use of technology. Using the Consolidated Framework for Implementation Research (CFIR), qualitative analyses yielded barrier themes related to characteristics of technology (e.g., cost, privacy), potential end-users (e.g., technology literacy, attitudes about technology), organization structure and climate (e.g., budget, infrastructure), and factors external to organizations (e.g., broadband accessibility, reimbursement policies). Number of reported barriers was higher among respondents representing agencies with lower annual budgets and smaller client bases relative to higher budget, larger clientele organizations. Individual barriers were differentially associated with budget, size of client base, and geographic location. Results are discussed in light of implementation science frameworks and proactive strategies to address perceived obstacles to adoption and use of technology-based behavioral health tools. PMID:25192755

Overcoming barriers to the use of osteopathic manipulation techniques in the emergency department.

PubMed

Roberge, Raymond J; Roberge, Marc R

2009-08-01

Osteopathic Manipulation Techniques (OMT) have been shown to be effective therapeutic modalities in various clinical settings, but appear to be underutilized in the emergency department (ED) setting. To examine barriers to the use of OMT in the ED and provide suggestions to ameliorate these barriers. Literature review While the medical literature cites numerous obstacles to the use of OMT in the ED setting, most can be positively addressed through education, careful planning, and ongoing research into use of these techniques. Recent prospective clinical trials of OMT have demonstrated the utility of these modalities. Osteopathic Manipulation Techniques are useful therapeutic modalities that could be utilized to a greater degree in the ED. As the number of osteopathic emergency physicians increases, the opportunity to employ these techniques should increase.

Educating patients: understanding barriers, learning styles, and teaching techniques.

PubMed

Beagley, Linda

2011-10-01

Health care delivery and education has become a challenge for providers. Nurses and other professionals are challenged daily to assure that the patient has the necessary information to make informed decisions. Patients and their families are given a multitude of information about their health and commonly must make important decisions from these facts. Obstacles that prevent easy delivery of health care information include literacy, culture, language, and physiological barriers. It is up to the nurse to assess and evaluate the patient's learning needs and readiness to learn because everyone learns differently. This article will examine how each of these barriers impact care delivery along with teaching and learning strategies will be examined. Copyright © 2011 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

Blood brain barrier: a challenge for effectual therapy of brain tumors.

PubMed

Bhowmik, Arijit; Khan, Rajni; Ghosh, Mrinal Kanti

2015-01-01

Brain tumors are one of the most formidable diseases of mankind. They have only a fair to poor prognosis and high relapse rate. One of the major causes of extreme difficulty in brain tumor treatment is the presence of blood brain barrier (BBB). BBB comprises different molecular components and transport systems, which in turn create efflux machinery or hindrance for the entry of several drugs in brain. Thus, along with the conventional techniques, successful modification of drug delivery and novel therapeutic strategies are needed to overcome this obstacle for treatment of brain tumors. In this review, we have elucidated some critical insights into the composition and function of BBB and along with it we have discussed the effective methods for delivery of drugs to the brain and therapeutic strategies overcoming the barrier.

Giving blood and enrolling on the stem cell donor registry: ranking of obstacles and motives in Switzerland.

PubMed

Bart, Thomas; Volken, Thomas; Fischer, Yvonne; Taleghani, Behrouz Mansouri

2014-07-01

To obtain a better understanding of factors affecting blood and blood stem cell donation behavior in Switzerland, a series of studies has been performed. In the recent study of this series, which is described here, motivators and barriers in the field of blood and blood stem cell donation were identified. Web-based survey data from a non-random sample of the Swiss population 2012/2013 (n = 3,153) were used to describe and compare the ranking of motives and obstacles to donate blood and to enroll on the Swiss blood stem cell registry. Wilcoxon rank-sum test and Spearman's rank correlations were used to assess differences and associations between ranks and groups. The prospect of saving lives and solidarity were the top two motives to donate blood or to enroll on the blood stem cell registry. The top two obstacles to enroll on the blood stem cell registry were lack of general information on blood stem cell donation and on its risks, whereas the top two obstacles to donate blood were the lack of information where and when to donate and deferral of or exclusion from blood donation. Classical altruistic motives are top drivers for giving blood as well as registering for blood stem cell donation. Recruitment campaigns should focus on these motivators. Similarities in motivational factors as well as in obstacles regarding blood and blood stem cell donation can be found.

Provision of magnetic resonance imaging for patients with 'MR-conditional' cardiac implantable electronic devices: an unmet clinical need.

PubMed

Sabzevari, Kian; Oldman, James; Herrey, Anna S; Moon, James C; Kydd, Anna C; Manisty, Charlotte

2017-03-01

Increasing need for magnetic resonance imaging (MRI) has driven the development of MR-conditional cardiac implantable electronic devices (CIEDs; pacemakers and defibrillators); however, patients still report difficulties obtaining scans. We sought to establish current provision for MRI scanning of patients with CIEDs in England. A survey was distributed to all hospitals in England with MRI, to assess current practice. Information requested included whether hospitals currently offer MRI to this patient group, the number and type of scans acquired, local safety considerations, complications experienced and perceived obstacles to service provision in those departments not currently offering it. Responses were received from 195 of 227 (86%) of hospitals surveyed. Although 98% of departments were aware of MR-conditional devices, only 46% (n = 89) currently offer MRI scans to patients with CIED's; of these, 85% of departments perform ≤10 scans per year. No major complications were reported from MRI scanning in patients with MR-conditional devices. Current barriers to service expansion include perceived concerns regarding potential risk, lack of training, logistical difficulties, and lack of cardiology support. Provision of MRI for patients with CIEDs is currently poor, despite increasing numbers of patients with MR-conditional devices and extremely low reported complication rates. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review.

PubMed

Hansotte, Elinor; Payne, Shirley I; Babich, Suzanne M

2017-01-01

Left undiagnosed and/or untreated, the short-and long-term sequelae of postpartum depression may negatively impact both mother and child. In Western countries, access to mental health care is influenced by socioeconomic factors. The objective of this systematic literature review is to compile factors that hinder and improve access to postpartum depression treatment in low-income women after a positive screen for postpartum depression. The key question of focus is: what are the characteristics associated with access to mental health treatment for low-income women with a positive postpartum depression screen in Western countries? A PRISMA-based systematic literature review was conducted of studies published in English before February 2016 that looked at treatment for postpartum depression in low-income women who had been identified with the condition. PubMed and EBSCO databases were searched using MESH and key terms and found 100 articles that met the selection criteria. After review by two independent researchers, 18 studies with 17 unique populations were included in the literature review. Two independent abstractors searched the included articles for themes surrounding impediments and advantages for low-income women identified with postpartum depression in obtaining mental health treatment. Characteristics of successful mental health treatment included studies that employed the use of a home visitor and those that separated outcomes for women with previous mental health treatment. Themes that emerged as treatment obstacles included cultural barriers, physical barriers, systemic health care barriers, and social barriers. This review will help to better inform screening and treatment priorities for those in the medical field who may encounter women experiencing postpartum depression and are not aware of the various barriers to care specific to low-income women. This review will also help policymakers identify specific obstacles that are not addressed in postpartum screening mandate policies which can affect the implementation of these policies.

Feeling the force: how pollen tubes deal with obstacles.

PubMed

Burri, Jan T; Vogler, Hannes; Läubli, Nino F; Hu, Chengzhi; Grossniklaus, Ueli; Nelson, Bradley J

2018-06-15

Physical forces are involved in the regulation of plant development and morphogenesis by translating mechanical stress into the modification of physiological processes, which, in turn, can affect cellular growth. Pollen tubes respond rapidly to external stimuli and provide an ideal system to study the effect of mechanical cues at the single-cell level. Here, pollen tubes were exposed to mechanical stress while monitoring the reconfiguration of their growth and recording the generated forces in real-time. We combined a lab-on-a-chip device with a microelectromechanical systems (MEMS)-based capacitive force sensor to mimic and quantify the forces that are involved in pollen tube navigation upon confronting mechanical obstacles. Several stages of obstacle avoidance were identified, including force perception, growth adjustment and penetration. We have experimentally determined the perceptive force threshold, which is the force threshold at which the pollen tube reacts to an obstacle, for Lilium longiflorum and Arabidopsis thaliana. In addition, the method we developed provides a way to calculate turgor pressure based on force and optical data. Pollen tubes sense physical barriers and actively adjust their growth behavior to overcome them. Furthermore, our system offers an ideal platform to investigate intracellular activity during force perception and growth adaption in tip growing cells. © 2018 The Authors. New Phytologist © 2018 New Phytologist Trust.

The politics of paying for health reform: zombies, payroll taxes, and the holy grail.

PubMed

Oberlander, Jonathan

2008-01-01

This paper analyzes the politics of paying for health care reform. It surveys the political strengths and weaknesses of major options to fund universal coverage and explores obstacles to changing how the United States finances health care. Finding a politically viable means to finance universal coverage remains a central barrier to enacting health reform.

Improving Cultural Competency and Disease Awareness among Oncology Nurses Caring for Adult T-Cell Leukemia and Lymphoma Patients

ERIC Educational Resources Information Center

Cortese-Peske, Marisa A.

2013-01-01

Foreign-born residents face significant challenges accessing and receiving quality healthcare in the U.S. These obstacles include a lack of information on how to access care, fear, as well as communication and cultural barriers (Portes, Fernandez-Kelly & Light, 2012). Increasing healthcare providers' knowledge regarding a patient's…

Potential adoption of agroforestry riparian buffers based on landowner and streamside characteristics

Treesearch

K.E. Trozzo; J.F. Munsell; J.L. Chamberlain; W.M. Aust

2014-01-01

Riparian forest buffers provide numerous environmental benefits, yet obstacles to landowner adoption are many. One barrier is the perception that riparian forest buffers are used for conservation at the expense of production. We present a study that focused on why landowners are more or less inclined to adopt native fruit and nut tree agroforestry riparian buffers that...

Minding the Gap: Tapping the Potential of Women to Transform Business. GMAC® Research Report RR-16-01

ERIC Educational Resources Information Center

Bruggeman, Paula; Chan, Hillary

2016-01-01

This white paper, highlights the advancement of women in the workplace, in higher education, and in graduate business education, in particular, and discusses the barriers and obstacles that impede women from progressing to the top levels of business leadership. It offers some thoughts on how changing the gender dynamics in businesses and in…

Japanese Language as an Organizational Barrier for International Students to Access to University Services: A Case of Aoyama Gakuin University

ERIC Educational Resources Information Center

Hiratsuka, Hiroyoshi

2016-01-01

In 2011, Aoyama Gakuin University (AGU) started a government-funded degree program (taught in English) to accept international students with limited or no Japanese language proficiency. However, the students faced obstacles in accessing all of the university resources provided. In this article, I investigated Japanese language as an organizational…

Lack of Follow-Up Exams after Failed School Vision Screenings: An Investigation of Contributing Factors

ERIC Educational Resources Information Center

Kimel, Linda S.

2006-01-01

Programs to facilitate professional eye exams after failed school vision screenings often are based on the assumption that funding and access to services are major obstacles to care. Despite such programs, many children do not receive professional exams. The purpose of this study was to identify additional barriers to follow-up eye care. School…

The Transcendent Teacher-Learner Relationship: A Class Investigation

ERIC Educational Resources Information Center

O'Hara, Hunter

2005-01-01

As children's challenges and needs climb at an alarming rate, teachers are called to a new pedagogy, called to move beyond the barriers of the past. Moreover, to meet the needs of all learners effectively, teachers must relate to children in new ways that transcend the obstacles that have long stood in the way of meaningful learning. All children,…

Importance and promotion of linguistic safety in the healthcare setting.

PubMed

Diaz, Desiree A; Allchin, Lynn

2013-08-01

The United States has always been and will continue to be a nation of many cultures and languages. In the healthcare arena, this means safety will depend on clear, linguistically appropriate communication between the patient and family and the healthcare provider. Three obstacles exist to this type of essential communication: limited English proficiency, low health literacy, and cultural barriers.

Induced vibrations facilitate traversal of cluttered obstacles

NASA Astrophysics Data System (ADS)

Thoms, George; Yu, Siyuan; Kang, Yucheng; Li, Chen

When negotiating cluttered terrains such as grass-like beams, cockroaches and legged robots with rounded body shapes most often rolled their bodies to traverse narrow gaps between beams. Recent locomotion energy landscape modeling suggests that this locomotor pathway overcomes the lowest potential energy barriers. Here, we tested the hypothesis that body vibrations induced by intermittent leg-ground contact facilitate obstacle traversal by allowing exploration of locomotion energy landscape to find this lowest barrier pathway. To mimic a cockroach / legged robot pushing against two adjacent blades of grass, we developed an automated robotic system to move an ellipsoidal body into two adjacent beams, and varied body vibrations by controlling an oscillation actuator. A novel gyroscope mechanism allowed the body to freely rotate in response to interaction with the beams, and an IMU and cameras recorded the motion of the body and beams. We discovered that body vibrations facilitated body rolling, significantly increasing traversal probability and reducing traversal time (P <0.0001, ANOVA). Traversal probability increased with and traversal time decreased with beam separation. These results confirmed our hypothesis and support the plausibility of locomotion energy landscapes for understanding the formation of locomotor pathways in complex 3-D terrains.

Three Dimensional Guidance for the NPS Autonomous Underwater Vehicle

DTIC Science & Technology

1991-09-01

is loaded into a least-squares-fit algorithm to determine surfaces of polyhedrons . These computed surfaces are then compared with the known...the obstacle information stored in the vehicle’s environmental database , there is great potential of encountering unplanned for obstacles during the... database that holds current posture information recorded by the navigator. This data store receives a new current posture on each cycle of the control

The opportunities for and obstacles against prevention: the example of Germany in the areas of tobacco and alcohol

PubMed Central

2010-01-01

Background Recent years have seen a growing research and policy interest in prevention in many developed countries. However, the actual efforts and resources devoted to prevention appear to have lagged well behind the lip service paid to the topic. Discussion We review the evidence on the considerable existing scope for health gains from prevention as well as for greater prevention policy efforts in Germany. We also discuss the barriers to "more and better" prevention and provide modest suggestions about how some of the obstacles could be overcome. Summary In Germany, there are substantial health gains to be reaped from the implementation of evidence-based, cost-effective preventive interventions and policies. Barriers to more prevention include social, historical, political, legal and economic factors. While there is sufficient evidence to scale up prevention efforts in some public health domains in Germany, in general there is a comparative shortage of research on non-clinical preventive interventions. Some of the existing barriers in Germany are at least in principle amenable to change, provided sufficient political will exists. More research on prevention by itself is no panacea, but could help facilitate more policy action. In particular, there is an economic efficiency-based case for public funding and promotion of research on non-clinical preventive interventions, in Germany and beyond, to confront the peculiar challenges that set this research apart from its clinical counterpart. PMID:20718995

Stellar winds and planetary bodies simulations: Magnetized obstacles in super-Alfvénic and sub-Alfvénic flows

NASA Astrophysics Data System (ADS)

Vernisse, Y.; Riousset, J. A.; Motschmann, U.; Glassmeier, K.-H.

2017-03-01

Most planetary bodies are moving in the solar wind, in a stellar wind, or in a plasma flow within the magnetosphere of a planet. The interaction of the body with the flowing plasma provides us with various interaction types, which mainly depend on the flow speed, the magnetization of the body, its conductivity, the presence of an ionosphere, and the size of the body. We establish two cornerstones representing highly magnetized obstacles embedded in a super-Alfvénic and sub-Alfvénic plasma. Those two cornerstones complete the two cornerstones defined in our previous study on inert obstacles in super-Alfvénic and sub-Alfvénic regimes. Tracking the transitions between these cornerstones enable better understanding of the feedback of the obstacle onto the plasma flow. Each interaction is studied by means of the hybrid model simulation code AIKEF. The results are summarized in three dimensional diagrams showing the current structures, which serve as a basis for our descriptions. We identify the major currents such as telluric, magnetosonic, Chapman-Ferraro, and bow-shock currents as the signatures of the particular state of development of the interaction region. We show that each type of interactions can be identified by studying the shape and the magnitude of its specific currents.

Fusion antibody for Alzheimer's disease with bidirectional transport across the blood-brain barrier and abeta fibril disaggregation.

PubMed

Boado, Ruben J; Zhang, Yufeng; Zhang, Yun; Xia, Chun-Fang; Pardridge, William M

2007-01-01

Delivery of monoclonal antibody therapeutics across the blood-brain barrier is an obstacle to the diagnosis or therapy of CNS disease with antibody drugs. The immune therapy of Alzheimer's disease attempts to disaggregate the amyloid plaque of Alzheimer's disease with an anti-Abeta monoclonal antibody. The present work is based on a three-step model of immune therapy of Alzheimer's disease: (1) influx of the anti-Abeta monoclonal antibody across the blood-brain barrier in the blood to brain direction, (2) binding and disaggregation of Abeta fibrils in brain, and (3) efflux of the anti-Abeta monoclonal antibody across the blood-brain barrier in the brain to blood direction. This is accomplished with the genetic engineering of a trifunctional fusion antibody that binds (1) the human insulin receptor, which mediates the influx from blood to brain across the blood-brain barrier, (2) the Abeta fibril to disaggregate amyloid plaque, and (3) the Fc receptor, which mediates the efflux from brain to blood across the blood-brain barrier. This fusion protein is a new antibody-based therapeutic for Alzheimer's disease that is specifically engineered to cross the human blood-brain barrier in both directions.

Developmental therapeutics for patients with breast cancer and central nervous system metastasis: current landscape and future perspectives.

PubMed

Costa, R; Carneiro, B A; Wainwright, D A; Santa-Maria, C A; Kumthekar, P; Chae, Y K; Gradishar, W J; Cristofanilli, M; Giles, F J

2017-01-01

Breast cancer is the second-leading cause of metastatic disease in the central nervous system (CNS). Recent advances in the biological understanding of breast cancer have facilitated an unprecedented increase of survival in a subset of patients presenting with metastatic breast cancer. Patients with HER2 positive (HER2+) or triple negative breast cancer are at highest risk of developing CNS metastasis, and typically experience a poor prognosis despite treatment with local and systemic therapies. Among the obstacles ahead in the realm of developmental therapeutics for breast cancer CNS metastasis is the improvement of our knowledge on its biological nuances and on the interaction of the blood–brain barrier with new compounds. This article reviews recent discoveries related to the underlying biology of breast cancer brain metastases, clinical progress to date and suggests rational approaches for investigational therapies.

Leveraging Psychological Insights to Encourage the Responsible Use of Consumer Debt.

PubMed

Hershfield, Hal E; Sussman, Abigail B; O'Brien, Rourke L; Bryan, Christopher J

2015-11-01

U.S. consumers currently hold $880 billion in revolving debt, with a mean household credit card balance of approximately $6,000. Although economic factors play a role in this societal issue, it is clear that psychological forces also affect consumers' decisions to take on and maintain unmanageable debt balances. We examine three psychological barriers to the responsible use of credit and debt. We discuss the tendency for consumers to (a) make erroneous predictions about future spending habits, (b) rely too heavily on values presented on billing statements, and (c) categorize debt and saving into separate mental accounts. To overcome these obstacles, we urge policymakers to implement methods that facilitate better budgeting of future expenses, modify existing credit card statement disclosures, and allow consumers to easily apply government transfers (such as tax credits) to debt repayment. In doing so, we highlight minimal and inexpensive ways to remedy the debt problem. © The Author(s) 2015.

Laser development for optimal helicopter obstacle warning system LADAR performance

NASA Astrophysics Data System (ADS)

Yaniv, A.; Krupkin, V.; Abitbol, A.; Stern, J.; Lurie, E.; German, A.; Solomonovich, S.; Lubashitz, B.; Harel, Y.; Engart, S.; Shimoni, Y.; Hezy, S.; Biltz, S.; Kaminetsky, E.; Goldberg, A.; Chocron, J.; Zuntz, N.; Zajdman, A.

2005-04-01

Low lying obstacles present immediate danger to both military and civilian helicopters performing low-altitude flight missions. A LADAR obstacle detection system is the natural solution for enhancing helicopter safety and improving the pilot situation awareness. Elop is currently developing an advanced Surveillance and Warning Obstacle Ranging and Display (SWORD) system for the Israeli Air Force. Several key factors and new concepts have contributed to system optimization. These include an adaptive FOV, data memorization, autonomous obstacle detection and warning algorithms and the use of an agile laser transmitter. In the present work we describe the laser design and performance and discuss some of the experimental results. Our eye-safe laser is characterized by its pulse energy, repetition rate and pulse length agility. By dynamically controlling these parameters, we are able to locally optimize the system"s obstacle detection range and scan density in accordance with the helicopter instantaneous maneuver.

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

Self-assembled nano-balls released from multistage vector for cancer therapy

NASA Astrophysics Data System (ADS)

Qian, Jin; Xia, Xiaojun; Xie, Yan

2017-03-01

The efficacy of cancer drugs is often compromised due to the existence of biological barriers such as nonspecific distribution, hemorheological flow limitation and endothelial extravasation, impaired delivery across tumor cell membranes and tissue, and multidrug resistance. To overcome these obstacles, Xu et al developed an injectable nanoparticle generator platform to negotiate with the biological barriers and enable self-assembly of nano-balls in situ in order to maximize drug accumulation inside the tumor tissues and hence the therapeutic efficacy. This perspective aims to elaborate the designing strategy, and discuss the mechanism of action of the new drug and the potential for future development of nanoparticulate drugs.

A comparison of professional-level faculty and student perceptions of active learning: its current use, effectiveness, and barriers.

PubMed

Miller, Cynthia J; Metz, Michael J

2014-09-01

Active learning is an instructional method in which students become engaged participants in the classroom through the use of in-class written exercises, games, problem sets, audience-response systems, debates, class discussions, etc. Despite evidence supporting the effectiveness of active learning strategies, minimal adoption of the technique has occurred in many professional programs. The goal of this study was to compare the perceptions of active learning between students who were exposed to active learning in the classroom (n = 116) and professional-level physiology faculty members (n = 9). Faculty members reported a heavy reliance on lectures and minimal use of educational games and activities, whereas students indicated that they learned best via the activities. A majority of faculty members (89%) had observed active learning in the classroom and predicted favorable effects of the method on student performance and motivation. The main reported barriers by faculty members to the adoption of active learning were a lack of necessary class time, a high comfort level with traditional lectures, and insufficient time to develop materials. Students hypothesized similar obstacles for faculty members but also associated many negative qualities with the traditional lecturers. Despite these barriers, a majority of faculty members (78%) were interested in learning more about the alternative teaching strategy. Both faculty members and students indicated that active learning should occupy portions (29% vs. 40%) of face-to-face class time. Copyright © 2014 The American Physiological Society.

Challenges confronting female surgical leaders: overcoming the barriers.

PubMed

Kass, Rena B; Souba, Wiley W; Thorndyke, Luanne E

2006-05-15

The number of women reaching top ranks in academic surgery is remarkably low. The purpose of this study was to identify: 1) barriers to becoming a female surgical leader; 2) key attributes that enable advancement and success; and 3) current leadership challenges faced as senior leaders. Semi-structured interviews of ten female surgical leaders queried the following dimensions: attributes for success, lessons learned, mistakes, key career steps, the role of mentoring, gender advantages/disadvantages, and challenges. Perseverance (60%) and drive (50%) were identified as critical success factors, as were good communication skills, a passion for scholarship, a stable home life and a positive outlook. Eighty percent identified discrimination or gender prejudice as a major obstacle in their careers. While 90% percent had mentors, 50% acknowledged that they had not been effectively mentored. Career advice included: develop broad career goals (50%); select a conducive environment (30%); find a mentor (60%); take personal responsibility (40%); organize time and achieve balance (40%); network (30%); create a niche (30%); pursue research (30%); publish (50%); speak in public (30%); and enjoy the process (30%). Being in a minority, being highly visible and being collaborative were identified as advantages. Obtaining buy-in and achieving consensus was the greatest leadership challenge reported. Female academic surgeons face challenges to career advancement. While these barriers are real, they can be overcome by resolve, commitment, and developing strong communication skills. These elements should be taken into consideration in designing career development programs for junior female surgical faculty.

A comparison of professional-level faculty and student perceptions of active learning: its current use, effectiveness, and barriers

PubMed Central

Metz, Michael J.

2014-01-01

Active learning is an instructional method in which students become engaged participants in the classroom through the use of in-class written exercises, games, problem sets, audience-response systems, debates, class discussions, etc. Despite evidence supporting the effectiveness of active learning strategies, minimal adoption of the technique has occurred in many professional programs. The goal of this study was to compare the perceptions of active learning between students who were exposed to active learning in the classroom (n = 116) and professional-level physiology faculty members (n = 9). Faculty members reported a heavy reliance on lectures and minimal use of educational games and activities, whereas students indicated that they learned best via the activities. A majority of faculty members (89%) had observed active learning in the classroom and predicted favorable effects of the method on student performance and motivation. The main reported barriers by faculty members to the adoption of active learning were a lack of necessary class time, a high comfort level with traditional lectures, and insufficient time to develop materials. Students hypothesized similar obstacles for faculty members but also associated many negative qualities with the traditional lecturers. Despite these barriers, a majority of faculty members (78%) were interested in learning more about the alternative teaching strategy. Both faculty members and students indicated that active learning should occupy portions (29% vs. 40%) of face-to-face class time. PMID:25179615

Cross-sector surveys assessing perceptions of key stakeholders towards barriers, concerns and facilitators to the appropriate use of adaptive designs in confirmatory trials.

PubMed

Dimairo, Munyaradzi; Julious, Steven A; Todd, Susan; Nicholl, Jonathan P; Boote, Jonathan

2015-12-23

Appropriately conducted adaptive designs (ADs) offer many potential advantages over conventional trials. They make better use of accruing data, potentially saving time, trial participants, and limited resources compared to conventional, fixed sample size designs. However, one can argue that ADs are not implemented as often as they should be, particularly in publicly funded confirmatory trials. This study explored barriers, concerns, and potential facilitators to the appropriate use of ADs in confirmatory trials among key stakeholders. We conducted three cross-sectional, online parallel surveys between November 2014 and January 2015. The surveys were based upon findings drawn from in-depth interviews of key research stakeholders, predominantly in the UK, and targeted Clinical Trials Units (CTUs), public funders, and private sector organisations. Response rates were as follows: 30(55 %) UK CTUs, 17(68 %) private sector, and 86(41 %) public funders. A Rating Scale Model was used to rank barriers and concerns in order of perceived importance for prioritisation. Top-ranked barriers included the lack of bridge funding accessible to UK CTUs to support the design of ADs, limited practical implementation knowledge, preference for traditional mainstream designs, difficulties in marketing ADs to key stakeholders, time constraints to support ADs relative to competing priorities, lack of applied training, and insufficient access to case studies of undertaken ADs to facilitate practical learning and successful implementation. Associated practical complexities and inadequate data management infrastructure to support ADs were reported as more pronounced in the private sector. For funders of public research, the inadequate description of the rationale, scope, and decision-making criteria to guide the planned AD in grant proposals by researchers were all viewed as major obstacles. There are still persistent and important perceptions of individual and organisational obstacles hampering the use of ADs in confirmatory trials research. Stakeholder perceptions about barriers are largely consistent across sectors, with a few exceptions that reflect differences in organisations' funding structures, experiences and characterisation of study interventions. Most barriers appear connected to a lack of practical implementation knowledge and applied training, and limited access to case studies to facilitate practical learning.

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

Follow-up client satisfaction in a supported education program.

PubMed

Mowbray, C T; Bybee, D; Collins, M E

2001-01-01

Satisfaction data have recently returned to popularity, as an outcome measure in managed behavioral healthcare systems. However, there are few examples of management uses of such data. We collected data 12 months after participants had completed a supported education program, concerning their retrospective satisfaction and the barriers, needs, and personal difficulties currently experienced in their attempts to pursue post-secondary education or training. Data on follow-up supportive contacts were also obtained. Results supported participants' continuing satisfaction, and identified particular information items which were endorsed as most helpful. However, the data indicated that personal difficulties presented obstacles to many and that a majority of participants had current needs for financial aid, tutoring, job placements, support groups, and transportation. Following completion of the supported education program, many participants had continuing contacts in support of their educational plans. The amount of contact was generally low, however. In the future, supported education programs need to build in mechanisms to ensure students receive ongoing support for education, since this support was found to positively and significantly affect individuals' enrolling in college or training.

Sleep Medicine in Saudi Arabia

PubMed Central

Almeneessier, Aljohara S.; BaHammam, Ahmed S.

2017-01-01

The practice of sleep medicine in Saudi Arabia began in the mid to late 1990s. Since its establishment, this specialty has grown, and the number of specialists has increased. Based on the available data, sleep disorders are prevalent among the Saudi population, and the demand for sleep medicine services is expected to increase significantly. Currently, two training programs are providing structured training and certification in sleep medicine in this country. Recently, clear guidelines for accrediting sleep medicine specialists and technologists were approved. Nevertheless, numerous obstacles hamper the progress of this specialty, including the lack of trained technicians, specialists, and funding. Increasing the awareness of sleep disorders and their serious consequences among health care workers, health care authorities, and insurance companies is another challenge. Future plans should address the medical educational system at all levels to demonstrate the importance of early detection and the treatment of sleep disorders. This review discusses the current position of and barriers to sleep medicine practice and education in Saudi Arabia. Citation: Almeneessier AS, BaHammam AS. Sleep medicine in Saudi Arabia. J Clin Sleep Med. 2017;13(4):641–645. PMID:28212693

The Economics of Biosimilars

PubMed Central

Blackstone, Erwin A.; Joseph, P. Fuhr

2013-01-01

Background The high cost of pharmaceuticals, especially biologics, has become an important issue in the battle to control healthcare costs. The Hatch-Waxman Act encourages generic competition but still provides incentives for pioneers to develop new drugs. The Biologics Price Competition and Innovation Act is intended to do the same for biologics and biosimilars. Objective To examine information related to biosimilars to determine their potential impact on competition in the biologic market. Method Using information concerning the European Union (EU) and the pharmaceutical industry, this article reviews and analyzes the experience of biosimilars in the EU, as well as the obstacles and opportunities that biosimilars face in the United States. Much of the analysis is based on examining current trends in biologic drugs and the potential implications on the future of biosimilars. Discussion This article reviews the mixed success of biosimilars in the EU and the implications for the United States. Because biologics are produced from living organisms, manufacturing issues are more important than in the chemical drug market. The barriers to biosimilar entry into the marketplace are much more difficult to overcome than challenges generic manufacturers typically face and are similar to obstacles specialty injectable producers encounter. The competitive responses by pioneers are also likely to be more important. The capital costs and risk issues with biosimilars make alliances and partnering arrangements very likely. Biosimilars often enter emerging markets, where the barriers to entry are easier to overcome. Nevertheless, the United States represents the greatest opportunity for biosimilar producers, in part because it is the largest biologics market and has high prices for biologics. As the United States enters the biosimilar market, the pharmaceutical industry is likely to grow at an accelerated pace. Automatic substitution is likely to be slow to develop, because of safety and quality concerns. The beneficial impact of biosimilars is likely to take a long time to be realized and to be fraught with more difficulties than was the case for small-molecule generics. Conclusion Various factors, such as safety, pricing, manufacturing, entry barriers, physician acceptance, and marketing, will make the biosimilar market develop different from the generic market. The high cost to enter the market and the size of the biologic drug market make entry attractive but risky. PMID:24991376

Three-dimensional obstacle classification in laser range data

NASA Astrophysics Data System (ADS)

Armbruster, Walter; Bers, Karl-Heinz

1998-10-01

The threat of hostile surveillance and weapon systems require military aircraft to fly under extreme conditions such as low altitude, high speed, poor visibility and incomplete terrain information. The probability of collision with natural and man-made obstacles during such contour missions is high if detection capability is restricted to conventional vision aids. Forward-looking scanning laser rangefinders which are presently being flight tested and evaluated at German proving grounds, provide a possible solution, having a large field of view, high angular and range resolution, a high pulse repetition rate, and sufficient pulse energy to register returns from wires at over 500 m range (depends on the system) with a high hit-and-detect probability. Despite the efficiency of the sensor, acceptance of current obstacle warning systems by test pilots is not very high, mainly due to the systems' inadequacies in obstacle recognition and visualization. This has motivated the development and the testing of more advanced 3d-scene analysis algorithm at FGAN-FIM to replace the obstacle recognition component of current warning systems. The basic ideas are to increase the recognition probability and to reduce the false alarm rate for hard-to-extract obstacles such as wires, by using more readily recognizable objects such as terrain, poles, pylons, trees, etc. by implementing a hierarchical classification procedure to generate a parametric description of the terrain surface as well as the class, position, orientation, size and shape of all objects in the scene. The algorithms can be used for other applications such as terrain following, autonomous obstacle avoidance, and automatic target recognition.

Overcoming Obstacles to Peace: Local Factors in Nation-Building

DTIC Science & Technology

2013-01-01

institutional barriers to private investment remained, and Bosnia had no commercial banking sector .15 The war largely destroyed the economy but not...World Bank worked to improve the management of state finances, reform the mining sector , and improve the civil service. Some bilateral assistance...present research findings and objective analysis that address the challenges facing the public and private sectors . All RAND reports undergo rigorous

Obstacles and Supports Related to the Use of Educational Technologies: The Role of Technological Expertise, Gender, and Age

ERIC Educational Resources Information Center

Lane, Cara A.; Lyle, Henry F.

2011-01-01

In order for institutions of higher education to provide essential technology resources and encourage the adoption of educational technologies, it is vital to gather information about the barriers their users encounter and the supports they find most helpful. The purpose of this study is to better understand how differences in user traits (e.g.,…

Turn Obstacles into Opportunities: Team Leaders Use a Skillful Approach to Move Past Barriers to Learning

ERIC Educational Resources Information Center

MacDonald, Elisa B.

2013-01-01

This article describes the role of the skillful leader and what practical solutions are needed to overcome hurdles. What distinguishes the skillful team leader from a less-effective leader is his or her approach to overcoming hurdles, and are rooted in the leader's values, mindset, intelligence, and skill. When faced with hurdles to team…

Overcoming Barriers to the Use of Osteopathic Manipulation Techniques in the Emergency Department

PubMed Central

Roberge, Raymond J.; Roberge, Marc R.

2009-01-01

Background: Osteopathic Manipulation Techniques (OMT) have been shown to be effective therapeutic modalities in various clinical settings, but appear to be underutilized in the emergency department (ED) setting. Objective: To examine barriers to the use of OMT in the ED and provide suggestions to ameliorate these barriers. Methods: Literature review Results: While the medical literature cites numerous obstacles to the use of OMT in the ED setting, most can be positively addressed through education, careful planning, and ongoing research into use of these techniques. Recent prospective clinical trials of OMT have demonstrated the utility of these modalities. Conclusion: Osteopathic Manipulation Techniques are useful therapeutic modalities that could be utilized to a greater degree in the ED. As the number of osteopathic emergency physicians increases, the opportunity to employ these techniques should increase. PMID:19718381

A Cognitive Framework for Understanding Barriers to the Productive Use of a Diabetes Home Telemedicine System

PubMed Central

Kaufman, David R.; Starren, Justin; Patel, Vimla L.; Morin, Philip C.; Hilliman, Charlyn; Pevzner, Jenia; Weinstock, Ruth S.; Goland, Robin; Shea, Steven

2003-01-01

Telemedicine has the potential to transcend geographic and socio-cultural barriers to the delivery of high quality health care to the medically underserved populations. However, there are significant cognitive and usability barriers. This paper presents a multifaceted cognitive evaluation of the IDEATel diabetes education and telemedicine program. The evaluation included a cognitive walkthrough analysis to characterize task complexity and identify potential problems as well as field usability testing in patients’ homes. The study revealed dimensions of the interface that impeded optimal access to system resources. In addition, we found significant obstacles corresponding to perceptual-motoric skills, mental models of the system, and health literacy. The objective of this work is to contribute to a design framework so that participants with a wide range of skills can better manage their chronic illnesses. PMID:14728194

Lack of follow-up exams after failed school vision screenings: an investigation of contributing factors.

PubMed

Kimel, Linda S

2006-06-01

Programs to facilitate professional eye exams after failed school vision screenings often are based on the assumption that funding and access to services are major obstacles to care. Despite such programs, many children do not receive professional exams. The purpose of this study was to identify additional barriers to follow-up eye care. School nurses in an urban, midwestern public school district identified elementary school students who had not received follow-up eye exams after failed school vision screenings. Parents of these students were interviewed during the summer to determine financial, logistical, social/family, and perceptual barriers to care. Family issues, parental perceptions of vision problems, and difficulty planning ahead were found to be significant factors. Strategies to increase follow-up compliance and recommendations for overcoming barriers to care were also identified.

Barriers to receiving substance abuse treatment among rural pregnant women in Kentucky.

PubMed

Jackson, Afton; Shannon, Lisa

2012-12-01

Research presenting outcomes for women who enter substance abuse treatment during pregnancy consistently shows benefits. While treatment has nearly universal benefits, there are many barriers to seeking substance abuse treatment for pregnant women. The purpose of this study is to explore barriers for rural pregnant women seeking substance abuse treatment. There were three eligibility criteria for study participation: (1) aged 18 and older, (2) pregnant, and (3) undergoing short-term inpatient detoxification at the University of Kentucky Chandler Medical Center. Eighty-five rural women (N = 85) were included in the analysis. Substance use history and previous treatment were assessed with measures adapted from the Addiction Severity Index. Treatment barriers were measured with three qualitative questions and were coded into four overarching categories: availability, accessibility, affordability, and acceptability barriers. This sample had an extensive substance use history. Almost all participants had used alcohol (98%), marijuana (98%), illicit opiates (99%), and cigarettes (97%). On average, participants reported about two barriers to receiving treatment (Mean = 1.8; SD = 1.3), with over 80% of the sample reporting having experienced any barrier to treatment. The majority experienced acceptability (51%) and accessibility (49%) barriers. Twenty-six percent (26%) of the sample reported availability barriers. A smaller percentage of participants reported affordability barriers (13%). Rural pregnant women seeking substance abuse treatment face many obstacles to receiving needed treatment. More studies on barriers to substance abuse treatment among rural pregnant women are needed. Identifying these barriers can help in improving treatment access and services.

Medical messages in the media--barriers and solutions to improving medical journalism.

PubMed

Larsson, Anna; Oxman, Andrew D; Carling, Cheryl; Herrin, Jeph

2003-12-01

Medical issues are widely reported in the mass media. These reports influence the general public, policy makers and health-care professionals. This information should be valid, but is often criticized for being speculative, inaccurate and misleading. An understanding of the obstacles medical reporters meet in their work can guide strategies for improving the informative value of medical journalism. To investigate constraints on improving the informative value of medical reports in the mass media and elucidate possible strategies for addressing these. We reviewed the literature and organized focus groups, a survey of medical journalists in 37 countries, and semi-structured telephone interviews. We identified nine barriers to improving the informative value of medical journalism: lack of time, space and knowledge; competition for space and audience; difficulties with terminology; problems finding and using sources; problems with editors and commercialism. Lack of time, space and knowledge were the most common obstacles. The importance of different obstacles varied with the type of media and experience. Many health reporters feel that it is difficult to find independent experts willing to assist journalists, and also think that editors need more education in critical appraisal of medical news. Almost all of the respondents agreed that the informative value of their reporting is important. Nearly everyone wanted access to short, reliable and up-to-date background information on various topics available on the Internet. A majority (79%) was interested in participating in a trial to evaluate strategies to overcome identified constraints. Medical journalists agree that the validity of medical reporting in the mass media is important. A majority acknowledge many constraints. Mutual efforts of health-care professionals and journalists employing a variety of strategies will be needed to address these constraints.

Medical messages in the media – barriers and solutions to improving medical journalism

PubMed Central

Larsson, Anna; Oxman, Andrew D; Carling, Cheryl; Herrin, Jeph

2003-01-01

Abstract Context  Medical issues are widely reported in the mass media. These reports influence the general public, policy makers and health‐care professionals. This information should be valid, but is often criticized for being speculative, inaccurate and misleading. An understanding of the obstacles medical reporters meet in their work can guide strategies for improving the informative value of medical journalism. Objective  To investigate constraints on improving the informative value of medical reports in the mass media and elucidate possible strategies for addressing these. Design  We reviewed the literature and organized focus groups, a survey of medical journalists in 37 countries, and semi‐structured telephone interviews. Results  We identified nine barriers to improving the informative value of medical journalism: lack of time, space and knowledge; competition for space and audience; difficulties with terminology; problems finding and using sources; problems with editors and commercialism. Lack of time, space and knowledge were the most common obstacles. The importance of different obstacles varied with the type of media and experience. Many health reporters feel that it is difficult to find independent experts willing to assist journalists, and also think that editors need more education in critical appraisal of medical news. Almost all of the respondents agreed that the informative value of their reporting is important. Nearly everyone wanted access to short, reliable and up‐to‐date background information on various topics available on the Internet. A majority (79%) was interested in participating in a trial to evaluate strategies to overcome identified constraints. Conclusion  Medical journalists agree that the validity of medical reporting in the mass media is important. A majority acknowledge many constraints. Mutual efforts of health‐care professionals and journalists employing a variety of strategies will be needed to address these constraints. PMID:15040794

Autism and Overcoming Job Barriers: Comparing Job-Related Barriers and Possible Solutions in and outside of Autism-Specific Employment

PubMed Central

Lorenz, Timo; Frischling, Cora; Cuadros, Raphael; Heinitz, Kathrin

2016-01-01

The aim of this study was to discover how individuals with autism succeed in entering the job market. We therefore sought to identify expected and occurred barriers, keeping them from taking up and staying in employment as well as to identify the solutions used to overcome these barriers. Sixty-six employed individuals with autism–17 of them with autism-specific employment–participated in an online survey. Results showed a variety of possible barriers. Individuals in autism-specific employment named formality problems–problems with organizational and practical process-related aspects of the job entry–most frequently while individuals in non-autism-specific employment mentioned social problems–obstacles concerning communication and human interaction–most. In terms of solutions, both groups used their own resources as much as external help, but differed in their specific strategies. In addition, correlations of an autism-specific employment with general and occupational self-efficacy as well as life and job satisfaction were examined. Possible implications of the results are discussed with regard to problem solving behavior and the use of strengths. PMID:26766183

Homogenous Nucleation and Crystal Growth in a Model Liquid from Direct Energy Landscape Sampling Simulation

NASA Astrophysics Data System (ADS)

Walter, Nathan; Zhang, Yang

Nucleation and crystal growth are understood to be activated processes involving the crossing of free-energy barriers. Attempts to capture the entire crystallization process over long timescales with molecular dynamic simulations have met major obstacles because of molecular dynamics' temporal constraints. Herein, we circumvent this temporal limitation by using a brutal-force, metadynamics-like, adaptive basin-climbing algorithm and directly sample the free-energy landscape of a model liquid Argon. The algorithm biases the system to evolve from an amorphous liquid like structure towards an FCC crystal through inherent structure, and then traces back the energy barriers. Consequently, the sampled timescale is macroscopically long. We observe that the formation of a crystal involves two processes, each with a unique temperature-dependent energy barrier. One barrier corresponds to the crystal nucleus formation; the other barrier corresponds to the crystal growth. We find the two processes dominate in different temperature regimes. Compared to other computation techniques, our method requires no assumptions about the shape or chemical potential of the critical crystal nucleus. The success of this method is encouraging for studying the crystallization of more complex

Perceived Barriers and Facilitators to Integrating HIV Prevention and Treatment with Cross-Sex Hormone Therapy for Transgender Women in Lima, Peru.

PubMed

Reisner, Sari L; Perez-Brumer, Amaya G; McLean, Sarah A; Lama, Javier R; Silva-Santisteban, Alfonso; Huerta, Leyla; Sanchez, Jorge; Clark, Jesse L; Mimiaga, Matthew J; Mayer, Kenneth H

2017-12-01

Transgender women (TW) represent a vulnerable population at increased risk for HIV infection in Peru. A mixed-methods study with 48 TW and 19 healthcare professionals was conducted between January and February 2015 to explore barriers and facilitators to implementing a model of care that integrates HIV services with gender-affirmative medical care (i.e., hormone therapy) in Lima, Peru. Perceived acceptability of the integrated care model was high among TW and healthcare professionals alike. Barriers included stigma, lack of provider training or Peruvian guidelines regarding optimal TW care, and service delivery obstacles (e.g., legal documents, spatial placement of clinics, hours of operation). The hiring of TW staff was identified as a key facilitator for engagement in health care. Working in partnership with local TW and healthcare provider organizations is critical to overcoming existing barriers to successful implementation of an integrated HIV services and gender-affirmative medical care model for this key population in Peru.

Telemedicine: legal and licensure issues

NASA Astrophysics Data System (ADS)

Wood, Michael B.; Whelan, Leo J.

1995-10-01

The National Information Infrastructure program offers a great opportunity for the United States to capitalize on remarkable technological advancements over a broad range of applications benefiting society. One such application, telemedicine, has the potential to offer widespread access to sophisticated medical care, curtailed health care delivery costs, and homogeneous health and health-related educational opportunities. However, there are a variety of barriers to widespread application of telemedicine once the technical infrastructure of the information highway is well established and ubiquitous. These barriers include technical limitations, reimbursement issues, equipment and networking costs, and appropriate scientific studies to document efficacy and cost effectiveness. These issues may prove to be only transient disincentives which can be surmounted. Additional barriers exist, however, that may not be as readily resolved by traditional methods of analysis and more widespread practice applications. These political and regulatory obstacles will require clarification of the issues and solutions based on national consensus. It is the purpose of this discussion to amplify on these particular barriers which include licensure and tort jurisdiction.

Factors that Can Promote or Impede the Advancement of Women as Leaders in Surgery: Results from an International Survey.

PubMed

Kawase, Kazumi; Carpelan-Holmström, Monika; Kwong, Ava; Sanfey, Hilary

2016-02-01

Compared with male surgeons, women have less success advancing their careers and are underrepresented in leadership positions in surgery. The purpose of this study is to identify the qualifications necessary to become leaders in surgery and the career barriers faced by women surgeons in various cultural environments. A survey was performed with women surgeons in Japan, USA, Finland, and Hong Kong, China, to assess various barriers faced by women surgeons in the respective countries. To develop appropriate survey tool, a preliminary questionnaire was distributed to leaders in surgery and also in various organizations worldwide. The response rate was 23 % with 225 of 964 survey returned. Japanese women surgeons identify lacked family support as impeding a successful surgical career. US women surgeons feel more latent gender discrimination. Finnish women surgeons are less likely to need to sacrifice work-life balance, when holding leadership positions. Women surgeons worldwide are highly motivated to develop their career and agree the percentage of women surgeons in leadership positions should be increased. Women surgeons in different countries perceive different challenges. We must develop strategies and should not hesitate to negotiate to overcome these issues to reach leadership positions in surgery. This may be accomplished through networking worldwide to improve current conditions and obstacles.

A cross-sectional study of facilitators and barriers of Iranian nurses' participation in continuing education programs.

PubMed

Hamzehgardeshi, Zeinab; Shahhosseini, Zohreh

2013-12-27

Continuing education is one of the modern strategies to maintain and elevate knowledge and professional skills of nurses which in turn elevate the health status of society. Since several factors affect nurses' participation in continuing education, it's essential to know promoters and obstacles in this issue and plan accordingly. In this cross-sectional study, 361 Iranian nurses who were recruited by convenience sampling method completed an anonymous, self-administered questionnaire from October 2012 to April 2013. Topics covered the participants' attitudes towards facilitators and barriers of their participation in continuing education. Mean and standard deviation of participants ' age were 37.14±7.58 years and 93.94% were female. The maximum score of facilitators and barriers to nurses' participation in continuing education were related to "Update my knowledge" and "Work commitments" respectively. The results showed among Iranian nurses, the mean score of personal and structural barriers was significantly higher than the mean score of interpersonal ones (F=2122.66, p<0.001). Results highlight policy makers and nursing managers' role on improving the accessibility to provided continuing education programs by enforcement of facilitators and reducing barriers focusing on the personal and structural barriers.

[Neurological disorders and the blood-brain barrier. Strategies and limitations for drug delivery to the brain].

PubMed

Domínguez, Alazne; Álvarez, Antonia; Suárez-Merino, Blanca; Goñi-de-Cerio, Felipe

2014-03-01

The incidence in the central nervous system diseases has increased with a growing elderly population. Unfortunately, conventional treatments used to treat the mentioned diseases are frequently ineffective due to the presence of the blood brain barrier. To illustrate the blood-brain barrier properties that limit drug transport into the brain and the main strategies employed to treat neurologic disorders. The blood-brain barrier is mainly composed of a specialized microvascular endothelium and of glial cells. It constitutes a valuable tool to separate the central nervous system from the rest of the body. Nevertheless, it also represents an obstacle to the delivery of therapeutic drugs to the brain. To be effective, drugs must reach their target in the brain. On one hand, therapeutic agents could be designed to be able to cross the blood brain barrier. On the other hand, drug delivery systems could be employed to facilitate the therapeutic agents' entry into the central nervous system. In vivo models of neurological diseases, in addition to in vitro models of the blood brain barrier, have been widely employed for the evaluation of drugs utilized to treat central nervous system diseases.

Challenges of Implementing New Technologies for Sustainable Energy. Opening address at the Sixth Grove Fuel Cell Symposium, London, 13-16 September 1999

NASA Astrophysics Data System (ADS)

Jørgen Koch, Hans

To meet the commitments made in Kyoto, energy-related CO 2 emissions would have to fall to almost 30% below the level projected for a "Business-As-Usual" scenario. Meeting this goal will require a large-scale shift toward climate-friendly technologies such as fuel cells, which have a large long-term potential for both stationary generation and transportation. The deployment of a technology is the last major stage in the process of technological shift. Climate-friendly technologies are not being deployed at a sufficient rate or in sufficient amount to allow IEA countries to meet their targets. Hence, if technology is to play an important roll in reducing emissions within the Kyoto time frame (2008-2012) and beyond, immediate and sustained action to accelerate technology deployment will be required. Obstacles in the way of the deployment of technologies that are ready or near-ready for normal use have come to be referred to as market barriers. The simplest yet most significant form of market barrier to a new technology is the out-of-pocket cost to the user relative to the cost of technologies currently in use. Some market barriers also involve market failure, where the market fails to take account of all the costs and benefits involved, such as omitting external environmental costs, and therefore retard the deployment of more environmentally sustainable technologies. Other barriers include poor information dissemination, excessive and costly regulations, slow capital turnover rates, and inadequate financing. Efforts by governments to alleviate market barriers play an important role to complement private-sector activities, and there are many policies and measures each government could take. In addition, international technology collaboration can help promote the best use of available R&D resources and can contribute to more effective deployment of the result of research and development by sharing costs, pooling information and avoiding duplication of efforts.

Computer vision techniques for rotorcraft low-altitude flight

NASA Technical Reports Server (NTRS)

Sridhar, Banavar; Cheng, Victor H. L.

1988-01-01

A description is given of research that applies techniques from computer vision to automation of rotorcraft navigation. The effort emphasizes the development of a methodology for detecting the ranges to obstacles in the region of interest based on the maximum utilization of passive sensors. The range map derived from the obstacle detection approach can be used as obstacle data for the obstacle avoidance in an automataic guidance system and as advisory display to the pilot. The lack of suitable flight imagery data, however, presents a problem in the verification of concepts for obstacle detection. This problem is being addressed by the development of an adequate flight database and by preprocessing of currently available flight imagery. Some comments are made on future work and how research in this area relates to the guidance of other autonomous vehicles.

Research productivity among faculty members at medical and health schools in Saudi Arabia. Prevalence, obstacles, and associated factors.

PubMed

Alghanim, Saad A; Alhamali, Rashid M

2011-12-01

To identify the prevalence, factors and obstacles affecting research productivity among academic staff at medical and health colleges in the Kingdom of Saudi Arabia. This cross-sectional survey employed self-administered questionnaires to collect data on faculty members' profile, research activities, and obstacles impeding research productivity. The questionnaires were distributed randomly to 500 faculty members, of which 389 (77.8%) completed the questionnaire at 10 medical and health colleges during January to April 2011. The data were analyzed and presented in a descriptive fashion. Only 150 (38.6%) respondents reported published work in the past 2 years. Of these, 80% indicated sole-authors research and around a quarter (26%) reported co-authors work. Males and young faculty members were more likely to publish research than their counterparts. Faculty members who reported involvement in administrative activities were less likely to publish. Those who reported supervising postgraduate students or had attained training on research methods were more likely to produce research. Respondents perceived that lack of time, lack of research assistants, lack of funds for research, and being busy with teaching load were the most cited obstacles impeding research productivity. Understanding factors and barriers impeding research productivity is a prerequisite for interventions that are directed to promote health services research among faculty members in medical schools.

English-as-a-Second Language (ESL) nursing student success: a critical review of the literature.

PubMed

Olson, Mary Angela

2012-01-01

Many English-as-a-Second Language (ESL) nursing students struggle in nursing school for a multitude of reasons. The purpose of this critical review of the literature is to identify barriers and discover bridges to ESL nursing student success. Twenty-five articles were identified for the review. Language barriers were identified as the single most significant obstacle facing the ESL nursing student. Bridges to ESL nursing student success include enhancing language development and acculturation into the American mainstream culture. A broad range of strategies to promote student success are outlined and the role of the nurse educator in ESL nursing student success is also addressed.

Achieving Cross-Domain Synergy: Overcoming Service Barriers to Joint Force 2020

DTIC Science & Technology

2014-06-13

culture. It is my hope that this thesis will be of value to the Joint community by contributing to their understanding of inter-service cultural...Identify leadership implications. 8. Identify metrics, measures, and milestones to maintain accountability. 9. Identify a communication strategy...Under- communicating the vision 5. Permitting obstacles to block the vision 6. Failing to create short-term wins 7. Declaring victory too soon 8

Day-Care Regulation: Serving Children or Bureaucrats? Cato Institute Policy Analysis No. 59.

ERIC Educational Resources Information Center

Lehrman, Karen; Pace, Jana

If the supply of day care is ever to keep pace with the rapidly rising demand, it is essential that there be a favorable climate for its growth. At present there is not, and the regulatory obstacle course laid out by state and local officials is in large part why. State barriers to the provision of day care involve licensing and registration and…

U.S. Wind projected to Be $60 billion business by 2013

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

NONE

2008-11-15

A recent U.S. Department of Energy report concluded that there are no insurmountable barriers to meeting 20 percent of U.S. electricity generation from wind by 2030, but identified upgrading of the transmission grid as a major challenge, requiring a $60+ billion investment. One major obstacle is the highly fragmented ownership of the 200,000-mile network among some 500 diverse, intensely territorial entities.

Border Security: Barriers Along the U.S. International Border

DTIC Science & Technology

2006-09-21

Mexican Government Press Release, “Crecimiento con Calidad: El Presidente Vicente Fox encabezará la cena de gala de la XI Cumbre Anual Hemispheria San...international border with Mexico , and covers approximately 7,000 square miles of territory. Located north of Tijuana and Tecate, Mexican cities with a...The study concluded that aliens attempting to enter the United States from Mexico had shown remarkable resiliency in bypassing or destroying obstacles

Am I a Qualified Literacy Researcher and Educator? A Counter-Story of a Professional Journey of One Asian Male Literacy Scholar in the United States

ERIC Educational Resources Information Center

Jang, Bong Gee

2017-01-01

Although there has been a significant increase in the number of minority faculty members in higher education, little is known about potential barriers and challenges we face during their early career development. In this counter-story article, I share my own professional experiences regarding the choices I made and obstacles I faced in developing…

Men's hopes, fears and challenges in engagement in perinatal health and the prevention of mother-to-child transmission of HIV in rural Kenya.

PubMed

Musoke, Pamela; Hatcher, Abigail; Rogers, Anna Joy; Achiro, Lillian; Bukusi, Elizabeth; Darbes, Lynae; Kwena, Zachary; Oyaro, Patrick; Weke, Elly; Turan, Janet M

2018-02-21

Male involvement in antenatal care has been shown to improve health outcomes for women and infants. However, little is known about how best to encourage male partners to support essential perinatal health activities. We explored men's perceptions of facilitators and barriers to involvement in antenatal care and HIV prevention including fears, hopes and challenges. Forty in-depth interviews were conducted with the male partners of HIV-positive and HIV-negative pregnant women in southwest Kenya. Most male partners believed engaging in pregnancy health-related activities was beneficial for keeping families healthy. However, thematic analysis revealed several obstacles that hindered participation. Poor couple relationship dynamics seemed negatively to influence male engagement. Some men were apprehensive that clinic staff might force them to test for HIV and disclose the results; if HIV-positive, men feared being labelled as 'victimisers' in situations of serodiscordancy, and described fears of abandonment by their wives. Some men avoided accompanying their wives, citing local culture as rationale for avoiding the 'effeminate' act of antenatal care attendance. Amidst these obstacles, some men chose to use their partners' HIV status as proxy for their own. Findings suggest that improving male engagement in essential maternal and child health-related activities will require addressing both structural and interpersonal barriers.

Back-gated graphene anode for more efficient thermionic energy converters

DOE PAGES

Yuan, Hongyuan; Riley, Daniel C.; Shen, Zhi-Xun; ...

2016-12-15

Thermionic energy converters (TECs) are a direct heat-to-electricity conversion technology with great potential for high efficiency and scalability. However, space charge barrier in the inter-electrode gap and high anode work function are major obstacles toward realizing high efficiency. Here, we demonstrate for the first time a prototype TEC using a back-gated graphene anode, a barium dispenser cathode, and a controllable inter-electrode gap as small as 17 µm, which simultaneously addresses these two obstacles. This leads to an electronic conversion efficiency of 9.8% at cathode temperature of 1000 °C, the highest reported by far. We first demonstrate that electrostatic gating ofmore » graphene by a 20 nm HfO 2 dielectric layer changes the graphene anode work function by 0.63 eV, as observed from the current-voltage characteristics of the TEC. Next, we show that the efficiency increases by a factor of 30.6 by reducing the gap from 1 mm down to 17 µm, after a mono-layer of Ba is deposited on graphene by the dispenser cathode. Lastlu, we show that electrostatic gating of graphene further reduces the graphene work function from 1.85 to 1.69 eV, leading to an additional 67% enhancement in TEC efficiency. Note that the overall efficiency using the back-gated graphene anode is 6.7 times higher compared with that of a TEC with a tungsten anode and the same inter-electrode gap.« less

Back-gated graphene anode for more efficient thermionic energy converters

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

Yuan, Hongyuan; Riley, Daniel C.; Shen, Zhi-Xun

Thermionic energy converters (TECs) are a direct heat-to-electricity conversion technology with great potential for high efficiency and scalability. However, space charge barrier in the inter-electrode gap and high anode work function are major obstacles toward realizing high efficiency. Here, we demonstrate for the first time a prototype TEC using a back-gated graphene anode, a barium dispenser cathode, and a controllable inter-electrode gap as small as 17 µm, which simultaneously addresses these two obstacles. This leads to an electronic conversion efficiency of 9.8% at cathode temperature of 1000 °C, the highest reported by far. We first demonstrate that electrostatic gating ofmore » graphene by a 20 nm HfO 2 dielectric layer changes the graphene anode work function by 0.63 eV, as observed from the current-voltage characteristics of the TEC. Next, we show that the efficiency increases by a factor of 30.6 by reducing the gap from 1 mm down to 17 µm, after a mono-layer of Ba is deposited on graphene by the dispenser cathode. Lastlu, we show that electrostatic gating of graphene further reduces the graphene work function from 1.85 to 1.69 eV, leading to an additional 67% enhancement in TEC efficiency. Note that the overall efficiency using the back-gated graphene anode is 6.7 times higher compared with that of a TEC with a tungsten anode and the same inter-electrode gap.« less

Factors Controlling the Position of the Martian Magnetic Pileup Boundary

NASA Technical Reports Server (NTRS)

Crider, D. H.; Acuna, M.; Vignes, D.; Krymskii, A.; Breus, T.; Ness, N.

2003-01-01

The magnetic pileup boundary (MPB) at Mars is the position where the dominant ion of the plasma changes from solar wind protons to heavy ions of planetary origin. As such, it is the obstacle to solar wind ions. We investigate the factors that influence the shape and position of the magnetic pileup boundary at Mars in order to better understand the Martian obstacle to the solar wind. Employing MGS data, we determine how the Martian MPB moves in response to factors including solar wind pressure and crustal magnetic fields. We also study the factors affecting the thickness of the MPB. Further, we compare the magnetic pileup boundary to the magnetic barrier at Venus. Direct comparison aids in our interpretation of the physics involved in the solar wind interaction with planets lacking a significant intrinsic magnetic field.

Legal services: a necessary component of patient navigation.

PubMed

Retkin, Randye; Antoniadis, Domna; Pepitone, Daniel F; Duval, Deanna

2013-05-01

Access to legal advocacy is an essential tool to help cancer patients and survivors through the continuum of care. This article examines delivery models that can seamlessly integrate into patient navigation programs. Technical reports, books, journal articles, and Web sites. Psychosocial obstacles are common barriers of low-income individuals facing a cancer diagnosis. Legal solutions can help to minimize these obstacles, yet patients rarely have access to these services. Training patient navigators to appropriately screen for legal issues and collaborate with attorneys can be used to help prevent, rather than just react to, legal issues by addressing them as a part of a treatment plan. Attorneys working with patient navigators, particularly nurse navigators, can impact oncology nursing practice by providing an innovative collaboration that is consistent with emerging trends in patient-centered treatment. Copyright © 2013. Published by Elsevier Inc.

Exploring the barriers to and facilitators of implementing research into practice.

PubMed

Johnston, Bridget; Coole, Carol; Narayanasamy, Melanie; Feakes, Ruth; Whitworth, Gillian; Tyrell, Tracy; Hardy, Beth

2016-08-02

District and community nursing roles have changed rapidly in recent years. Community nurses are increasingly being tasked with carrying out multiple roles, which require them to put research into practice and use evidence-based tools and interventions. The implementation of interventions and tools needs to be developed from empirical research, requiring evidence, to be translated into practice. However, this process may be compromised or enhanced by a number of factors. This exploratory, descriptive qualitative study sought to identify barriers and facilitators to community nurses implementing research into practice. Four focus groups were conducted with registered community nurses and district nurses (n=22). Analysis identified four main themes: keeping up to date with evidence; using a clinical tool; education/training and implementation. Findings suggest that there are barriers at a personal, professional and organisational level. Strategies are suggested to overcome these obstacles.

Governance of quality of care: a qualitative study of health service boards in Victoria, Australia

PubMed Central

Bismark, Marie M; Studdert, David M

2014-01-01

Objectives To describe the engagement of health service boards with quality-of-care issues and to identify factors that influence boards’ activities in this area. Methods We conducted semistructured interviews with 35 board members and executives from 13 public health services in Victoria, Australia. Interviews focused on the role currently played by boards in overseeing quality of care. We also elicited interviewees’ perceptions of factors that have influenced their current approach to governance in this area. Thematic analysis was used to identify key themes from interview transcripts. Results Virtually all interviewees believed boards had substantial opportunities to influence the quality of care delivered within the service, chiefly through setting priorities, monitoring progress, holding staff to account and shaping culture. Perceived barriers to leveraging this influence included insufficient resources, gaps in skills and experience among board members, inadequate information on performance and regulatory requirements that miss the mark. Interviewees converged on four enablers of more effective quality governance: stronger regional collaborations; more tailored board training on quality issues; smarter use of reporting and accreditation requirements; and better access to data that was reliable, longitudinal and allowed for benchmarking against peer organisations. Conclusions Although health service boards are eager to establish quality of care as a governance priority, several obstacles are blocking progress. The result is a gap between the rhetoric of quality governance and the reality of month-to-month activities at the board level. The imperative for effective board-level engagement in this area cannot be met until these barriers are addressed. PMID:24327735

The impact of wind energy turbine piles on ocean dynamics

NASA Astrophysics Data System (ADS)

Grashorn, Sebastian; Stanev, Emil V.

2016-04-01

The small- and meso-scale ocean response to wind parks has not been investigated in the southern North Sea until now with the help of high-resolution numerical modelling. Obstacles such as e.g. wind turbine piles may influence the ocean current system and produce turbulent kinetic energy which could affect sediment dynamics in the surrounding area. Two setups of the unstructured-grid model SCHISM (Semi-implicit Cross-scale Hydroscience Integrated System Model) have been developed for an idealized channel including a surface piercing cylindrical obstacle representing the pile and a more realistic test case including four exemplary piles. Experiments using a constant flow around the obstacles and a rotating M2 tidal wave are carried out. The resulting current and turbulence patterns are investigated to estimate the influence of the obstacles on the surrounding ocean dynamics. We demonstrate that using an unstructured ocean model provides the opportunity to embed a high-resolution representation of a wind park turbine pile system into a coarser North Sea setup, which is needed in order to perform a seamless investigation of the resulting geophysical processes.

Obstacle avoidance and concealed target detection using the Army Research Lab ultra-wideband synchronous impulse reconstruction (UWB SIRE) forward imaging radar

NASA Astrophysics Data System (ADS)

Nguyen, Lam; Wong, David; Ressler, Marc; Koenig, Francois; Stanton, Brian; Smith, Gregory; Sichina, Jeffrey; Kappra, Karl

2007-04-01

The U.S. Army Research Laboratory (ARL), as part of a mission and customer funded exploratory program, has developed a new low-frequency, ultra-wideband (UWB) synthetic aperture radar (SAR) for forward imaging to support the Army's vision of an autonomous navigation system for robotic ground vehicles. These unmanned vehicles, equipped with an array of imaging sensors, will be tasked to help detect man-made obstacles such as concealed targets, enemy minefields, and booby traps, as well as other natural obstacles such as ditches, and bodies of water. The ability of UWB radar technology to help detect concealed objects has been documented in the past and could provide an important obstacle avoidance capability for autonomous navigation systems, which would improve the speed and maneuverability of these vehicles and consequently increase the survivability of the U. S. forces on the battlefield. One of the primary features of the radar is the ability to collect and process data at combat pace in an affordable, compact, and lightweight package. To achieve this, the radar is based on the synchronous impulse reconstruction (SIRE) technique where several relatively slow and inexpensive analog-to-digital (A/D) converters are used to sample the wide bandwidth of the radar signals. We conducted an experiment this winter at Aberdeen Proving Ground (APG) to support the phenomenological studies of the backscatter from positive and negative obstacles for autonomous robotic vehicle navigation, as well as the detection of concealed targets of interest to the Army. In this paper, we briefly describe the UWB SIRE radar and the test setup in the experiment. We will also describe the signal processing and the forward imaging techniques used in the experiment. Finally, we will present imagery of man-made obstacles such as barriers, concertina wires, and mines.

Different protocols for analyzing behavior and adaptability in obstacle crossing in Parkinson's disease.

PubMed

Mollaei, Nafiseh; Bicho, Estela; Sousa, Nuno; Gago, Miguel Fernandes

2017-01-01

Imbalance and tripping over obstacles as a result of altered gait in older adults, especially in patients with Parkinson's disease (PD), are one of the most common causes of falls. During obstacle crossing, patients with PD modify their behavior in order to decrease the mechanical demands and enhance dynamic stability. Various descriptions of dynamic traits of gait that have been collected over longer periods, probably better synthesize the underlying structure and pattern of fluctuations in gait and can be more sensitive markers of aging or early neurological dysfunction and increased risk of falls. This confirmation challenges the clinimetric of different protocols and paradigms used for gait analysis up till now, in particular when analyzing obstacle crossing. The authors here present a critical review of current knowledge concerning the interplay between the cognition and gait in aging and PD, emphasizing the differences in gait behavior and adaptability while walking over different and challenging obstacle paradigms, and the implications of obstacle negotiation as a predictor of falls. Some evidence concerning the effectiveness of future rehabilitation protocols on reviving obstacle crossing behavior by trial and error relearning, taking advantage of dual-task paradigms, physical exercise, and virtual reality have been put forward in this article.

Nano-scale gene delivery systems; current technology, obstacles, and future directions.

PubMed

Garcia-Guerra, Antonio; Dunwell, Thomas L; Trigueros, Sonia

2018-01-07

Within the different applications of nanomedicine currently being developed, nano-gene delivery is appearing as an exciting new technique with the possibility to overcome recognised hurdles and fulfill several biological and medical needs. The central component of all delivery systems is the requirement for the delivery of genetic material into cells, and for them to eventually reside in the nucleus where their desired function will be exposed. However, genetic material does not passively enter cells; thus, a delivery system is necessary. The emerging field of nano-gene delivery exploits the use of new materials and the properties that arise at the nanometre-scale to produce delivery vectors that can effectively deliver genetic material into a variety of different types of cells. The novel physicochemical properties of the new delivery vectors can be used to address the current challenges existing in nucleic acid delivery in vitro and in vivo. While there is a growing interest in nanostructure-based gene delivery, the field is still in its infancy, and there is yet much to discover about nanostructures and their physicochemical properties in a biological context. We carry out an organized and focused search of bibliographic databases. Our results suggest that despite new breakthroughs in nanostructure synthesis and advanced characterization techniques, we still face many barriers in producing highly efficient and non-toxic delivery systems. In this review, we overview the types of systems currently used for clinical and biomedical research applications along with their advantages and disadvantages, as well as discussing barriers that arise from nano-scale interactions with biological material. In conclusion, we hope that by bringing the far reaching multidisciplinary nature of nano-gene delivery to light, new targeted nanotechnology-bases strategies are developed to overcome the major challenges covered in this review. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Evaluating barriers to adopting telemedicine worldwide: A systematic review.

PubMed

Scott Kruse, Clemens; Karem, Priyanka; Shifflett, Kelli; Vegi, Lokesh; Ravi, Karuna; Brooks, Matthew

2018-01-01

Introduction and objective Studies on telemedicine have shown success in reducing the geographical and time obstacles incurred in the receipt of care in traditional modalities with the same or greater effectiveness; however, there are several barriers that need to be addressed in order for telemedicine technology to spread. The aim of this review is to evaluate barriers to adopting telemedicine worldwide through the analysis of published work. Methods The authors conducted a systematic literature review by extracting the data from the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed (MEDLINE) research databases. The reviewers in this study analysed 30 articles (nine from CINAHL and 21 from Medline) and identified barriers found in the literature. This review followed the checklist from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009. The reviewers organized the results into one table and five figures that depict the data in different ways, organized by: barrier, country-specific barriers, organization-specific barriers, patient-specific barriers, and medical-staff and programmer-specific barriers. Results The reviewers identified 33 barriers with a frequency of 100 occurrences through the 30 articles. The study identified the issues with technically challenged staff (11%), followed by resistance to change (8%), cost (8%), reimbursement (5%), age of patient (5%), and level of education of patient (5%). All other barriers occurred at or less than 4% of the time. Discussion and conclusions Telemedicine is not yet ubiquitous, and barriers vary widely. The top barriers are technology-specific and could be overcome through training, change-management techniques, and alternating delivery by telemedicine and personal patient-to-provider interaction. The results of this study identify several barriers that could be eliminated by focused policy. Future work should evaluate policy to identify which one to lever to maximize the results.

When an object appears unexpectedly: anticipatory movement and object circumvention in individuals with and without Developmental Coordination Disorder.

PubMed

Wilmut, K; Barnett, A L

2017-05-01

Obstacles often appear unexpectedly in our pathway and these require us to make adjustments to avoid collision. Previous research has demonstrated that healthy adults will make anticipatory adjustments to gait where they have been told there is the possibility of an obstacle appearing. One population that may find this type of anticipatory movement difficult is individuals with Developmental Coordination Disorder (DCD). The current study considered how individuals with and without DCD adjust to the possibility of an obstacle appearing which would require circumvention. Fortyfour individuals with DCD and 44 age-matched controls (aged from 7 to 34 years of age) walked down an 11 m walkway under three conditions. Initially they were told this was a clear pathway and nothing in the environment would change (1, no possibility of an obstacle, no obstacle). They then performed a series of trials in which a gate may (2, possibility of an obstacle, obstacle) or may not (3, possibility of an obstacle, no obstacle) partially obstruct their pathway. We found that all participants increased medio-lateral trunk acceleration when there was the possibility of an obstacle but before the obstacle appeared, in addition the typical adults and older children also increased step width. When describing circumvention we found that the younger children showed an increase in trunk velocity and acceleration in all three directions compared to older children and adults. We also found that the individuals with DCD adjusted their path sooner and deviated more than their peers. The degree of adjustment to step width in anticipation of an obstacle was related to later medio-lateral velocity and timing of the deviation. Therefore, the lack of 'readying' the system where there is the possibility of an obstacle appearing seen in the individuals with DCD and the younger typical children may explain the increased medio-lateral velocity seen during circumvention.

Critical Care Nurses' Perceptions of End-of-Life Care Obstacles: Comparative 17-Year Data.

PubMed

Beckstrand, Renea L; Lamoreaux, Nicole; Luthy, Karlen E; Macintosh, Janelle L B

Nurses working in intensive care units (ICUs) frequently care for patients and their families at the end of life (EOL). Providing high-quality EOL care is important for both patients and families, yet ICU nurses face many obstacles that hinder EOL care. Researchers have identified various ICU nurse-perceived obstacles, but no studies have been found addressing the progress that has been made for the last 17 years. The aims of this study were to determine the most common and current obstacles in EOL care as perceived by ICU nurses and then to evaluate whether meaningful changes have occurred since data were first gathered in 1998. A quantitative-qualitative mixed methods design was used. A random, geographically dispersed sample of 2000 members of the American Association of Critical-Care Nurses was surveyed. Five obstacle items increased in mean score and rank as compared with 1999 data including (1) family not understanding what the phrase "lifesaving measures" really means, (2) providing lifesaving measures at families' requests despite patient's advance directive listing no such care, (3) family not accepting patient's poor prognosis, (4) family members fighting about the use of life support, and (5) not enough time to provide EOL care because the nurse is consumed with lifesaving measures attempting to save the patient's life. Five obstacle items decreased in mean score and rank compared with 1999 data including (1) physicians differing in opinion about care of the patient, (2) family and friends who continually call the nurse rather than calling the designated family member, (3) physicians who are evasive and avoid families, (4) nurses having to deal with angry families, and (5) nurses not knowing their patient's wishes regarding continuing with tests and treatments. Obstacles in EOL care, as perceived by critical care nurses, still exist. Family-related obstacles have increased over time. Obstacles related to families may not be easily overcome as each family, dealing with a dying family member in an ICU, likely has not previously experienced a similar situation. On the basis of the current top 5 obstacles, recommendations for possible areas of focus include (1) improved health literacy assessment of families followed by earlier directed, appropriate, and specific EOL information; (2) improved physician/team communication; and (3) ensuring patients' wishes are followed as written. In general, patient- and family-centered care using clear and open EOL communication regarding wishes and desires between patients and families, their physicians, and nurses will help decrease common obstacles, thus improving the quality of EOL care provided to dying patients and families.

Liposomes and nanotechnology in drug development: focus on ocular targets

PubMed Central

Honda, Miki; Asai, Tomohiro; Oku, Naoto; Araki, Yoshihiko; Tanaka, Minoru; Ebihara, Nobuyuki

2013-01-01

Poor drug delivery to lesions in patients’ eyes is a major obstacle to the treatment of ocular diseases. The accessibility of these areas to drugs is highly restricted by the presence of barriers, including the corneal barrier, aqueous barrier, and the inner and outer blood–retinal barriers. In particular, the posterior segment is difficult to reach for drugs because of its structural peculiarities. This review discusses various barriers to drug delivery and provides comprehensive information for designing nanoparticle-mediated drug delivery systems for the treatment of ocular diseases. Nanoparticles can be designed to improve penetration, controlled release, and drug targeting. As highlighted in this review, the therapeutic efficacy of drugs in ocular diseases has been reported to be enhanced by the use of nanoparticles such as liposomes, micro/nanospheres, microemulsions, and dendrimers. Our recent data show that intravitreal injection of targeted liposomes encapsulating an angiogenesis inhibitor caused significantly greater suppression of choroidal neovascularization than did the injection of free drug. Recent progress in ocular drug delivery systems research has provided new insights into drug development, and the use of nanoparticles for drug delivery is thus a promising approach for advanced therapy of ocular diseases. PMID:23439842

Mitigation of explosions of hydrogen-air mixtures using bulk materials and aqueous foam

NASA Astrophysics Data System (ADS)

Medvedev, S. P.; Khomik, S. V.; Mikhalkin, V. N.; Ivantsov, A. N.; Agafonov, G. L.; Cherepanov, A. A.; Cherepanova, T. T.; Betev, A. S.

2018-01-01

The objective of this work is to determine experimentally the effectiveness of protective barriers under conditions when blast waves are generated during premixed hydrogen- air combustion in various regimes. Experiments are conducted in a vertical tube having a diameter of 54 mm and a length of up to 2 m. Blast loads are produced by acceleration of premixed hydrogen-air flames in the tube with ring obstacles. Comparative tests are performed between protection barriers made of bulk materials with different densities and aqueous foams with different expansion ratios. It is demonstrated that the degree of blast load attenuation by an aqueous foam barrier increases with decreasing molecular weight of the filling gas and increasing density (decreasing expansion ratio) of the foam. An Aerosil barrier three times thicker than a titanium-dioxide one is found to have a similar attenuating effect on blast action. However, the mass per unit area of an Aerosil barrier is lower than titanium dioxide by a factor of 6 and is comparable to foam. The observed dependence of blast load attenuation on parameters of bulk materials and aqueous foams must be taken into account in systems designed to mitigate the consequences of accidental hydrogen release and combustion.

Intracavity double diode structures with GaInP barrier layers for thermophotonic cooling

NASA Astrophysics Data System (ADS)

Tiira, Jonna; Radevici, Ivan; Haggren, Tuomas; Hakkarainen, Teemu; Kivisaari, Pyry; Lyytikäinen, Jari; Aho, Arto; Tukiainen, Antti; Guina, Mircea; Oksanen, Jani

2017-02-01

Optical cooling of semiconductors has recently been demonstrated both for optically pumped CdS nanobelts and for electrically injected GaInAsSb LEDs at very low powers. To enable cooling at larger power and to understand and overcome the main obstacles in optical cooling of conventional semiconductor structures, we study thermophotonic (TPX) heat transport in cavity coupled light emitters. Our structures consist of a double heterojunction (DHJ) LED with a GaAs active layer and a corresponding DHJ or a p-n-homojunction photodiode, enclosed within a single semiconductor cavity to eliminate the light extraction challenges. Our presently studied double diode structures (DDS) use GaInP barriers around the GaAs active layer instead of the AlGaAs barriers used in our previous structures. We characterize our updated double diode structures by four point probe IV- measurements and measure how the material modifications affect the recombination parameters and coupling quantum efficiencies in the structures. The coupling quantum efficiency of the new devices with InGaP barrier layers is found to be approximately 10 % larger than for the structures with AlGaAs barriers at the point of maximum efficiency.

Transgender Patients: What Radiologists Need to Know.

PubMed

Sowinski, John S; Gunderman, Richard B

2018-05-01

The purposes of this article are to examine a few of the barriers the transgender population faces in achieving equitable health care, to suggest ways radiologists and radiology staff can help to address these obstacles and provide high-quality care to transgender patients, and to discuss a number of evidence-based guidelines regarding appropriate imaging and screening tests for the transgender population. Lesbian, gay, bisexual, and transgender individuals face numerous health care disparities, including stigmatization and discrimination in health care environments. Radiology personnel can help to remove such barriers by providing a welcoming clinical environment, practicing cultural humility, and staying up-to-date with rapidly changing recommendations related to transgender care. Continued research will help to provide even stronger evidence-based guidelines for transgender care.

Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments.

PubMed

Ben-Assuli, Ofir

2015-03-01

Recently, the healthcare sector has shown a growing interest in information technologies. Two popular health IT (HIT) products are the electronic health record (EHR) and health information exchange (HIE) networks. The introduction of these tools is believed to improve care, but has also raised some important questions and legal and privacy issues. The implementation of these systems has not gone smoothly, and still faces some considerable barriers. This article reviews EHR and HIE to address these obstacles, and analyzes the current state of development and adoption in various countries around the world. Moreover, legal and ethical concerns that may be encountered by EHR users and purchasers are reviewed. Finally, links and interrelations between EHR and HIE and several quality of care issues in today's healthcare domain are examined with a focus on EHR and HIE in the emergency department (ED), whose unique characteristics makes it an environment in which the implementation of such technology may be a major contributor to health, but also faces substantial challenges. The paper ends with a discussion of specific policy implications and recommendations based on an examination of the current limitations of these systems. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Influence of excitability on unpinning and termination of spiral waves.

PubMed

Luengviriya, Jiraporn; Sutthiopad, Malee; Phantu, Metinee; Porjai, Porramain; Kanchanawarin, Jarin; Müller, Stefan C; Luengviriya, Chaiya

2014-11-01

Application of electrical forcing to release pinned spiral waves from unexcitable obstacles and to terminate the rotation of free spiral waves at the boundary of excitable media has been investigated in thin layers of the Belousov-Zhabotinsky (BZ) reaction, prepared with different initial concentrations of H_{2}SO_{4}. Increasing [H_{2}SO_{4}] raises the excitability of the reaction and reduces the core diameter of free spiral waves as well as the wave period. An electric current with density stronger than a critical value Junpin causes a pinned spiral wave to drift away from the obstacle. For a given obstacle size, Junpin increases with [H_{2}SO_{4}]. Under an applied electrical current, the rotation center of a free spiral wave drifts along a straight path to the boundary. When the current density is stronger than a critical value Jterm, the spiral tip is forced to hit the boundary, where the spiral wave is terminated. Similar to Junpin for releasing a pinned spiral wave, Jterm also increases with [H_{2}SO_{4}]. These experimental findings were confirmed by numerical simulations using the Oregonator model, in which the excitability was adjusted via the ratio of the excitation rate to the recovery rate of the BZ reaction. Therefore, our investigation shows that decreasing the excitability can facilitate elimination of spiral waves by electrical forcing, either in the presence of obstacles or not.

Brüstle v. Greenpeace: Implications for Commercialisation of Translational Stem Cell Research.

PubMed

Mansnérus, Juli

2015-04-01

The lack of consensus on a common definition of the term 'embryo' has resulted in legal uncertainty affecting the permissibility of human embryonic stem cell (hESC) research and the commercialisation prospects and patenting of inventions of hESC origin in the EU. The Brüstle v. Greenpeace case, which by providing a very broad definition of a human embryo restricts the patentability of hESC-based inventions, aims at harmonising the patenting practices regarding interpretation of Article 6.2.c of Directive 98/44/ EC. It fills the gaps in national laws by providing binding interpretation guidelines for national courts. As currently no marketing authorisations have been granted to hESC-based products, implications of this judgment for translational hESC research together with other barriers to commercialisation of such research need to be analysed. In addition, whether the main obstacles relate to patenting restrictions or whether something else in the innovation system is impeding the market entry of these innovative products is discussed.

Opportunities and barriers to establishing a cell therapy programme in South Africa

PubMed Central

2013-01-01

The establishment of a cell therapy programme in South Africa has the potential to contribute to the alleviation of the country’s high disease burden and also to contribute to economic growth. South Africa has various positive attributes that favour the establishment of such a high-profile venture; however, there are also significant obstacles which need to be overcome. We discuss the positive and negative features of the current health biotechnology sector. The positive factors include a strong market pull and a highly innovative scientific and medical community, while the most problematic features include the lack of human resources and education and limited funding. The South African Government has undertaken to strengthen the biotechnology sector in general, but a focus on cell therapy is lacking. The next important step would be to provide financial, legal/ethical and other support for groups that are active and productive in this field through the development of a local cell therapy programme. PMID:23719318

Medical Readiness of the Reserve Component.

PubMed

Brauner, Marygail K; Jackson, Timothy; Gayton, Elizabeth

2012-01-01

The reserve components (RCs) of the U.S. military must ensure that reservists are not only properly equipped and trained, but also medically ready to serve. Medical readiness means that service members are free from health-related conditions, including dental conditions, that could limit their ability to carry out their duties. Medically ready reservists require less medical and dental support in theater and fewer medical evacuations from theater, both of which save money and free assets for other purposes. This article identifies existing medical readiness requirements, quantifies the current status of RC medical readiness, identifies obstacles to achieving compliance, and suggests options for improving medical readiness in a cost-effective manner. The authors find that time and expense are the major barriers to the RCs achieving their overall goals for medical readiness. Recommendations include standardizing medical readiness criteria across services, improving data reporting and archiving processes, providing incentives to individuals and units to achieve medical readiness, and continuing to extend TRICARE coverage to reservists prior to deployment.

Mussel adhesion is dictated by time-regulated secretion and molecular conformation of mussel adhesive proteins

NASA Astrophysics Data System (ADS)

Petrone, Luigi; Kumar, Akshita; Sutanto, Clarinda N.; Patil, Navinkumar J.; Kannan, Srinivasaraghavan; Palaniappan, Alagappan; Amini, Shahrouz; Zappone, Bruno; Verma, Chandra; Miserez, Ali

2015-10-01

Interfacial water constitutes a formidable barrier to strong surface bonding, hampering the development of water-resistant synthetic adhesives. Notwithstanding this obstacle, the Asian green mussel Perna viridis attaches firmly to underwater surfaces via a proteinaceous secretion (byssus). Extending beyond the currently known design principles of mussel adhesion, here we elucidate the precise time-regulated secretion of P. viridis mussel adhesive proteins. The vanguard 3,4-dihydroxy-L-phenylalanine (Dopa)-rich protein Pvfp-5 acts as an adhesive primer, overcoming repulsive hydration forces by displacing surface-bound water and generating strong surface adhesion. Using homology modelling and molecular dynamics simulations, we find that all mussel adhesive proteins are largely unordered, with Pvfp-5 adopting a disordered structure and elongated conformation whereby all Dopa residues reside on the protein surface. Time-regulated secretion and structural disorder of mussel adhesive proteins appear essential for optimizing extended nonspecific surface interactions and byssus' assembly. Our findings reveal molecular-scale principles to help the development of wet-resistant adhesives.

Sociobehavioural research methods for the introduction of vaccines in the Diseases of the Most Impoverished Programme.

PubMed

Kaljee, Linda M; Pack, Rob; Pach, Al; Nyamete, Andrew; Stanton, Bonita F

2004-09-01

Participation in vaccination campaigns worldwide, particularly the Expanded Programme on Immunization, has increased significantly in recent years. However, there remain multiple and integrated behavioural, sociocultural and political-economic barriers to vaccination. The Diseases of the Most Impoverished (DOMI) Programme has undertaken shigellosis disease-burden studies and oral cholera and typhoid Vi polysaccharide vaccine trials in seven Asian countries. As part of these projects, sociobehavioural studies have been undertaken to determine the potential demand for vaccines for these diseases and the obstacles and enabling factors that may affect acceptance, delivery, and use of vaccines. A theoretical model of acceptance of vaccination and a triangulation of qualitative and quantitative methods have been used for fully elucidating the range of issues relating to vaccination for shigellosis, cholera, and typhoid fever. In this paper, the theoretical and methodological basis of the DOMI projects has been reviewed in a context of current sociobehavioural research on the acceptability and desirability of vaccination.

Ravens, Corvus corax, follow gaze direction of humans around obstacles.

PubMed Central

Bugnyar, Thomas; Stöwe, Mareike; Heinrich, Bernd

2004-01-01

The ability to follow gaze (i.e. head and eye direction) has recently been shown for social mammals, particularly primates. In most studies, individuals could use gaze direction as a behavioural cue without understanding that the view of others may be different from their own. Here, we show that hand-raised ravens not only visually co-orient with the look-ups of a human experimenter but also reposition themselves to follow the experimenter's gaze around a visual barrier. Birds were capable of visual co-orientation already as fledglings but consistently tracked gaze direction behind obstacles not before six months of age. These results raise the possibility that sub-adult and adult ravens can project a line of sight for the other person into the distance. To what extent ravens may attribute mental significance to the visual behaviour of others is discussed. PMID:15306330

Rural Veteran Access to Healthcare Services: Investigating the Role of Information and Communication Technologies in Overcoming Spatial Barriers

PubMed Central

Schooley, Benjamin L; Horan, Thomas A; Lee, Pamela W; West, Priscilla A

2010-01-01

This multimethod pilot study examined patient and practitioner perspectives on the influence of spatial barriers to healthcare access and the role of health information technology in overcoming these barriers. The study included a survey administered to patients attending a Department of Veterans Affairs (VA) health visit, and a focus group with VA care providers. Descriptive results and focus group findings are presented. Spatial distance is a significant factor for many rural veterans when seeking healthcare. For this sample of rural veterans, a range of telephone, computer, and Internet technologies may become more important for accessing care as Internet access becomes more ubiquitous and as younger veterans begin using the VA health system. The focus group highlighted the negative impact of distance, economic considerations, geographic barriers, and specific medical conditions on access to care. Lack of adequate technology infrastructure was seen as an obstacle to utilization. This study discusses the need to consider distance, travel modes, age, and information technology infrastructure and adoption when designing health information technology to care for rural patients. PMID:20697468

Different protocols for analyzing behavior and adaptability in obstacle crossing in Parkinson’s disease

PubMed Central

Mollaei, Nafiseh; Bicho, Estela; Sousa, Nuno; Gago, Miguel Fernandes

2017-01-01

Imbalance and tripping over obstacles as a result of altered gait in older adults, especially in patients with Parkinson’s disease (PD), are one of the most common causes of falls. During obstacle crossing, patients with PD modify their behavior in order to decrease the mechanical demands and enhance dynamic stability. Various descriptions of dynamic traits of gait that have been collected over longer periods, probably better synthesize the underlying structure and pattern of fluctuations in gait and can be more sensitive markers of aging or early neurological dysfunction and increased risk of falls. This confirmation challenges the clinimetric of different protocols and paradigms used for gait analysis up till now, in particular when analyzing obstacle crossing. The authors here present a critical review of current knowledge concerning the interplay between the cognition and gait in aging and PD, emphasizing the differences in gait behavior and adaptability while walking over different and challenging obstacle paradigms, and the implications of obstacle negotiation as a predictor of falls. Some evidence concerning the effectiveness of future rehabilitation protocols on reviving obstacle crossing behavior by trial and error relearning, taking advantage of dual-task paradigms, physical exercise, and virtual reality have been put forward in this article. PMID:29158667

Substance Abuse: A Hidden Problem within the D/deaf and Hard of Hearing Communities

ERIC Educational Resources Information Center

Guthmann, Debra; Graham, Vicki

2004-01-01

Current research indicates that D/deaf and hard of hearing clients seeking treatment for substance abuse often encounter obstacles in receiving the help they need. Many of these obstacles are the result of a lack of knowledge and experience with regard to treating D/deaf and hard of hearing people. Programs designed for hearing people that attempt…

A Different Kind of Smart: A Study of the Educational Obstacles Confronting Homeless Youth in New England.

ERIC Educational Resources Information Center

Wilson, Melanie; Houghton, Alison

This study provides information on obstacles facing homeless youth in school. Research occurred in four diverse New England cities. Researchers collected detailed case histories on youth age 10-15 years who were currently homeless or who had recently been homeless. Data came from staff of local youth agencies, government officials, and youths…

Turkish Teachers' Use of the Outdoors as a Teaching Resource: Perceived Facilitators and Obstacles

ERIC Educational Resources Information Center

Lane, Jennie F.; Ateskan, Armagan; Dulun, Öykü

2018-01-01

Several studies have investigated teachers' use of local environments. There has been limited research in Turkey about teacher perceptions of facilitators and obstacles. The current study received permission to use a survey conducted in the United States and to administer it to alumni of a teacher education program in Turkey. Compared to other…

Ubiquitous Health in Korea: Progress, Barriers, and Prospects

PubMed Central

Lee, Yountae

2012-01-01

Objectives Korea has one of the most advanced information technology (IT) infrastructures in the world, and the application of IT in health systems is rapidly progressing from computerization to information systems, ubiquitous systems, and smart systems. This study aims to analyze Korean environments in regards to the development of their u-Health industry and propose directions for u-Healthcare services based on this analysis. Methods This paper reviews the background, progress history, and current status of u-Health in Korea, and suggests strategies for the u-Health industry based on an analysis of its barriers and obstacles. Results When u-Health was introduced to Koreans, their policies and approaches focused mainly on environmental factors, yet these efforts have not progressed further to impact the u-Healthcare service industry itself. To develop the u-Healthcare industry, four points need to be considered: the development and support of the practical service model, institutional support, support of core technology and industry, and the institutionalization of health management service. Conclusions Korea is at a strategic point to start building u-Healthcare service delivery models. u-Healthcare is a healthcare service that provides added value through u-Health environments. By identifying critical success factors in u-Healthcare, we can strengthen the u-Health industry and implement policies to coordinate our efforts in the process of value chains to which we belong. PMID:23346474

Occupancy change detection system and method

DOEpatents

Bruemmer, David J [Idaho Falls, ID; Few, Douglas A [Idaho Falls, ID

2009-09-01

A robot platform includes perceptors, locomotors, and a system controller. The system controller executes instructions for producing an occupancy grid map of an environment around the robot, scanning the environment to generate a current obstacle map relative to a current robot position, and converting the current obstacle map to a current occupancy grid map. The instructions also include processing each grid cell in the occupancy grid map. Within the processing of each grid cell, the instructions include comparing each grid cell in the occupancy grid map to a corresponding grid cell in the current occupancy grid map. For grid cells with a difference, the instructions include defining a change vector for each changed grid cell, wherein the change vector includes a direction from the robot to the changed grid cell and a range from the robot to the changed grid cell.

Representative of America: Creating Inclusion in the Senior Executive Service

DTIC Science & Technology

2012-02-27

to reach the upper echelons of organizations in America. According to a 1995 study commissioned by the Federal Glass Ceiling Commission, “97% of the...There is a direct correlation between the similarity/attraction theory and the Glass Ceiling and barriers in DoD that may be a Purple Ceiling (senior...managers who are former military officers).17 The Glass Ceiling refers to obstacles that often confront ethnic groups and females as they attempt

A tool to assess knowledge, attitude and behavior of Indonesian health care workers regarding infection control.

PubMed

Duerink, D O; Hadi, U; Lestari, E S; Roeshadi, Djoko; Wahyono, Hendro; Nagelkerke, N J D; Van der Meulen, R G; Van den Broek, P J

2013-07-01

to investigate knowledge, attitude and behaviour toward infection control in two teaching hospitals on the island of Java by means of a questionnaire and to evaluate the use of the questionnaire as a tool. we investigated knowledge, attitude and behaviour toward infection control in two teaching hospitals on the island of Java by means of a questionnaire to identify problem areas, barriers and facilitators. The target was to include at least 50% of all health care workers (physicians, nurses, assistant nurses and infection control nurses) in each hospital, department and profession. Differences between demographic variables and scores for individual questions and groups of questions were compared using the chi-square statistic and analysis of variance and Spearman's rho was used to test for correlations between knowledge, attitude, self-reported behaviour and perceived obstacles. more than half of the health care workers of the participating departments completed the questionnaire. Of the 1036 respondents (44% nurses, 37% physicians and 19% assistant nurses), 34% were vaccinated against hepatitis B, 77% had experienced needle stick accidents and 93% had been instructed about infection control. The mean of the correct answers to the knowledge questions was 44%; of the answers to the attitude questions 67% were in agreement with the correct attitude; obstacles to compliance with infection control guidelines were perceived in 30% of the questions and the mean self-reported compliance was 63%. Safe handling of sharps, hand hygiene and the use of personal protective equipment were identified as the most important aspects for interventions. Significant positive correlations were found between knowledge, attitude, self-reported behaviour and perceived obstacles. the questionnaire in conjunction with site visits and interviews was a valuable strategy to identify trouble spots in the hospitals and to determine barriers to facilitators of change that should be taken into account when planning interventions. Successful interventions should cover hospital management, the infection control team, as well as the health care workers on the wards.

Obstacles to implementing evidence-based practice in Belgium: a context-specific qualitative evidence synthesis including findings from different health care disciplines.

PubMed

Hannes, K; Goedhuys, J; Aertgeerts, B

2012-01-01

A number of barriers to the implementation of evidence-based practice have already been inventoried. However, little attention has been given to their context-specific nature. This qualitative evidence synthesis examines commonalities in the obstacles perceived by different groups of health care practitioners working in the Belgian health care system and sets out to discuss potential strategies to bridge some of these barriers. We actively searched for primary studies addressing our topic of interest in international and national databases (1990 to May 2008), consulted experts and screened references of retrieved studies. We opted for the meta-aggregative approach, developed by the Joanna Briggs Institute, to analyse our findings. The findings indicate that (1) evidence might have a limited role in decision-making processes; (2) aspects other than quality of care steer the evidence-based practice agenda; (3) some health care providers benefit less from evidence-based practice than others and (4) there is a lack of competences to put the evidence-based principles in practice. Belgian policy makers might consider health care system characteristics from and strategies developed or suggested by others to respond to country-specific obstacles. Examples include but are not limited to; (a) providing incentives for patient-centred care coordination and patient communication, (b) supporting practitioners interested in applying research-related activities, (c) considering direct access systems and interprofessional learning to respond to the demand for autonomous decision-making from satellite professional groups, (d) systematically involving allied health professionals in important governmental advisory boards, (e) considering pharmaceutical companies perceived as 'the enemy' an ally in filling in research gaps, (f) embedding the evaluation of evidence-based knowledge and skills in examinations (g) moving from (in)formative learning to transformative learning and (h) organizing high quality catch-up programs for those who missed out on evidence-based medicine in their curriculum.

[Approaches, knowledge and capabilities of nurses and physicians regarding evidence-based clinical practice in the Imbadura province (Ecuador)].

PubMed

Molina Mula, Jesús; Muñoz Navarro, Paulina; Vaca Auz, Janeth; Cabascango Cabascango, Carmita; Cabascango Cabascango, Katty

2015-01-01

The research raises the need to increase understanding of organizational and personal factors that influence the attitude and aptitude of each professional, with respect to evidence-based clinical practice. The aim of this study is to describe the transfer of knowledge into clinical practice in hospital units in Imbabura (Ecuador) identifying the obstacles to implementing evidence-based clinical practice validated questionnaire EBPQ-19. A cross-sectional observational study was conducted in hospitals of the Ministry of Public Health of Imbabura of Ecuador took place, including a total of 281 nurses and physicians. Nurses and physicians showed positive attitudes toward evidence-based clinical practice (EBCP) and their use to support clinical decision-making. This research evidences perceptions of professionals on strategies for knowledge transfer and obstacles to carry it out. Significant differences between the perception of the use of EBCP strategies between nurses and physicians are observed. Physicians consider they use them frequently, while nurses acknowledge using them less (chi-square: 105.254, P=.018). In conclusion, we can say that these factors should be considered as necessary to improve the quality of care that is provided to users based on the best available evidence. It is necessary to start developing change interventions in this regard to remedy the current situation of clinical practice based not on evidence, but rather on experience only. Experimental studies demonstrating the effectiveness of strategies to eliminate barriers to scientific evidence-based clinical practice should be conducted. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Swedish nurses encounter barriers when promoting healthy habits in children.

PubMed

Ljungkrona-Falk, Lena; Brekke, Hilde; Nyholm, Maria

2014-12-01

To increase the understanding of difficulties in promoting healthy habits to parents, we explore barriers in health-care provision. The aim of this study is to describe nurses' perceived barriers when discussing with parents regarding healthy food habits, physical activity and their child's body weight. A mixed method approach was chosen. Nurses (n = 76) working at 29 different Child Health Care Centers' in an area in west Sweden were included in the study. Three focus group interviews were conducted and 17 nurses were selected according to maximum variation. Data were categorized and qualitative content analysis was the chosen analysis method. In the second method, data were obtained from a questionnaire distributed to all 76 nurses. The latent content was formulated into a theme: even with encouragement and support, the nurses perceive barriers of both an external and internal nature. The results identified four main barriers: experienced barriers in the workplace-internal and external; the nurse's own fear and uncertainty; perceived obstacles in nurse-parent interactions and modern society impedes parents' ability to promote healthy habits. The nurses' perceived barriers were confirmed by the results from 62 of the nurses who completed the questionnaire. Despite education and professional support, the health professionals perceived both external and internal barriers in promoting healthy habits to parents when implementing a new method of health promotion in primary care. Further qualitative studies are needed to gain deeper understanding of the perceived barriers when promoting healthy habits to parents. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Governance of quality of care: a qualitative study of health service boards in Victoria, Australia.

PubMed

Bismark, Marie M; Studdert, David M

2014-06-01

To describe the engagement of health service boards with quality-of-care issues and to identify factors that influence boards' activities in this area. We conducted semistructured interviews with 35 board members and executives from 13 public health services in Victoria, Australia. Interviews focused on the role currently played by boards in overseeing quality of care. We also elicited interviewees' perceptions of factors that have influenced their current approach to governance in this area. Thematic analysis was used to identify key themes from interview transcripts. Virtually all interviewees believed boards had substantial opportunities to influence the quality of care delivered within the service, chiefly through setting priorities, monitoring progress, holding staff to account and shaping culture. Perceived barriers to leveraging this influence included insufficient resources, gaps in skills and experience among board members, inadequate information on performance and regulatory requirements that miss the mark. Interviewees converged on four enablers of more effective quality governance: stronger regional collaborations; more tailored board training on quality issues; smarter use of reporting and accreditation requirements; and better access to data that was reliable, longitudinal and allowed for benchmarking against peer organisations. Although health service boards are eager to establish quality of care as a governance priority, several obstacles are blocking progress. The result is a gap between the rhetoric of quality governance and the reality of month-to-month activities at the board level. The imperative for effective board-level engagement in this area cannot be met until these barriers are addressed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The experiences of female athletic trainers in the role of the head athletic trainer.

PubMed

Mazerolle, Stephanie M; Burton, Laura; Cotrufo, Raymond J

2015-01-01

Very few women have leadership positions in athletic training (ie, head athletic training positions) in intercollegiate athletics. Research exists on the barriers to attaining the role; however, our understanding about the experiences of those currently engaged in the role is limited. To examine the experiences of female head athletic trainers as they worked toward and attained the position of head athletic trainer. Qualitative study. National Collegiate Athletic Association Division I setting. Eight female athletic trainers serving in the role of head athletic trainer participated in our study. The mean age of the participants was 45 ± 12 years, with 5 ± 1.5 years of experience in the role of head athletic trainer and 21 ± 10 years of experience as athletic trainers. We conducted phone interviews with the 8 participants following a semistructured format. Interviews were transcribed verbatim and analyzed following a general inductive approach as described by Thomas. To establish credibility, we used a peer reviewer, member checks, and multiple-analyst triangulation. Six major themes emerged from our analysis regarding the experiences of female head athletic trainers. Opportunities to become a head athletic trainer, leadership qualities, and unique personal characteristics were discussed as factors leading to the assumption of the role of the head athletic trainer. Where women hold back, family challenges, and organizational barriers speak to the potential obstacles to assuming the role of head athletic trainer. Female head athletic trainers did not seek the role, but through persistence and encouragement, they find themselves assuming the role. Leadership skills were discussed as important for success in the role of head athletic trainer. Life balancing and parenting were identified as barriers to women seeking the role of head athletic trainer.

Cancer nanomedicine: a review of recent success in drug delivery.

PubMed

Tran, Stephanie; DeGiovanni, Peter-Joseph; Piel, Brandon; Rai, Prakash

2017-12-11

Cancer continues to be one of the most difficult global healthcare problems. Although there is a large library of drugs that can be used in cancer treatment, the problem is selectively killing all the cancer cells while reducing collateral toxicity to healthy cells. There are several biological barriers to effective drug delivery in cancer such as renal, hepatic, or immune clearance. Nanoparticles loaded with drugs can be designed to overcome these biological barriers to improve efficacy while reducing morbidity. Nanomedicine has ushered in a new era for drug delivery by improving the therapeutic indices of the active pharmaceutical ingredients engineered within nanoparticles. First generation nanomedicines have received widespread clinical approval over the past two decades, from Doxil ® (liposomal doxorubicin) in 1995 to Onivyde ® (liposomal irinotecan) in 2015. This review highlights the biological barriers to effective drug delivery in cancer, emphasizing the need for nanoparticles for improving therapeutic outcomes. A summary of different nanoparticles used for drug delivery applications in cancer are presented. The review summarizes recent successes in cancer nanomedicine in the clinic. The clinical trials of Onivyde leading to its approval in 2015 by the Food and Drug Adminstration are highlighted as a case study in the recent clinical success of nanomedicine against cancer. Next generation nanomedicines need to be better targeted to specifically destroy cancerous tissue, but face several obstacles in their clinical development, including identification of appropriate biomarkers to target, scale-up of synthesis, and reproducible characterization. These hurdles need to be overcome through multidisciplinary collaborations across academia, pharmaceutical industry, and regulatory agencies in order to achieve the goal of eradicating cancer. This review discusses the current use of clinically approved nanomedicines, the investigation of nanomedicines in clinical trials, and the challenges that may hinder development of the nanomedicines for cancer treatment.

Perceived Barriers to Information Access Among Medical Residents in Iran: Obstacles to Answering Clinical Queries in Settings with Limited Internet Accessibility

PubMed Central

Mazloomdoost, Danesh; Mehregan, Shervineh; Mahmoudi, Hilda; Soltani, Akbar; Embi, Peter J.

2007-01-01

Studies performed in the US and other Western countries have documented that physicians generate many clinical questions during a typical day and rely on various information sources for answers. Little is known about the information seeking behaviors of physicians practicing in other countries, particularly those with limited Internet connectivity. We conducted this study to document the perceived barriers to information resources used by medical residents in Iran. Our findings reveal that different perceived barriers exist for electronic versus paper-based resources. Notably, paper-based resources are perceived to be limited by resident time-constraints and availability of resources, whereas electronic resources are limited by cost decentralized resources (such as PDAs) and accessibility of centralized, Internet access. These findings add to the limited literature regarding health information-seeking activities in international healthcare settings, particularly those with limited Internet connectivity, and will supplement future studies of and interventions in such settings. PMID:18693891

Perceived barriers to information access among medical residents in Iran: obstacles to answering clinical queries in settings with limited Internet accessibility.

PubMed

Mazloomdoost, Danesh; Mehregan, Shervineh; Mahmoudi, Hilda; Soltani, Akbar; Embi, Peter J

2007-10-11

Studies performed in the US and other Western countries have documented that physicians generate many clinical questions during a typical day and rely on various information sources for answers. Little is known about the information seeking behaviors of physicians practicing in other countries, particularly those with limited Internet connectivity. We conducted this study to document the perceived barriers to information resources used by medical residents in Iran. Our findings reveal that different perceived barriers exist for electronic versus paper-based resources. Notably, paper-based resources are perceived to be limited by resident time-constraints and availability of resources, whereas electronic resources are limited by cost decentralized resources (such as PDAs) and accessibility of centralized, Internet access. These findings add to the limited literature regarding health information-seeking activities in international healthcare settings, particularly those with limited Internet connectivity, and will supplement future studies of and interventions in such settings.

Next Steps for Science and Policy on Promoting Vegetable Consumption among US Infants and Young Children12

PubMed Central

Fisher, Jennifer O; Dwyer, Johanna T

2016-01-01

Vegetables are an important part of a healthy diet for infants and young children, but they are poorly accepted and underconsumed. This paper highlights major themes and research needs for understanding how to raise children to consume and enjoy vegetables as part of a healthful diet. A range of factors impedes US infants and young children from eating as many vegetables as experts consider optimal for child nutrition, health, and development. Barriers include biological and behavioral issues relating to infant and child development, household- and family-related barriers, obstacles in the larger community, economic limitations, and some government policies and programs. These barriers must be removed to encourage children to eat more vegetables. Research gaps also must be filled. We summarize the basic and applied research that is needed to craft more effective messages, devise strategies for parents and other child caretakers to take within households, develop action in the larger community, and modify some government policies and programs. PMID:26773035

Next Steps for Science and Policy on Promoting Vegetable Consumption among US Infants and Young Children.

PubMed

Fisher, Jennifer O; Dwyer, Johanna T

2016-01-01

Vegetables are an important part of a healthy diet for infants and young children, but they are poorly accepted and underconsumed. This paper highlights major themes and research needs for understanding how to raise children to consume and enjoy vegetables as part of a healthful diet. A range of factors impedes US infants and young children from eating as many vegetables as experts consider optimal for child nutrition, health, and development. Barriers include biological and behavioral issues relating to infant and child development, household- and family-related barriers, obstacles in the larger community, economic limitations, and some government policies and programs. These barriers must be removed to encourage children to eat more vegetables. Research gaps also must be filled. We summarize the basic and applied research that is needed to craft more effective messages, devise strategies for parents and other child caretakers to take within households, develop action in the larger community, and modify some government policies and programs. © 2016 American Society for Nutrition.

Physical Health Problems and Barriers to Optimal Health Care Among Children in Foster Care.

PubMed

Deutsch, Stephanie Anne; Fortin, Kristine

2015-10-01

Children and adolescents in foster care placement represent a unique population with special health care needs, often resulting from pre-placement early adversity and neglected, unaddressed health care needs. High rates of all health problems, including acute and/or chronic physical, mental, and developmental issues prevail. Disparities in health status and access to health care are observed. This article summarizes the physical health problems of children in foster care, who are predisposed to poor health outcomes when complex care needs are unaddressed. Despite recognition of the significant burden of health care need among this unique population, barriers to effective and optimal health care delivery remain. Legislative solutions to overcome obstacles to health care delivery for children in foster care are discussed. Copyright © 2015 Mosby, Inc. All rights reserved.

Targeting receptor-mediated transport for delivery of biologics across the blood-brain barrier.

PubMed

Lajoie, Jason M; Shusta, Eric V

2015-01-01

Biologics are an emerging class of medicines with substantial promise to treat neurological disorders such as Alzheimer's disease, stroke, and multiple sclerosis. However, the blood-brain barrier (BBB) presents a formidable obstacle that appreciably limits brain uptake and hence the therapeutic potential of biologics following intravenous administration. One promising strategy for overcoming the BBB to deliver biologics is the targeting of endogenous receptor-mediated transport (RMT) systems that employ vesicular trafficking to transport ligands across the BBB endothelium. If a biologic is modified with an appropriate targeting ligand, it can gain improved access to the brain via RMT. Various RMT-targeting strategies have been developed over the past 20 years, and this review explores exciting recent advances, emphasizing studies that show brain targeting in vivo.

Towards Improvements for Penetrating the Blood–Brain Barrier—Recent Progress from a Material and Pharmaceutical Perspective

PubMed Central

He, Quanguo; Liu, Jun; Liang, Jing; Liu, Xiaopeng; Li, Wen; Liu, Zhi; Ding, Ziyu; Tuo, Du

2018-01-01

The blood–brain barrier (BBB) is a critical biological structure that prevents damage to the brain and maintains its bathing microenvironment. However, this barrier is also the obstacle to deliver beneficial drugs to treat CNS (central nervous system) diseases. Many efforts have been made for improvement of delivering drugs across the BBB in recent years to treat CNS diseases. In this review, the anatomical and functional structure of the BBB is comprehensively discussed. The mechanisms of BBB penetration are summarized, and the methods and effects on increasing BBB permeability are investigated in detail. It also elaborates on the physical, chemical, biological and nanocarrier aspects to improve drug delivery penetration to the brain and introduces some specific drug delivery effects on BBB permeability. PMID:29570659

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

Aboriginal health workers experience multilevel barriers to quitting smoking: a qualitative study.

PubMed

Dawson, Anna P; Cargo, Margaret; Stewart, Harold; Chong, Alwin; Daniel, Mark

2012-05-23

Long-term measures to reduce tobacco consumption in Australia have had differential effects in the population. The prevalence of smoking in Aboriginal peoples is currently more than double that of the non-Aboriginal population. Aboriginal Health Workers are responsible for providing primary health care to Aboriginal clients including smoking cessation programs. However, Aboriginal Health Workers are frequently smokers themselves, and their smoking undermines the smoking cessation services they deliver to Aboriginal clients. An understanding of the barriers to quitting smoking experienced by Aboriginal Health Workers is needed to design culturally relevant smoking cessation programs. Once smoking is reduced in Aboriginal Health Workers, they may then be able to support Aboriginal clients to quit smoking. We undertook a fundamental qualitative description study underpinned by social ecological theory. The research was participatory, and academic researchers worked in partnership with personnel from the local Aboriginal health council. The barriers Aboriginal Health Workers experience in relation to quitting smoking were explored in 34 semi-structured interviews (with 23 Aboriginal Health Workers and 11 other health staff) and 3 focus groups (n = 17 participants) with key informants. Content analysis was performed on transcribed text and interview notes. Aboriginal Health Workers spoke of burdensome stress and grief which made them unable to prioritise quitting smoking. They lacked knowledge about quitting and access to culturally relevant quitting resources. Interpersonal obstacles included a social pressure to smoke, social exclusion when quitting, and few role models. In many workplaces, smoking was part of organisational culture and there were challenges to implementation of Smokefree policy. Respondents identified inadequate funding of tobacco programs and a lack of Smokefree public spaces as policy level barriers. The normalisation of smoking in Aboriginal society was an overarching challenge to quitting. Aboriginal Health Workers experience multilevel barriers to quitting smoking that include personal, social, cultural and environmental factors. Multidimensional smoking cessation programs are needed that reduce the stress and burden for Aboriginal Health Workers; provide access to culturally relevant quitting resources; and address the prevailing normalisation of smoking in the family, workplace and community.

Aboriginal Health Workers experience multilevel barriers to quitting smoking: a qualitative study

PubMed Central

2012-01-01

Introduction Long-term measures to reduce tobacco consumption in Australia have had differential effects in the population. The prevalence of smoking in Aboriginal peoples is currently more than double that of the non-Aboriginal population. Aboriginal Health Workers are responsible for providing primary health care to Aboriginal clients including smoking cessation programs. However, Aboriginal Health Workers are frequently smokers themselves, and their smoking undermines the smoking cessation services they deliver to Aboriginal clients. An understanding of the barriers to quitting smoking experienced by Aboriginal Health Workers is needed to design culturally relevant smoking cessation programs. Once smoking is reduced in Aboriginal Health Workers, they may then be able to support Aboriginal clients to quit smoking. Methods We undertook a fundamental qualitative description study underpinned by social ecological theory. The research was participatory, and academic researchers worked in partnership with personnel from the local Aboriginal health council. The barriers Aboriginal Health Workers experience in relation to quitting smoking were explored in 34 semi-structured interviews (with 23 Aboriginal Health Workers and 11 other health staff) and 3 focus groups (n = 17 participants) with key informants. Content analysis was performed on transcribed text and interview notes. Results Aboriginal Health Workers spoke of burdensome stress and grief which made them unable to prioritise quitting smoking. They lacked knowledge about quitting and access to culturally relevant quitting resources. Interpersonal obstacles included a social pressure to smoke, social exclusion when quitting, and few role models. In many workplaces, smoking was part of organisational culture and there were challenges to implementation of Smokefree policy. Respondents identified inadequate funding of tobacco programs and a lack of Smokefree public spaces as policy level barriers. The normalisation of smoking in Aboriginal society was an overarching challenge to quitting. Conclusions Aboriginal Health Workers experience multilevel barriers to quitting smoking that include personal, social, cultural and environmental factors. Multidimensional smoking cessation programs are needed that reduce the stress and burden for Aboriginal Health Workers; provide access to culturally relevant quitting resources; and address the prevailing normalisation of smoking in the family, workplace and community. PMID:22621767

Dynamic traversal of high bumps and large gaps by a small legged robot

NASA Astrophysics Data System (ADS)

Gart, Sean; Winey, Nastasia; de La Tijera Obert, Rafael; Li, Chen

Small animals encounter and negotiate diverse obstacles comparable in size or larger than themselves. In recent experiments, we found that cockroaches can dynamically traverse bumps up to 4 times hip height and gaps up to 1 body length. To better understand the physics that governs these locomotor transitions, we studied a small six-legged robot negotiating high bumps and large gaps and compared it to animal observations. We found that the robot was able to traverse bumps as large as 1 hip height and gaps as wide as 0.5 body length. For the bump, the robot often climbed over to traverse when initial body yaw was small, but was often deflected laterally and failed to traverse when initial body yaw was large. A simple locomotion energy landscape model explained these observations. For the gap, traversal probability decreased with gap width, which was well explained by a simple Lagrangian model of a forward-moving rigid body falling over the gap edge. For both the bump and the gap, animal performance far exceeded that of the robot, likely due to their relatively higher running speeds and larger rotational oscillations prior to and during obstacle traversal. Differences between animal and robot obstacle negotiation behaviors revealed that animals used active strategies to overcome potential energy barriers.

Prediction of air blast mitigation in an array of rigid obstacles using smoothed particle hydrodynamics

NASA Astrophysics Data System (ADS)

Prasanna Kumar, S. S.; Patnaik, B. S. V.; Ramamurthi, K.

2018-04-01

The mitigation of blast waves propagating in air and interacting with rigid barriers and obstacles is numerically investigated using the mesh-free smoothed particle hydrodynamics method. A novel virtual boundary particle procedure with a skewed gradient wall boundary treatment is applied at the interfaces between air and rigid bodies. This procedure is validated with closed-form solutions for strong and weak shock reflection from rigid surfaces, supersonic flows over a wedge, formation of reflected, transverse, and Mach stem shocks, and also earlier experiments on interaction of a blast wave with concrete blocks. The mitigation of the overpressure and impulse transmitted to the protected structure due to an array of rigid obstacles of different shapes placed in the path of the blast wave is thereafter determined and discussed in the context of the existing experimental and numerical studies. It is shown that blockages having the shape of a right facing triangle or square placed in tandem or staggered provide better mitigation. The influence of the distance between the blockage array and protected structure is assessed, and the incorporation of a gap in the blockages is shown to improve the mitigation. The mechanisms responsible for the attenuation of air blast are identified through the simulations.

Increase the success of weight loss programs by creating an environment for change.

PubMed

Churchill, Julie

2010-12-01

Veterinary professionals frequently recommend weight loss programs for pets, but success is often elusive. By learning techniques to assess clients' readiness for change, the veterinary team can apply communication tools and strategies to help clients overcome obstacles and barriers to sustainable change. With a better assessment of a client's ability to change, a weight loss plan can be implemented at the right time in the right way to achieve better adherence to the agreed-upon plan and improve patient health.

Barriers and facilitators among health professionals in primary care to prevention of cardiometabolic diseases: A systematic review.

PubMed

Wändell, Per E; de Waard, Anne-Karien M; Holzmann, Martin J; Gornitzki, Carl; Lionis, Christos; de Wit, Niek; Søndergaard, Jens; Sønderlund, Anders L; Kral, Norbert; Seifert, Bohumil; Korevaar, Joke C; Schellevis, François G; Carlsson, Axel C

2018-01-29

The aim of this study is to identify potential facilitators and barriers for health care professionals to undertake selective prevention of cardiometabolic diseases (CMD) in primary health care. We developed a search string for Medline, Embase, Cinahl and PubMed. We also screened reference lists of relevant articles to retain barriers and facilitators for prevention of CMD. We found 19 qualitative studies, 7 quantitative studies and 2 mixed qualitative and quantitative studies. In terms of five overarching categories, the most frequently reported barriers and facilitators were as follows: Structural (barriers: time restraints, ineffective counselling and interventions, insufficient reimbursement and problems with guidelines; facilitators: feasible and effective counselling and interventions, sufficient assistance and support, adequate referral, and identification of obstacles), Organizational (barriers: general organizational problems, role of practice, insufficient IT support, communication problems within health teams and lack of support services, role of staff, lack of suitable appointment times; facilitators: structured practice, IT support, flexibility of counselling, sufficient logistic/practical support and cooperation with allied health staff/community resources, responsibility to offer and importance of prevention), Professional (barriers: insufficient counselling skills, lack of knowledge and of experience; facilitators: sufficient training, effective in motivating patients), Patient-related factors (barriers: low adherence, causes problems for patients; facilitators: strong GP-patient relationship, appreciation from patients), and Attitudinal (barriers: negative attitudes to prevention; facilitators: positive attitudes of importance of prevention). We identified several frequently reported barriers and facilitators for prevention of CMD, which may be used in designing future implementation and intervention studies. © The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Relationship between performance barriers and pharmacist competency towards the implementation of an expanded public health pharmacy role.

PubMed

Mathialagan, Amuthaganesh; Nagalinggam, Preesha; Mathialagan, Saravanabavan; Kirby, Brian P

2015-10-01

The objective of this study was to examine the relationship between performance barriers and competency, and implementation of an expanded public health role for community pharmacists. A validated questionnaire was utilised for this study whereby three variables of the study (performance barriers, competency and public health role) were measured using a 5-point Likert scale. Three hundred questionnaires were distributed to target respondents of registered community pharmacies in five states (Johor, Negeri Sembilan, Selangor, Perak and Penang) in Malaysia. The data were analysed utilising the principles of structural equation modelling. There were 191 completed and usable responses received, which represented a 66.7% response rate. This study showed perceived competency had a direct relationship with delivering a general public health role. A perceived lack of competency was shown to be a barrier to fulfilling a public health role. However, other factors, such as design of premises, IT infrastructure and pay, were not viewed as barriers to carrying out a public health role. Perceived competency is an obstacle for community pharmacists to undertake a public health role in Malaysia. Adequate training programmes in pharmaceutical public health have to be put in place to address this concern and this should therefore be a priority. © 2015 Royal Pharmaceutical Society.

Injection Drug Users' Perceived Barriers to Using Self-Initiated Harm Reduction Strategies.

PubMed

Bonar, Erin E; Rosenberg, Harold

2014-08-01

Increasing the frequency with which injecting drug users (IDUs) engage in self-initiated harm reduction strategies could improve their health, but few investigations have examined IDUs' perceived barriers to engaging in these behaviors. We interviewed 90 IDUs recruited from needle exchanges to assess: a) perceived obstacles to their use of two specific harm reduction strategies (i.e., test shots and pre-injection skin cleaning) designed to reduce two unhealthy outcomes (i.e., overdose and bacterial infections, respectively) and b) their use of other risk-reduction practices. The most frequently cited barrier for both test shots and skin cleaning was being in a rush to inject one's drugs. Other, less commonly cited barriers were strategy-specific (e.g., buying drugs from a known dealer as a reason not to do a test shot; not having access to cleaning supplies as a reason not to clean skin). Regarding other risk reduction practices, participants' most frequently reported using new or clean injecting supplies and avoiding sharing needles and injecting supplies. Some, but not all, of the barriers generated by participants in our study were similar to those frequently reported in other investigations, perhaps due to differences in the type of sample recruited or in the harm reduction behaviors investigated.

Injection Drug Users’ Perceived Barriers to Using Self-Initiated Harm Reduction Strategies

PubMed Central

Rosenberg, Harold

2014-01-01

Introduction and Aims Increasing the frequency with which injecting drug users (IDUs) engage in self-initiated harm reduction strategies could improve their health, but few investigations have examined IDUs’ perceived barriers to engaging in these behaviors. Method We interviewed 90 IDUs recruited from needle exchanges to assess: a) perceived obstacles to their use of two specific harm reduction strategies (i.e., test shots and pre-injection skin cleaning) designed to reduce two unhealthy outcomes (i.e., overdose and bacterial infections, respectively) and b) their use of other risk-reduction practices. Results The most frequently cited barrier for both test shots and skin cleaning was being in a rush to inject one’s drugs. Other, less commonly cited barriers were strategy-specific (e.g., buying drugs from a known dealer as a reason not to do a test shot; not having access to cleaning supplies as a reason not to clean skin). Regarding other risk reduction practices, participants’ most frequently reported using new or clean injecting supplies and avoiding sharing needles and injecting supplies. Discussion and Conclusions Some, but not all, of the barriers generated by participants in our study were similar to those frequently reported in other investigations, perhaps due to differences in the type of sample recruited or in the harm reduction behaviors investigated. PMID:25419201

Transportation Energy Futures Series: Non-Cost Barriers to Consumer Adoption of New Light-Duty Vehicle Technologies

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

Stephens, T.

2013-03-01

Consumer preferences are key to the adoption of new vehicle technologies. Barriers to consumer adoption include price and other obstacles, such as limited driving range and charging infrastructure; unfamiliarity with the technology and uncertainty about direct benefits; limited makes and models with the technology; reputation or perception of the technology; standardization issues; and regulations. For each of these non-cost barriers, this report estimates an effective cost and summarizes underlying influences on consumer preferences, approximate magnitude and relative severity, and assesses potential actions, based on a comprehensive literature review. While the report concludes that non-cost barriers are significant, effective cost andmore » potential market share are very uncertain. Policies and programs including opportunities for drivers to test drive advanced vehicles, general public outreach and information programs, incentives for providing charging and fueling infrastructure, and development of technology standards were examined for their ability to address barriers, but little quantitative data exists on the effectiveness of these measures. This is one in a series of reports produced as a result of the Transportation Energy Futures project, a Department of Energy-sponsored multi-agency effort to pinpoint underexplored strategies for reducing GHGs and petroleum dependence related to transportation.« less

Effect of thermal barrier coatings on the performance of steam and water-cooled gas turbine/steam turbine combined cycle system

NASA Technical Reports Server (NTRS)

Nainiger, J. J.

1978-01-01

An analytical study was made of the performance of air, steam, and water-cooled gas-turbine/steam turbine combined-cycle systems with and without thermal-barrier coatings. For steam cooling, thermal barrier coatings permit an increase in the turbine inlet temperature from 1205 C (2200 F), resulting in an efficiency improvement of 1.9 percentage points. The maximum specific power improvement with thermal barriers is 32.4 percent, when the turbine inlet temperature is increased from 1425 C (2600 F) to 1675 C (3050 F) and the airfoil temperature is kept the same. For water cooling, the maximum efficiency improvement is 2.2 percentage points at a turbine inlet temperature of 1683 C (3062 F) and the maximum specific power improvement is 36.6 percent by increasing the turbine inlet temperature from 1425 C (2600 F) to 1730 C (3150 F) and keeping the airfoil temperatures the same. These improvements are greater than that obtained with combined cycles using air cooling at a turbine inlet temperature of 1205 C (2200 F). The large temperature differences across the thermal barriers at these high temperatures, however, indicate that thermal stresses may present obstacles to the use of coatings at high turbine inlet temperatures.

Results of a feasibility study: barriers and facilitators in implementing the Sherbrooke model in France.

PubMed

Fassier, Jean-Baptiste; Durand, Marie-José; Caillard, Jean-François; Roquelaure, Yves; Loisel, Patrick

2015-05-01

Return-to-work interventions associated with the workplace environment are often more effective than conventional care. The Sherbrooke model is an integrated intervention that has proved successful in preventing work disability due to low-back pain. Implementation, however, runs up against many obstacles, and failure has been reported in many countries. The present study sought to identify barriers to and facilitators of the implementation of the Sherbrooke model within the French health system. A multiple case study with nested levels of analysis was performed in two regions of France. A conceptual framework was designed and refined to identify barriers and facilitators at the individual, organizational and contextual levels. Qualitative data were collected via semi-structured interview (N=22), focus groups (N=7), and observation and from the gray literature. Participants (N=61) belonged to three fields: healthcare, social insurance, and the workplace. Numerous barriers and facilitators were identified in each field and at each level, some specific and others common to workers in all fields. Individual and organizational barriers comprised lack of time and resources, discordant professional values, and perceived risk. Legal barriers comprised medical confidentiality, legal complexity, and priority given to primary prevention. Individual-level facilitators comprised needs and perceived benefits. Some organizations had concordant values and practices. Legal facilitators comprised possibilities of collaboration and gradual return to work. The present feasibility analysis of implementing the Sherbrooke model revealed numerous barriers and facilitators suggesting a new implementation strategy be drawn up if failure is to be avoided.

Reducing Stator Current Harmonics for a Doubly-Fed Induction Generator Connected to a Distorted Grid

DTIC Science & Technology

2013-09-01

electric grid voltage harmonics, which is a potential obstacle for implementing stable wind -energy systems. Two existing rotor voltage controllers...electric grid voltage harmonics, which is a potential obstacle for implementing stable wind -energy systems. Two existing rotor voltage controllers...speed of the DFIG can be adjusted to optimize turbine efficiency for given wind conditions. A common method for controlling the operating speed is

Do characteristics of a stationary obstacle lead to adjustments in obstacle stepping strategies?

PubMed

Worden, Timothy A; De Jong, Audrey F; Vallis, Lori Ann

2016-01-01

Navigating cluttered and complex environments increases the risk of falling. To decrease this risk, it is important to understand the influence of obstacle visual cues on stepping parameters, however the specific obstacle characteristics that have the greatest influence on avoidance strategies is still under debate. The purpose of the current work is to provide further insight on the relationship between obstacle appearance in the environment and modulation of stepping parameters. Healthy young adults (N=8) first stepped over an obstacle with one visible top edge ("floating"; 8 trials) followed by trials where experimenters randomly altered the location of a ground reference object to one of 7 different positions (8 trials per location), which ranged from 6cm in front of, directly under, or up to 6cm behind the floating obstacle (at 2cm intervals). Mean take-off and landing distance as well as minimum foot clearance values were unchanged across different positions of the ground reference object; a consistent stepping trajectory was observed for all experimental conditions. Contrary to our hypotheses, results of this study indicate that ground based visual cues are not essential for the planning of stepping and clearance strategies. The simultaneous presentation of both floating and ground based objects may have provided critical information that lead to the adoption of a consistent strategy for clearing the top edge of the obstacle. The invariant foot placement observed here may be an appropriate stepping strategy for young adults, however this may not be the case across the lifespan or in special populations. Copyright © 2015 Elsevier B.V. All rights reserved.

Obstacles to the discussion of sexual problems in menopausal women: a qualitative study of healthcare providers.

PubMed

Ghazanfarpour, Masoumeh; Khadivzadeh, Talat; Latifnejad Roudsari, Robab; Mehdi Hazavehei, Seyed Mohammad

2017-07-01

The aim of this study was to explore issues that challenge menopausal women in discussions of their sexual problems with a physician. This was done from the perspective of healthcare providers. In a descriptive exploratory qualitative study, using a semi-structured interview and purposive sampling, a sample set of 12 midwives and 13 general practitioners aged 25-70 years were selected in order to elicit meaning behind their experiences about the subject under study. Data analysis was carried out using qualitative content analysis. Results were used to identify a number of obstacles that hindered women from seeking help for sexual problems from GPs and midwives. These obstacles included the following: (1) traditional and cultural beliefs; (2) religious belief; (3) individuals' beliefs and (4) access to services. More research is needed to explore effective strategies to overcome these problems. Impact statement Current knowledge on the subject: In the literature, many reasons have been identified for the unwillingness of Iranian women to discuss their sexual problems with health providers. These include lack of time, feelings of shame and an expectation that a doctor cannot help. However, no qualitative study has addressed barriers held by menopausal women for seeking treatment for sexual problems. The contribution made by the results of this study: The results of this study add to the growing body of research on reasons that determine why most postmenopausal women rarely visit a doctor unless they were in tremendous physical or emotional pain. Also, menopausal women thought that an unmarried health provider would be less understanding about sexual and marital problems and they felt guilty about sharing such issues with them. Patients' opinions on the nature of menopause (a pathological vs. physiological process) affect the way in which the symptoms of menopause and sexual problems are handled by patient. The implications are of these findings for clinical practice and further research: The results of this study can be used to formulate guidelines to cultural sensitivity appropriate to Iranian society.

Path Planning Method in Multi-obstacle Marine Environment

NASA Astrophysics Data System (ADS)

Zhang, Jinpeng; Sun, Hanxv

2017-12-01

In this paper, an improved algorithm for particle swarm optimization is proposed for the application of underwater robot in the complex marine environment. Not only did consider to avoid obstacles when path planning, but also considered the current direction and the size effect on the performance of the robot dynamics. The algorithm uses the trunk binary tree structure to construct the path search space and A * heuristic search method is used in the search space to find a evaluation standard path. Then the particle swarm algorithm to optimize the path by adjusting evaluation function, which makes the underwater robot in the current navigation easier to control, and consume less energy.

Uptake Mechanism of ApoE-Modified Nanoparticles on Brain Capillary Endothelial Cells as a Blood-Brain Barrier Model

PubMed Central

Wagner, Sylvia; Zensi, Anja; Wien, Sascha L.; Tschickardt, Sabrina E.; Maier, Wladislaw; Vogel, Tikva; Worek, Franz; Pietrzik, Claus U.; Kreuter, Jörg; von Briesen, Hagen

2012-01-01

Background The blood-brain barrier (BBB) represents an insurmountable obstacle for most drugs thus obstructing an effective treatment of many brain diseases. One solution for overcoming this barrier is a transport by binding of these drugs to surface-modified nanoparticles. Especially apolipoprotein E (ApoE) appears to play a major role in the nanoparticle-mediated drug transport across the BBB. However, at present the underlying mechanism is incompletely understood. Methodology/Principal Findings In this study, the uptake of the ApoE-modified nanoparticles into the brain capillary endothelial cells was investigated to differentiate between active and passive uptake mechanism by flow cytometry and confocal laser scanning microscopy. Furthermore, different in vitro co-incubation experiments were performed with competing ligands of the respective receptor. Conclusions/Significance This study confirms an active endocytotic uptake mechanism and shows the involvement of low density lipoprotein receptor family members, notably the low density lipoprotein receptor related protein, on the uptake of the ApoE-modified nanoparticles into the brain capillary endothelial cells. This knowledge of the uptake mechanism of ApoE-modified nanoparticles enables future developments to rationally create very specific and effective carriers to overcome the blood-brain barrier. PMID:22396775

Uptake mechanism of ApoE-modified nanoparticles on brain capillary endothelial cells as a blood-brain barrier model.

PubMed

Wagner, Sylvia; Zensi, Anja; Wien, Sascha L; Tschickardt, Sabrina E; Maier, Wladislaw; Vogel, Tikva; Worek, Franz; Pietrzik, Claus U; Kreuter, Jörg; von Briesen, Hagen

2012-01-01

The blood-brain barrier (BBB) represents an insurmountable obstacle for most drugs thus obstructing an effective treatment of many brain diseases. One solution for overcoming this barrier is a transport by binding of these drugs to surface-modified nanoparticles. Especially apolipoprotein E (ApoE) appears to play a major role in the nanoparticle-mediated drug transport across the BBB. However, at present the underlying mechanism is incompletely understood. In this study, the uptake of the ApoE-modified nanoparticles into the brain capillary endothelial cells was investigated to differentiate between active and passive uptake mechanism by flow cytometry and confocal laser scanning microscopy. Furthermore, different in vitro co-incubation experiments were performed with competing ligands of the respective receptor. This study confirms an active endocytotic uptake mechanism and shows the involvement of low density lipoprotein receptor family members, notably the low density lipoprotein receptor related protein, on the uptake of the ApoE-modified nanoparticles into the brain capillary endothelial cells. This knowledge of the uptake mechanism of ApoE-modified nanoparticles enables future developments to rationally create very specific and effective carriers to overcome the blood-brain barrier.

Specific needs of families of young adults with profound intellectual disability during and after transition to adulthood: What are we missing?

PubMed

Gauthier-Boudreault, Camille; Gallagher, Frances; Couture, Mélanie

2017-07-01

At the age of 21, the trajectory of services offered to youth with profound intellectual disability (ID) change significantly since access to specialised services is more limited. Despite the desire of parents to avoid any impact on their child, several factors can influence the course of this transition. However, there is little research on facilitators and obstacles to the transition to adulthood, and impacts on people with a profound ID. It is therefore difficult to provide solutions that meet their specific needs. The study aimed to document the needs of parents and young adults with profound ID during and after the transition to adulthood by exploring their transitioning experience and factors that influenced it. Using a descriptive qualitative design, two individual semi-structured interviews were conducted with fourteen (14) parents of young adults aged between 18 and 26 with a profound ID. At this point, many material, informative, cognitive and emotional needs of young adults and their parents are not met. Obstacles, mainly organisational, persist and result in a particularly difficult transition to adulthood experience. By knowing the specific needs of these families, it is possible to develop and implement solutions tailored to their reality. WHAT THE PAPERS ADDS?: The transition to adulthood is a critical period for families with young adults with an intellectual disability (ID), a reality observed internationally. Current literature on all levels of ID suggests some barriers to transition that lead to negative impacts on both parents and young adults with ID. However, presently, very little research exists on the reality of families of young adults with profound ID and factors influencing transition to adult life. Most of studies target people with mild to moderate ID. Considering the significant disabilities of people with profound ID, it is possible to imagine that their experience of transition will be even more difficult and they will present specific needs. The lack of understanding of these needs makes it difficult to introduce solutions tailored to their reality. The results of this current study suggest that many needs of young adults with profound ID and their parents are not met despite existent transition planning services. Transition to adulthood seems particularly difficult for these families who face many challenges. Parents in this study proposed different obstacles during transition to adulthood that could be improved for creation of future solutions adapted to their reality. Copyright © 2017. Published by Elsevier Ltd.

Barriers along the care cascade of HIV-infected men in a large urban center of Brazil.

PubMed

Hoffmann, Michael; MacCarthy, Sarah; Batson, Ashley; Crawford-Roberts, Ann; Rasanathan, Jennifer; Nunn, Amy; Silva, Luis Augusto; Dourado, Ines

2016-01-01

Global and national HIV/AIDS policies utilize the care cascade to emphasize the importance of continued engagement in HIV services from diagnosis to viral suppression. Several studies have documented barriers that men experience in accessing services at specific stages of care, but few have analyzed how these barriers operate along the care cascade. Brazil offers a unique setting for analyzing barriers to HIV care because it is a middle-income country with a large HIV epidemic and free, universal access to HIV/AIDS services. Semi-structured interviews were conducted in 2011 with HIV-infected men (n = 25) receiving care at the only HIV/AIDS state reference center in Salvador, Brazil, the third largest city in the country. Interviews were transcribed and coded for analysis. Researchers identified barriers to services along the care cascade: health service-related obstacles (poor-quality care, lengthy wait times, and drug supply problems); psychosocial and emotional challenges (fear of disclosure and difficulty accepting HIV diagnosis); indirect costs (transportation and absenteeism at work or school); low perceived risk of HIV; and toxicity and complexity of antiretroviral drug (ARV) regimens. The stages of the care cascade interrupted by each barrier were also identified. Most barriers affected multiple, and often all, stages of care, while toxicity and complexity of ARV regimens was only present at a single care stage. Efforts to eliminate more prevalent barriers have the potential to improve care continuity at multiple stages. Going forward, assessing the relative impact of barriers along one's entire care trajectory can help tailor improvements in service provision, facilitate achievement of viral suppression, and improve access to life-saving testing, treatment, and care.

Contribution of Sudanese medical diaspora to the healthcare delivery system in Sudan: exploring options and barriers.

PubMed

Abdalla, Fayrouz Mohammed; Omar, Maye Abu; Badr, Elsheikh Elsiddig

2016-06-30

Medical diaspora options, including the engagement of expatriate physicians in development efforts within their home country, are being called for to reverse the effects of brain drain from developing countries. This paper presents the results of a study exploring the potential contributions for the Sudanese Medial Diaspora Options to the healthcare delivery system (HCDS) in Sudan, focusing on the options of temporal and permanent returns and the likely obstacles faced in their implementation. This was a cross-sectional study using a mixed methods design including quantitative and qualitative approaches. For the quantitative approach, the study, which focused on the possible contribution of the diaspora to healthcare delivery in Sudan, was based on an online survey using random purposive and snowballing sampling techniques involving 153 Sudanese physicians working in Saudi Arabia and other Gulf States, the United Kingdom, the Republic of Ireland, and the United States of America. The qualitative approach involved in-depth interviews with returnee physicians and key informants in Sudan, focusing on the return experiences, the barriers for return, and the options to improve future contributions. Despite contributions of the Sudanese medical diaspora being of a small scale considering the size of the phenomenon, as well as infrequent and not appropriately organized, their inputs to academia and the links built with overseas institutions and specialist clinical services were nevertheless remarkable. The main barrier to temporal return was inappropriate organization by the local counterparts, while those for permanent return of physicians were poor work environment, insufficient financial payment, unsecured accommodation, and offspring education. The study identified short-term return as a feasible option considering the country's current conditions. Proper coordination mechanisms for short-term returns and facilitation of permanent return through stakeholders' collaboration were proposed to improve diaspora contributions. The potentials of Sudanese medial diaspora contributions to the HCDS in Sudan are promising. Short-term contributions were observed as the best option for the current country situation. Creation of a coordinating body from within the healthcare sector in Sudan to effectively coordinate diaspora contributions is recommended.

Debris flow runup on vertical barriers and adverse slopes

USGS Publications Warehouse

Iverson, Richard M.; George, David L.; Logan, Matthew

2016-01-01

Runup of debris flows against obstacles in their paths is a complex process that involves profound flow deceleration and redirection. We investigate the dynamics and predictability of runup by comparing results from large-scale laboratory experiments, four simple analytical models, and a depth-integrated numerical model (D-Claw). The experiments and numerical simulations reveal the important influence of unsteady, multidimensional flow on runup, and the analytical models highlight key aspects of the underlying physics. Runup against a vertical barrier normal to the flow path is dominated by rapid development of a shock, or jump in flow height, associated with abrupt deceleration of the flow front. By contrast, runup on sloping obstacles is initially dominated by a smooth flux of mass and momentum from the flow body to the flow front, which precedes shock development and commonly increases the runup height. D-Claw simulations that account for the emergence of shocks show that predicted runup heights vary systematically with the adverse slope angle and also with the Froude number and degree of liquefaction (or effective basal friction) of incoming flows. They additionally clarify the strengths and limitations of simplified analytical models. Numerical simulations based on a priori knowledge of the evolving dynamics of incoming flows yield quite accurate runup predictions. Less predictive accuracy is attained in ab initio simulations that compute runup based solely on knowledge of static debris properties in a distant debris flow source area. Nevertheless, the paucity of inputs required in ab initio simulations enhances their prospective value in runup forecasting.

"Siempre me critican": barriers to reproductive health in Ocotal, Nicaragua.

PubMed

Luffy, Samantha M; Evans, Dabney P; Rochat, Roger W

2015-05-01

To identify perceived barriers to accessing reproductive health care according to the women of Ocotal, Nicaragua; describe their understanding of their reproductive rights; and document their opinions about Nicaragua's total ban on abortion. From May to June 2014, three focus group discussions were held in Spanish with 17 women from two different neighborhoods (barrios) in the city of Ocotal, Nicaragua. A semi-structured discussion guide with open-ended questions was employed to elucidate local perspectives regarding the focus group discussions themes. Serious obstacles including 1) violence against women, 2) machismo, 3) criticism from others, and 4) lack of communication and education limit women's ability to make their own reproductive health decisions. Women had a pervasive lack of knowledge about reproductive rights and the international human rights documents that define them. In addition, due to religious and cultural ideologies, most women supported the country's total ban on abortion in most circumstances, with the possible exception of rape. Both men and women in Ocotal should be encouraged to participate in community-level programs designed to reduce the impact of the following obstacles to receiving reproductive health care: 1) violence against women and machismo; 2) insufficient, non-standardized sexual education and information about reproductive rights; and 3) poor communication within families and the community at large. Any future public health campaigns to address women's reproductive health needs in Ocotal should implement these types of programs, at the neighborhood level, to reduce stigma surrounding sexual health and activity.

Caregiver Leave-Taking in Spain: Rate, Motivations, and Barriers.

PubMed

Rogero-García, Jesús; García-Sainz, Cristina

2016-01-01

This paper aims to (1) determine the rate of (full- and part-time) caregiver leave-taking in Spain, (2) identify the reasons conducive to a more intense use of this resource, and (3) ascertain the main obstacles to its use, as perceived by caregivers. All 896 people covered by the sample were engaging in paid work and had cared for dependent adults in the last 12 years. This resource, in particular the full-time alternative, was found to be a minority option. The data showed that legal, work-related, and family and gender norm issues are the four types of factors that determine the decision to take such leaves. The most significant obstacles to their use are the forfeiture of income and the risk of losing one's job. Our results suggest that income replacement during a leave would increase the take-up of these resources. Moreover, enlargement of public care services would promote the use of leave as a free choice of caregivers.

Student Obstacles in Ratio and Proportion Learning

NASA Astrophysics Data System (ADS)

Andini, W.; Jupri, Al

2017-02-01

Ratio and proportion are mathematics topics that are learned in elementary school. In the learning process, teachers often found students who have difficulties in learning these topics. Analysing the difficulties on the topics is important for teachers, as an attempt to doa reflection of the learning process and as a reference in devising a learning plan, including for anticipation of the possibility of these barriers that might appear in the next learning process. This research used as the qualitative method, and involved 49 students of grade 5 and one teacher. From the analysis of the data, i.e., student test results and observation of the learning, we found some obstacles that faced by students, such as students confused in understanding about ratio and proportion topic, students found it difficult in completing the problem which have different contexts, the learning material of ratio and proportion topic that presented in textbooks are still partial (not depth), and the lack of ability of the teacher in creating problems.

Corporate culture and the employment of persons with disabilities.

PubMed

Schur, Lisa; Kruse, Douglas; Blanck, Peter

2005-01-01

This article addresses key questions arising from the economic and social disparities that individuals with disabilities experience in the United States. For instance, "What role does corporate culture play in the employment of people with disabilities?" "How does it facilitate or hinder their employment and promotional opportunities, and how can corporations develop supportive cultures that benefit people with disabilities, non-disabled employees, and the organization as a whole?" Corporate culture can create attitudinal, behavioral, and physical barriers for workers and job applicants with disabilities. This research concludes that if the employment prospects of people with disabilities are to be improved significantly, attention must be paid to the ways in which corporate culture creates or reinforces obstacles to employees with disabilities, and how these obstacles can be removed or overcome. Ultimately, we will make the case that corporate culture and societal attitudes must change if people with disabilities are to be accepted and incorporated fully into the workplace. 2005 John Wiley & Sons, Ltd.

Biosphere Reserve for All: Potentials for Involving Underrepresented Age Groups in the Development of a Biosphere Reserve through Intergenerational Practice.

PubMed

Mitrofanenko, Tamara; Snajdr, Julia; Muhar, Andreas; Penker, Marianne; Schauppenlehner-Kloyber, Elisabeth

2018-05-22

Stakeholder participation is of high importance in UNESCO biosphere reserves as model regions for sustainable development; however, certain groups remain underrepresented. The paper proposes Intergenerational Practice (IP) as a means of involving youth and elderly women and explores its options and barriers, using the example of the Salzburger Lungau and Kärntner Nockberge Biosphere Reserve in Austria. Case study analysis is used involving mixed methods. The results reveal obstacles and motivations to participating in biosphere reserve implementation and intergenerational activities for the youth and the elderly women and imply that much potential for IP exists in the biosphere reserve region. The authors propose suitable solutions from the intergenerational field to overcome identified participation obstacles and suggest benefits of incorporating IP as a management tool into biosphere reserve activities. Suggestions for future research include evaluating applications of IP in the context of protected areas, testing of methods used in other contexts, and contribution to theory development.

Beyond physical access: a qualitative analysis into the barriers to policy implementation and service provision experienced by persons with disabilities living in a rural context.

PubMed

Neille, Joanne; Penn, Claire

2015-01-01

Persons with disabilities make up approximately 15% of the world's population, with vulnerable communities disproportionately affected by the incidence of disability. Research reflects that persons with disabilities are vulnerable to stigma and discrimination, social isolation, and have physical barriers to accessing support services, all of which serve to perpetuate a sense of uncertainty and vulnerability within their lives. Recently a number of policies and models of intervention have been introduced intended to protect the rights of those affected by disability, yet limited research has been conducted into the lived experiences of persons with disabilities, particularly in rural contexts. This implies that little is known about the impact of the rural context on the lived experience of disability and the ways in which context impacts on the implementation of policies and practices. The current study employed a qualitative design underpinned by the principles of narrative inquiry and participant observation. Thirty adults with a variety of congenital and acquired disabilities (15 men and 15 women, ranging in age from 19 to 83 years) living in 12 rural communities in the Mpumalanga Province of South Africa were recruited through snowball sampling. Data collection comprised a combination of narrative inquiry and participant observation. Narratives were collected in SiSwati with the assistance of a SiSwati-speaking research mediator and were transcribed and translated into English. Data were analysed inductively according to the principles of thematic analysis. Findings confirmed that the experience of living with a disability in a rural area is associated with discrimination, social exclusion, and isolation and barriers to accessing services, underpinned by numerous context-specific experiences, including mortality rates, exposure to numerous and repeated forms of violence across the lifespan, and corruption and lack of transparency in the implementation of government policies and practices. These experiences are not currently reflected in the literature or in guidelines on the implementations of policies and service provision, and thus have the potential to offer novel insights into the barriers faced by persons with disabilities living in rural areas. The results of this study suggest that barriers to service provision extend beyond physical obstacles, and include a variety of sociocultural and sociopolitical barriers. By failing to take these into account, policies and current models of service provision are only able to provide limited support to persons with disabilities living in rural areas. The findings reveal narrative inquiry to be a powerful and culturally safe tool for exploring lived experience among vulnerable populations and hold significant implications for both practitioners and policy developers. Furthermore, it emerges that one-size-fits-all policies are unable to meet the needs of persons with disabilities living in rural areas. However, the implementation of site-specific needs analyses with the use of flexible and culturally appropriate tools has the potential to redress the discrepancies in policy implementation and can be used to strengthen institutional ties and referral pathways.

Obstacles and Future Prospects: Considerations on Health Promotion Activities for Older Workers in Europe.

PubMed

Magnavita, Nicola

2018-05-28

The ageing of workers is one of the most important issues for occupational health and safety in Europe. The ageing of the active population means that health promotion is a necessity rather than a mere option. This review considers barriers and perspectives for workplace health promotion for older workers. Lack of awareness on the part of management and inflexibility in the occupational health and safety system appear to be major barriers. To overcome these, it will be necessary to disseminate knowledge regarding the effectiveness of health promotion actions for older workers, encourage greater involvement on the part of social partners, recover resources by replacing medical consumerism and bureaucratic practices, adopt an integrated approach combining the prevention of occupational risks and the promotion of healthy lifestyles, and recognize subsidiarity and the ability of working communities to regulate themselves.

HIV treatment in US prisons.

PubMed

Wakeman, Sarah E; Rich, Josiah D

2010-09-03

Arguably one of the most marginalized populations in our society, prisoners bear a disproportionate burden of infectious diseases, particularly HIV. In addition, groups known to be at an inordinately higher risk of HIV, including minorities, the addicted, the mentally ill and the impoverished are overrepresented among incarcerated populations. This concentration of HIV among groups that have been historically difficult to reach, with limited intersections with healthcare, provides an opportunity for testing, diagnosis, treatment, linkage to care and prevention. Providing HIV care within correctional facilities poses unique challenges. Barriers to confidentiality, access to medication and prior records, and lack of comprehensive discharge planning can serve as obstacles to providing optimal care. This article discusses the public health implications and importance of providing HIV care to prisoners, and also discusses the practicalities of working within an environment that poses particular barriers to care.

Blood-brain barrier transport of non-viral gene and RNAi therapeutics.

PubMed

Boado, Ruben J

2007-09-01

The development of gene- and RNA interference (RNAi)-based therapeutics represents a challenge for the drug delivery field. The global brain distribution of DNA genes, as well as the targeting of specific regions of the brain, is even more complicated because conventional delivery systems, i.e. viruses, have poor diffusion in brain when injected in situ and do not cross the blood-brain barrier (BBB), which is only permeable to lipophilic molecules of less than 400 Da. Recent advances in the "Trojan Horse Liposome" (THL) technology applied to the transvascular non-viral gene therapy of brain disorders presents a promising solution to the DNA/RNAi delivery obstacle. The THL is comprised of immunoliposomes carrying either a gene for protein replacement or small hairpin RNA (shRNA) expression plasmids for RNAi effect, respectively. The THL is engineered with known lipids containing polyethyleneglycol (PEG), which stabilizes its structure in vivo in circulation. The tissue target specificity of THL is given by conjugation of approximately 1% of the PEG residues to peptidomimetic monoclonal antibodies (MAb) that bind to specific endogenous receptors (i.e. insulin and transferrin receptors) located on both the BBB and the brain cellular membranes, respectively. These MAbs mediate (a) receptor-mediated transcytosis of the THL complex through the BBB, (b) endocytosis into brain cells and (c) transport to the brain cell nuclear compartment. The present review presents an overview of the THL technology and its current application to gene therapy and RNAi, including experimental models of Parkinson's disease and brain tumors.

FACTORS INFLUENCING SINGLE MOTHER’S EMPLOYMENT STATUS

PubMed Central

Youngblut, JoAnne M.; Brady, Noreen R.; Brooten, Dorothy; Thomas, Debera J.

2009-01-01

Changes in the welfare system limit the length of time a person can receive welfare benefits, thus mandating employment for many current welfare recipients. Single mothers with young children who do not become employed will lose financial support for housing, food, clothing, and health care and place their own and their children’s health and safety at risk. The purpose of this qualitative study was to explore women’s experiences of being unemployed and to examine the barriers to employment perceived by single mothers who expressed a desire to be employed. Nine mothers were recruited from a larger sample of single mothers who had participated in a quantitative study about employment conducted 1 to 2 years earlier. Using focus group interviews, mothers were asked what it was like to be a single mother, and then what barriers to their employment they perceived. Two dimensions were identified from the mothers’ statements. The first, a sense of obligation, included themes of “being there” for their own and their child’s benefit and doing what it takes to optimize the child’s growth and development. The second, negotiating the obstacles, referred to problems regarding child care, lack of involvement of the child’s father, and lack of support from relatives and friends for the mother’s efforts toward securing employment. These findings have important implications for welfare reform, namely, that efforts aimed at moving nonemployed single mothers into the workforce will fail if these factors are not considered. PMID:10818834

The role of twinning deformation on the hardening response of polycrystalline magnesium from discrete dislocation dynamics simulations

DOE PAGES

Fan, Haidong; Aubry, Sylvie; Arsenlis, Athanasios; ...

2015-04-13

The mechanical response of micro-twinned polycrystalline magnesium was studied through three-dimensional discrete dislocation dynamics (DDD). A systematic interaction model between dislocations and (1012) tension twin boundaries (TBs) was proposed and introduced into the DDD framework. In addition, a nominal grain boundary (GB) model agreeing with experimental results was also introduced to mimic the GB’s barrier effect. The current simulation results show that TBs act as a strong obstacle to gliding dislocations, which contributes significantly to the hardening behavior of magnesium. On the other hand, the deformation accommodated by twinning plays a softening role. Therefore, the concave shape of the Mgmore » stress-strain curve results from the competition between dislocation-TB induced hardening and twinning deformation induced softening. At low strain levels, twinning deformation induced softening dominates and a decreasing hardening rate is observed in Stage-I. In Stage-II, both the hardening and softening effects decline, but twinning deformation induced softening declines faster, which leads to an increasing hardening rate.« less

Combinatorial Approaches for the Identification of Brain Drug Delivery Targets

PubMed Central

Stutz, Charles C.; Zhang, Xiaobin; Shusta, Eric V.

2018-01-01

The blood-brain barrier (BBB) represents a large obstacle for the treatment of central nervous system diseases. Targeting endogenous nutrient transporters that transcytose the BBB is one promising approach to selectively and noninvasively deliver a drug payload to the brain. The main limitations of the currently employed transcytosing receptors are their ubiquitous expression in the peripheral vasculature and the inherent low levels of transcytosis mediated by such systems. In this review, approaches designed to increase the repertoire of transcytosing receptors which can be targeted for the purpose of drug delivery are discussed. In particular, combinatorial protein libraries can be screened on BBB cells in vitro or in vivo to isolate targeting peptides or antibodies that can trigger transcytosis. Once these targeting reagents are discovered, the cognate BBB transcytosis system can be identified using techniques such as expression cloning or immunoprecipitation coupled with mass spectrometry. Continued technological advances in BBB genomics and proteomics, membrane protein manipulation, and in vitro BBB technology promise to further advance the capability to identify and optimize peptides and antibodies capable of mediating drug transport across the BBB. PMID:23789958

Nanobiomaterials' applications in neurodegenerative diseases.

PubMed

Silva Adaya, Daniela; Aguirre-Cruz, Lucinda; Guevara, Jorge; Ortiz-Islas, Emma

2017-02-01

The blood-brain barrier is the interface between the blood and brain, impeding the passage of most circulating cells and molecules, protecting the latter from foreign substances, and maintaining central nervous system homeostasis. However, its restrictive nature constitutes an obstacle, preventing therapeutic drugs from entering the brain. Usually, a large systemic dose is required to achieve pharmacological therapeutic levels in the brain, leading to adverse effects in the body. As a consequence, various strategies are being developed to enhance the amount and concentration of therapeutic compounds in the brain. One such tool is nanotechnology, in which nanostructures that are 1-100 nm are designed to deliver drugs to the brain. In this review, we examine many nanotechnology-based approaches to the treatment of neurodegenerative diseases. The review begins with a brief history of nanotechnology, followed by a discussion of its definition, the properties of most reported nanomaterials, their biocompatibility, the mechanisms of cell-material interactions, and the current status of nanotechnology in treating Alzheimer's, Parkinson's diseases, and amyotrophic lateral sclerosis. Of all strategies to deliver drug to the brain that are used in nanotechnology, drug release systems are the most frequently reported.

The influence of underlying topography on lava channel networks and flow behavior (Invited)

NASA Astrophysics Data System (ADS)

Dietterich, H. R.; Cashman, K. V.; Rust, A.

2013-12-01

New high resolution mapping of historical lava flows in Hawai';i reveals complex topographically controlled channel networks. Network morphologies range from distributary systems dominated by branching around local obstacles, to tributary systems constricted by topographic confinement. Because channel networks govern the distribution of lava within the flow, they can dramatically alter the effective volumetric flux, which affects both flow length and advance rate. The influence of flow bifurcations is evidenced by (1) channelized flows from Pu';u ';O';o episodes 1-20 at Kilauea Volcano, where flow front velocities decreased by approximately half each time a flow split, and (2) the length of confined flows, such as the Mauna Loa 1859 flow, which traveled twice as far as the distributary Mauna Loa 1984 flow, despite similar effusion rates and durations. To study the underlying controls on flow bifurcations, we have undertaken a series of analogue experiments with golden syrup (a Newtonian fluid) to better understand the physics of obstacle interaction and its influence on flow behavior and morphology. Controlling the effusion rate and surface slope, we extrude flows onto a surface with a cylindrical or V-shaped obstacle of variable angle. When the flow is sufficiently fast, a stationary wave forms upslope of the obstacle; if the stationary wave is sufficiently high, the flow can overtop, rather than split around, the obstacle. The stationary wave height increases with flow velocity and with the effective obstacle width. Evidence for stationary waves in Hawaiian lava flows comes from both photographs of active flows and waveforms frozen into solidified flows. We have also performed a preliminary set of similar experiments with molten basalt to identify the effect of cooling and investigate flow merging. In these experiments, a stationary wave develops upslope of the obstacle, which allows the surface to cool and thicken. After splitting, the syrup experiments show minimal impact of the split on flow advance, except in cases where the flow is very thin, and surface tension controls the flow behavior. In contrast, the experiments with molten basalt slow markedly, as measured by both flow front and surface velocities. This difference demonstrates the effect of cooling and crust formation on flowing lava. Crust formation also controls the ability of split flows to merge below an obstacle, such that flows can converge only at high flow rates, which limits time for crust formation, and at narrow obstacle angles, which limits the lateral spreading required for convergence. Our experiments qualitatively support theoretical descriptions of crustal controls on flow spreading and levee development, but our poor knowledge of the appropriate parameter values, particularly that of the strength of the viscoelastic crust, prevents a quantitative comparison. These experiments, and our observations from natural systems, have significant implications for predicting lava flow behavior and inform efforts to mitigate flow hazards with diversion barriers.

Physician's perceived roles, as well as barriers, towards caring for women sex assault survivors

PubMed Central

Amin, Priyanka; Buranosky, Raquel; Chang, Judy C.

2016-01-01

Background Sexual assault (SA) affects about 40% of women in the US and has many mental and physical health sequelae. Physicians often do not address SA with patients although SA survivors describe a desire to talk to physicians to obtain additional help. Little information exists on how providers perceive their roles regarding caring for women SA survivors and what barriers they face in providing this care. Methods We performed a qualitative study using semi-structured one-on-one interviews with sixteen faculty physicians from five specialties: obstetrics and gynecology (four), internal medicine (four), family medicine (one), emergency medicine (three), and psychiatry (four). Interviews were conducted between July 2011 and July 2012, transcribed verbatim, and coded using a constant comparative approach. Once a final coding scheme was applied to all transcripts, we identified patterns and themes related to perceived roles and barriers to caring for SA survivors. Results Physicians described two main categories of roles: clinical tasks (e.g. testing and treating for sexually transmitted infections, managing associated mental health sequelae) and interpersonal roles (e.g. providing support, acting as patient advocate). Physician barriers fell into three main categories: (1) internal barriers (e.g. discomfort with the topic of SA); (2) physician-patient communication; and (3) system obstacles (e.g. competing priorities for time). Conclusions Although physicians describe key roles in caring for SA survivors, several barriers hinder their ability to fulfill these roles. Training interventions are needed to reduce the barriers that would ultimately improve clinical care for SA survivors. PMID:27863981

Barriers of access to care in a managed competition model: lessons from Colombia.

PubMed

Vargas, Ingrid; Vázquez, María Luisa; Mogollón-Pérez, Amparo Susana; Unger, Jean-Pierre

2010-10-29

The health sector reform in Colombia, initiated by Law 100 (1993) that introduced a managed competition model, is generally presented as a successful experience of improving access to care through a health insurance regulated market. The study's objective is to improve our understanding of the factors influencing access to the continuum of care in the Colombian managed competition model, from the social actors' point of view. An exploratory, descriptive-interpretative qualitative study was carried out, based on case studies of four healthcare networks in rural and urban areas. Individual semi-structured interviews were conducted to a three stage theoretical sample: I) cases, II) providers and III) informants: insured and uninsured users (35), health professionals (51), administrative personnel (20), and providers' (18) and insurers' (10) managers. Narrative content analysis was conducted; segmented by cases, informant's groups and themes. Access, particularly to secondary care, is perceived as complex due to four groups of obstacles with synergetic effects: segmented insurance design with insufficient services covered; insurers' managed care and purchasing mechanisms; providers' networks structural and organizational limitations; and, poor living conditions. Insurers' and providers' values based on economic profit permeate all factors. Variations became apparent between the two geographical areas and insurance schemes. In the urban areas barriers related to market functioning predominate, whereas in the rural areas structural deficiencies in health services are linked to insufficient public funding. While financial obstacles are dominant in the subsidized regime, in the contributory scheme supply shortage prevails, related to insufficient private investment. The results show how in the Colombian healthcare system structural and organizational barriers to care access, that are common in developing countries, are widened by both the insurers' use of mechanisms that limit the utilization and the public healthcare providers' change of behavior in a competition environment. They provide evidence to question the promotion of the managed competition model in low and middle-income countries.

Barriers of access to care in a managed competition model: lessons from Colombia

PubMed Central

2010-01-01

Background The health sector reform in Colombia, initiated by Law 100 (1993) that introduced a managed competition model, is generally presented as a successful experience of improving access to care through a health insurance regulated market. The study's objective is to improve our understanding of the factors influencing access to the continuum of care in the Colombian managed competition model, from the social actors' point of view. Methods An exploratory, descriptive-interpretative qualitative study was carried out, based on case studies of four healthcare networks in rural and urban areas. Individual semi-structured interviews were conducted to a three stage theoretical sample: I) cases, II) providers and III) informants: insured and uninsured users (35), health professionals (51), administrative personnel (20), and providers' (18) and insurers' (10) managers. Narrative content analysis was conducted; segmented by cases, informant's groups and themes. Results Access, particularly to secondary care, is perceived as complex due to four groups of obstacles with synergetic effects: segmented insurance design with insufficient services covered; insurers' managed care and purchasing mechanisms; providers' networks structural and organizational limitations; and, poor living conditions. Insurers' and providers' values based on economic profit permeate all factors. Variations became apparent between the two geographical areas and insurance schemes. In the urban areas barriers related to market functioning predominate, whereas in the rural areas structural deficiencies in health services are linked to insufficient public funding. While financial obstacles are dominant in the subsidized regime, in the contributory scheme supply shortage prevails, related to insufficient private investment. Conclusions The results show how in the Colombian healthcare system structural and organizational barriers to care access, that are common in developing countries, are widened by both the insurers' use of mechanisms that limit the utilization and the public healthcare providers' change of behavior in a competition environment. They provide evidence to question the promotion of the managed competition model in low and middle-income countries. PMID:21034481

[Barriers for introducing a health technology assessment organization to inform health care decision-making in the Spanish National Health System].

PubMed

Artells, Juan José; Peiró, Salvador; Meneu, Ricard

2014-01-01

To identify difficulties, obstacles and limitations to establish an organizational structure devoted to the evaluation of healthcare technologies for incorporation, maintenance or removal from the services portfolio of the Spanish National Health System (sNHS). Panel of 14 experts, structured according to processes adapted from brainstorming, nominal group, and Rand consensus method techniques. The panel proposed 77 items as potential obstacles to the establishment of an official and independent "agency" able to inform on sNHS healthcare benefits funding or selective disinvestment. These items were focused on: 1) lack of political motivation to introduce the cost-effectiveness analysis from the state and regional governments and lack of independence and transparency of the evaluation processes, 2) the tension between a decentralized health system and evaluation activities with significant scale economies, 3) technical difficulties of the evaluation processes, including their ability to influence decision making and 4) social and professional refusal to the exclusion of healthcare benefits when it is perceived as indiscriminate. Although there is a different number and type of obstacles for developing the capacity of the sNHS to include or exclude healthcare benefits based on the evaluation of their effectiveness and efficiency, experts place in the political arena (political motivation, transparency, governance) the main difficulties to advance in this field.

Why TQM does not work in Iranian healthcare organisations.

PubMed

Mosadeghrad, Ali Mohammad

2014-01-01

Despite the potential benefits of total quality management (TQM), many healthcare organisations encountered difficulties in its implementation. The purpose of this paper is to explore the barriers to successful implementation of TQM in healthcare organisations of Iran. This study involved a mixed research design. In-depth interviews were conducted with TQM practitioners to explore TQM implementation obstacles in Iranian healthcare organisations. In addition, this study involved survey-based research on the obstacles associated with successful TQM transformation. TQM implementation and its impact depend on the ability of managers to adopt and adapt its values and concepts in professional healthcare organisations. Unsuccessful TQM efforts in Iranian healthcare organisations can be attributed to the non-holistic approach adopted in its implementation, inadequate knowledge of managers' about TQM implementation, frequent top management turnover, poor planning, vague and short-termed improvement goals, lack of consistent managers' and employees' commitment to and involvement in TQM implementation, lack of a corporate quality culture, lack of team orientation, lack of continuous education and training and lack of customer focus. Human resource problems, cultural and strategic problems were the most important obstacles to TQM successful implementation, respectively. Understanding the factors that are likely to obstruct TQM implementation would enable managers to develop more viable strategies for achieving business excellence. Understanding the factors that are likely to obstruct TQM implementation will help organisations in planning better TQM models.

[Therapeutic education in pediatric dentistry: analysis of obstacles and levers to the development of programmes in France in 2016].

PubMed

Marquillier, Thomas; Trentesaux, Thomas; Gagnayre, Rémi

2017-01-01

Over recent years, therapeutic patient education has become part of dental medicine. Management of early childhood caries, known to be a very common chronic disease, has evolved to include an educational dimension. The objective of this study was to identify the levers and barriers to the development of formalized therapeutic education programmes and alternatives. A comprehensive exploratory qualitative study was conducted between November 2015 and June 2016 on a targeted sample of 15 people aware of the problem of TPE in dentistry. The study showed that TPE training in dentistry is underdeveloped, despite its numerous benefits: change of the healthcare professional's approach, implementation of structured educational programmes, development of research, etc. There are many obstacles to the development of TPE programmes: insufficient resources, rigid legislation or lack of knowledge of TPE practices. The dental profession is an obstacle itself because of its lack of understanding and variable degrees of integration the medical community. There are multiple levers, but the main ones are changing attitudes of the profession and the provision of resources to develop TPE. Although alternatives to TPE programmes exist (accompanying measures, short educational strategies, connected health), they cannot replace TPE. More educational strategies must be developed in the field of dentistry. However, the framework of TPE must be adapted to the profession to ensure good uptake.

Work Activity and Obstacles to Work among TANF Recipients. New Federalism: National Survey of America's Families, Series B, No. B-2. Assessing the New Federalism: An Urban Institute Program To Assess Changing Social Policies.

ERIC Educational Resources Information Center

Zedlewski, Sheila R.

Dramatic shifts from cash assistance to work, embodied in the 1996 replacement of Aid to Families with Dependent Children with Temporary Assistance for Needy Families (TANF), highlight the need to understand how current cash assistance recipients participate in required work-related activities and obstacles faced in getting and keeping jobs. The…

A biologically inspired neural net for trajectory formation and obstacle avoidance.

PubMed

Glasius, R; Komoda, A; Gielen, S C

1996-06-01

In this paper we present a biologically inspired two-layered neural network for trajectory formation and obstacle avoidance. The two topographically ordered neural maps consist of analog neurons having continuous dynamics. The first layer, the sensory map, receives sensory information and builds up an activity pattern which contains the optimal solution (i.e. shortest path without collisions) for any given set of current position, target positions and obstacle positions. Targets and obstacles are allowed to move, in which case the activity pattern in the sensory map will change accordingly. The time evolution of the neural activity in the second layer, the motor map, results in a moving cluster of activity, which can be interpreted as a population vector. Through the feedforward connections between the two layers, input of the sensory map directs the movement of the cluster along the optimal path from the current position of the cluster to the target position. The smooth trajectory is the result of the intrinsic dynamics of the network only. No supervisor is required. The output of the motor map can be used for direct control of an autonomous system in a cluttered environment or for control of the actuators of a biological limb or robot manipulator. The system is able to reach a target even in the presence of an external perturbation. Computer simulations of a point robot and a multi-joint manipulator illustrate the theory.

Transportation Energy Futures Series. Non-Cost Barriers to Consumer Adoption of New Light-Duty Vehicle Technologies

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

Stephens, Thomas

2013-03-01

Consumer preferences are key to the adoption of new vehicle technologies. Barriers to consumer adoption include price and other obstacles, such as limited driving range and charging infrastructure; unfamiliarity with the technology and uncertainty about direct benefits; limited makes and models with the technology; reputation or perception of the technology; standardization issues; and regulations. For each of these non-cost barriers, this report estimates an effective cost and summarizes underlying influences on consumer preferences, approximate magnitude and relative severity, and assesses potential actions, based on a comprehensive literature review. While the report concludes that non-cost barriers are significant, effective cost andmore » potential market share are very uncertain. Policies and programs including opportunities for drivers to test drive advanced vehicles, general public outreach and information programs, incentives for providing charging and fueling infrastructure, and development of technology standards were examined for their ability to address barriers, but little quantitative data exists on the effectiveness of these measures. This is one in a series of reports produced as a result of the Transportation Energy Futures project, a Department of Energy-sponsored multi-agency effort to pinpoint underexplored strategies for reducing GHGs and petroleum dependence related to transportation. View all reports on the TEF Web page, http://www.eere.energy.gov/analysis/transportationenergyfutures/index.html.« less

Barriers to nutrition education for older adults, and nutrition and aging training opportunities for educators, healthcare providers,volunteers and caregivers.

PubMed

Meck Higgins, Mary; Barkley, Mary Clarke

2004-01-01

Literature citations of barriers to nutrition education found in those who teach and care for older adults, as well as within older adults themselves, are discussed. No attempt was made to compare educational barriers for learners of varying ages. These obstacles need to be addressed in order for nutrition to be taught or learned effectively so that nutrition practices and health improve. Barriers for healthcare professionals to providing nutrition education include misconceptions and stereotypes about older adults and about their nutritional concerns; lack of attention to and lack of funding for older adult educational programs; and difficulties recruiting older learners. Hindrances for older adults in responding to nutrition education can be categorized as attitudinal, motivational, environmental, and related to low literacy and poverty. Published examples of opportunities for education and training about nutrition and aging that are in place for health educators, healthcare providers, volunteers and caregivers regarding nutrition and aging are discussed. Suggestions are presented regarding future efforts to minimize educational barriers and to provide training for healthcare professionals, volunteers and caregivers. New research is needed in this field of study in order to realize the potential quality of life benefits and reduced healthcare costs associated with providing effective nutrition education to older adults. This is one of a series of reviews of recent literature on nutrition education for older adults.

A 3D Real-Scale, Biomimetic, and Biohybrid Model of the Blood-Brain Barrier Fabricated through Two-Photon Lithography.

PubMed

Marino, Attilio; Tricinci, Omar; Battaglini, Matteo; Filippeschi, Carlo; Mattoli, Virgilio; Sinibaldi, Edoardo; Ciofani, Gianni

2018-02-01

The investigation of the crossing of exogenous substances through the blood-brain barrier (BBB) is object of intensive research in biomedicine, and one of the main obstacles for reliable in vitro evaluations is represented by the difficulties at the base of developing realistic models of the barrier, which could resemble as most accurately as possible the in vivo environment. Here, for the first time, a 1:1 scale, biomimetic, and biohybrid BBB model is proposed. Microtubes inspired to the brain capillaries were fabricated through two-photon lithography and used as scaffolds for the co-culturing of endothelial-like bEnd.3 and U87 glioblastoma cells. The constructs show the maturation of tight junctions, good performances in terms of hindering dextran diffusion through the barrier, and a satisfactory trans-endothelial electrical resistance. Moreover, a mathematical model is developed, which assists in both the design of the 3D microfluidic chip and its characterization. Overall, these results show the effective formation of a bioinspired cellular barrier based on microtubes reproducing brain microcapillaries to scale. This system will be exploited as a realistic in vitro model for the investigation of BBB crossing of nanomaterials and drugs, envisaging therapeutic and diagnostic applications for several brain pathologies, including brain cancer. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Feasibility of a psychosocial and patient navigation intervention to improve access to treatment among underserved breast cancer patients.

PubMed

Madore, Shannon; Kilbourn, Kristin; Valverde, Patricia; Borrayo, Evelinn; Raich, Peter

2014-08-01

Medically underserved women with recently diagnosed breast cancer face a number of significant obstacles that impact the timeliness and quality of their care. The Breast CARES (Cancer Advocacy, Resources Education and Support) intervention combined patient navigation with telephone counseling to guide newly diagnosed breast cancer patients in overcoming treatment barriers. The study aimed to learn more about the types of barriers encountered by the participants. The study also sought to understand the relationship between patient-reported barriers and patient-reported psychosocial distress in underserved women recently diagnosed with breast cancer. Data were analyzed using a mixed-methods approach. Participants were assessed pre- and post-intervention. Psychosocial measures included cancer-related distress, depression, anxiety, social support, and quality of life. Case notes and responses to process evaluation questions were used to determine whether the CARES intervention adequately addressed the needs of the participants. The mean age of participants (N = 20) was 54 years (SD = 12.5), 40% were Hispanic, 70% were unemployed, 50% were uninsured, and 20% were mono-lingual in Spanish. Qualitative analysis revealed four categories of barriers: psychosocial, medical, logistical, and communication. Similarities and differences existed between the PN and TC regarding how barriers were addressed. Post-intervention psychosocial scores indicate a decrease in depression and cancer-related distress and an increase in social support. The participants reported that participation in the Breast CARES program helped them overcome financial barriers (73%), transportation problems (60%), and communication barriers with medical staff (73%). This study demonstrates the unique and complementary roles for PNs and TCs in overcoming barriers to treatment adherence faced by underserved breast cancer patients.

Development and implementation of Strategic Environmental Assessment in Taiwan

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

Liou, M.-L.; Yu, Y.-H

2004-04-01

Taiwan is one of the few Asian countries to have officially adopted Strategic Environmental Assessment (SEA) as one important means towards the achievement of environmental conservation and sustainable development. Despite implementation almost a decade ago, SEA remains premature in its development. This paper analyzes the progress and characteristics of SEA in Taiwan and, through examination of its limited case studies, reveals the positive and apparent influence of SEA on policy making. This paper also identifies the barriers hindering SEA's advancement and concludes with recommendations on strategies to overcome these obstacles.

Refugee Health: An Ongoing Commitment and Challenge

PubMed Central

Efird, Jimmy T.; Bith-Melander, Pollie

2018-01-01

Refugees represent a diverse group of displaced individuals with unique health issues and disease risks. The obstacles facing this population have their origins in war, violence, oppression, exploitation, and fear of persecution. Regardless of country of origin, a common bond exists, with refugees often confronting inadequate healthcare resources, xenophobia, discrimination, and a complex web of legal barriers in their new homelands. In many cases, the plight of refugees is multigenerational, manifesting as mental health issues, abuse, poverty, and family disruption. The health trajectory of refugees remains an ongoing commitment and challenge. PMID:29342831

Solvent recovery opportunities in the pharmaceutical industry.

PubMed

Barton, P I

2000-11-01

Opportunities for recovering and recycling waste solvent streams in the pharmaceutical industry are reviewed. A major obstacle to solvent recovery and recycling is the existence of azeotropic compositions, and thus separation barriers, in the mixtures in question. Advances in the understanding of these complex separation problems are discussed. Recent progress on novel designs for small-scale, flexible azeotropic separation processes is reviewed. Also considered is the alternative and complementary approach of integrating solvent use within a batch process so that the formation of hard-to-separate azeotropic compositions is prevented.

Symbiotic Navigation in Multi-Robot Systems with Remote Obstacle Knowledge Sharing

PubMed Central

Ravankar, Abhijeet; Ravankar, Ankit A.; Kobayashi, Yukinori; Emaru, Takanori

2017-01-01

Large scale operational areas often require multiple service robots for coverage and task parallelism. In such scenarios, each robot keeps its individual map of the environment and serves specific areas of the map at different times. We propose a knowledge sharing mechanism for multiple robots in which one robot can inform other robots about the changes in map, like path blockage, or new static obstacles, encountered at specific areas of the map. This symbiotic information sharing allows the robots to update remote areas of the map without having to explicitly navigate those areas, and plan efficient paths. A node representation of paths is presented for seamless sharing of blocked path information. The transience of obstacles is modeled to track obstacles which might have been removed. A lazy information update scheme is presented in which only relevant information affecting the current task is updated for efficiency. The advantages of the proposed method for path planning are discussed against traditional method with experimental results in both simulation and real environments. PMID:28678193

Achievements and barriers in the organ donation process: a critical analysis of donation coordinators' discourse.

PubMed

Mercado-Martínez, Francisco J; Díaz-Medina, Blanca A; Hernández-Ibarra, Eduardo

2013-09-01

Donation coordinators play an important role in the success or failure of organ donation and transplant programs. Nevertheless, these professionals' perspectives and practices have hardly been explored, particularly in low- and middle-income countries. To examine donation coordinators' discourse on the organ donation process and the barriers they perceive. A critical qualitative study was carried out in Guadalajara, Mexico. Twelve donation coordinators from public and private hospitals participated. DATA GATHERING AND ANALYSIS: Data were gathered by using semistructured interviews and critical discourse analysis. Participants indicated that partial results have been achieved in deceased organ donation. Concomitantly, multiple obstacles have adversely affected the process and outcomes: at the structural level, the fragmentation of the health system and the scarcity of financial and material resources; at the relational level, nonegalitarian relationships between coordinators and hospital personnel; at the ideational level, the transplant domain and its specialists overshadow the donation domain and its coordinators. Negative images are associated with donation coordinators. Organ donation faces structural, relational, and ideational barriers; hence, complex interventions should be undertaken. Donation coordinators also should be recognized by the health system.

Scale transition using dislocation dynamics and the nudged elastic band method

DOE PAGES

Sobie, Cameron; Capolungo, Laurent; McDowell, David L.; ...

2017-08-01

Microstructural features such as precipitates or irradiation-induced defects impede dislocation motion and directly influence macroscopic mechanical properties such as yield point and ductility. In dislocation-defect interactions both atomic scale and long range elastic interactions are involved. Thermally assisted dislocation bypass of obstacles occurs when thermal fluctuations and driving stresses contribute sufficient energy to overcome the energy barrier. The Nudged Elastic Band (NEB) method is typically used in the context of atomistic simulations to quantify the activation barriers for a given reaction. In this work, the NEB method is generalized to coarse-grain continuum representations of evolving microstructure states beyond the discretemore » particle descriptions of first principles and atomistics. The method we employed enables the calculation of activation energies for a View the MathML source glide dislocation bypassing a [001] self-interstitial atom loop of size in the range of 4-10 nm with a spacing larger than 150nm in α-iron for a range of applied stresses and interaction geometries. This study is complemented by a comparison between atomistic and continuum based prediction of barriers.« less

Various drug delivery approaches to the central nervous system.

PubMed

Pasha, Santosh; Gupta, Kshitij

2010-01-01

The presence of the blood-brain barrier (BBB), an insurmountable obstacle, in particular, and other barriers in brain and periphery contribute to hindrance of the successful diagnosis and treatment of a myriad of central nervous system pathologies. This review discusses several strategies adopted to define a rational drug delivery approach to the CNS along with a short description of the strategies implemented by the authors' group to enhance the analgesic activity, a CNS property, of chimeric peptide of Met-enkephalin and FMRFa (YGGFMKKKFMRFa-YFa). Various approaches for drug delivery to the CNS with their beneficial and non-beneficial aspects, supported by an extensive literature survey published recently, up to August 2009. The reader will have the privilege of gaining an understanding of previous as well as recent approaches to breaching the CNS barriers. Among the various strategies discussed, the potential for efficacious CNS drug targeting in future lies either with the non-invasively administered multifunctional nanosystems or these nanosystems without characterstics such as long systemic circulating capability and avoiding reticuloendothelial system scavenging system of the body, endogenous transporters and efflux inhibitors administered by convection-enhanced delivery.

Exploring the Barriers: A Qualitative Study about the Experiences of Mid-SES Roma Navigating the Spanish Healthcare System.

PubMed

Aiello, Emilia; Flecha, Ainhoa; Serradell, Olga

2018-02-22

Whereas the topic of the 'cultural sensitivity' of healthcare systems has been addressed extensively in the US and the UK, literature on the subject in most European countries, specifically looking at the situation of Roma, is still scarce. Drawing on qualitative research conducted mainly in the city of Barcelona under the communicative approach with Roma subjects who have stable socioeconomic positions and higher cultural capitals (end-users, professionals of the healthcare system, and key informants of a regional policy oriented to the improvement of Roma living conditions), the present study aims to fill this gap. We explore the barriers that the Roma face in accessing the healthcare system, reflecting on how these barriers are accentuated by the existing anti-Roma prejudices and institutional arrangements that do not account for minority cultures. Our results point out a series of obstacles at two levels, in the interaction with healthcare professionals, and in relation to existing institutional arrangements, which prevent Roma families from having equal access to the healthcare system. Education stands up as a mechanism to contest anti-Roma sentiments among healthcare professionals.

25 tips for working through language and cultural barriers in your medical practice.

PubMed

Hills, Laura Sachs

2009-01-01

The language and cultural barriers facing medical patients with limited English language proficiency pose tremendous challenges and risks. Moreover, medical practices today are more likely than ever to employ individuals whose first language is not English or who do not possess native-like knowledge of American culture. Knowing how to work through the language and cultural barriers you are likely to encounter in your medical practice has become increasingly more important. This article is written by a practice management consultant who has graduate-level linguistics training and second-language teaching credentials and experience. It offers 25 practical tips to help you communicate more effectively with individuals who are outside of your native culture and language. These include easy-to-implement tips about English language pronunciation, grammar, and word choice. This article also suggests what you can do personally to bridge the cultural divide with your patients and co-workers. Finally, this article includes a case study of one Virginia practice in which cultural differences interfered with the practice's smooth operation. It explains how the practice eventually worked through and overcame this cultural obstacle.

Self-management of type 2 diabetes: a survey of low-income urban Puerto Ricans.

PubMed

von Goeler, Dorothea S; Rosal, Milagros C; Ockene, Judith K; Scavron, Jeffrey; De Torrijos, Fernando

2003-01-01

This study explored self-reported barriers to diabetes self-management in a population of urban, low-income Puerto Rican individuals. A cross-sectional exploratory survey was conducted with 30 Puerto Rican adults with type 2 diabetes. Participants were randomly selected and recruited from a health center, an elder center, and a community outreach database. A survey was used to assess participants' diabetes-related knowledge, attitudes, and patterns of and barriers to self-management. Participants were older and had limited education and good access to health care. Although two thirds had participated in diabetes education, most demonstrated major deficits in diabetes knowledge. Negative attitudes about living with diabetes were common as was dietary knowledge and nonadherence. Most participants were overweight or obese, did regular self-monitoring of blood glucose but did not use the results to improve their diabetes control, and frequently missed doses of their diabetes medications. Self-reported barriers to self-management were financial and social obstacles and competing health and family concerns. The knowledge and self-management behaviors in this population of Puerto Rican individuals with type 2 diabetes need to be improved.

Substance-Treatment Professionals' Perceived Barriers to Incorporating Mindfulness Into Treatment.

PubMed

Edwards, Emily Rachel; Cohen, Mia Gintoft; Wupperman, Peggilee

2016-12-05

Despite scientific favor, psychological interventions supported by research are often underutilized by practitioners due to perceived obstacles in implementation. Increased transparency between researchers and practitioners throughout treatment development and dissemination is therefore necessary. The rising popularity of mindfulness-based approaches in the treatment of substance-use disorders suggests such transparency is necessary in further developing, disseminating, and implementing such approaches within the context of substance treatment. The present study aimed to increase transparency by surveying substance-treatment professionals regarding their perceptions of barriers to adopting mindfulness in the treatment of substance use. Substance-treatment professionals throughout the United States (N = 103) completed an online survey about their perceptions of potential barriers to implementing mindfulness into substance treatment. Overall, professionals were moderately familiar with mindfulness as a treatment for substance use. Approximately one-third reported providing mindfulness in substance treatment; however, only 7% reported providing mindfulness using a research-supported treatment manual. Across professionals of various backgrounds, the need for further training was rated as the greatest barrier to implementation. Results suggest that practitioners are generally familiar with and willing to implement mindfulness in the treatment of substance use. Future research and implementation efforts should focus on methods of increasing training availability, accessibility, and relevance to address the needs and expectations of substance-treatment professionals.

Linking farmers to community stores to increase consumption of local produce: a case study of the Navajo Nation.

PubMed

Setala, Ashley; Gittelsohn, Joel; Speakman, Kristen; Oski, Jane; Martin, Tammy; Moore, Regina; Tohannie, Marcella; Bleich, Sara N

2011-09-01

To understand the barriers to farmer participation in Farm-to-Table (F2T) programmes and to identify possible solutions to these obstacles. Cross-sectional analysis of farmer perspectives on F2T programmes. Three service units on the Navajo Nation (Chinle, Tuba City and Fort Defiance). Forty-four Navajo farmers. Most participants reported that farming on the Navajo Nation is getting harder (61 %) but that it is very important to maintain Navajo farming traditions (98 %). A modest number of farmers (43 %) expressed interest in participating in an F2T programme. All farmers reported that childhood obesity was a very serious or serious problem in the Navajo Nation. The farmers expressed support for an F2T programme if key barriers to farming, including water access and pest control, could be addressed. Key barriers to participation identified included lack of fruits and vegetables to sell, sale price of crops and lack of certification of produce by the US Food and Drug Administration. Navajo farmers are aware of the burden of childhood obesity on the Navajo Nation and feel that an F2T programme could be beneficial. To successfully implement a Farm-to-Table programme, the barriers to participation identified will need to be addressed.

Fish population genetic structure shaped by hydroelectric power plants in the upper Rhine catchment.

PubMed

Gouskov, Alexandre; Reyes, Marta; Wirthner-Bitterlin, Lisa; Vorburger, Christoph

2016-02-01

The Rhine catchment in Switzerland has been transformed by a chain of hydroelectric power stations. We addressed the impact of fragmentation on the genetic structure of fish populations by focusing on the European chub (Squalius cephalus). This fish species is not stocked and copes well with altered habitats, enabling an assessment of the effects of fragmentation per se. Using microsatellites, we genotyped 2133 chub from 47 sites within the catchment fragmented by 37 hydroelectric power stations, two weirs and the Rhine Falls. The shallow genetic population structure reflected drainage topology and was affected significantly by barriers to migration. The effect of power stations equipped with fishpasses on genetic differentiation was detectable, albeit weaker than that of man-made barriers without fishpasses. The Rhine Falls as the only long-standing natural obstacle (formed 14 000 to 17 000 years ago) also had a strong effect. Man-made barriers also exacerbated the upstream decrease in allelic diversity in the catchment, particularly when lacking fishpasses. Thus, existing fishpasses do have the desired effect of mitigating fragmentation, but barriers still reduce population connectivity in a fish that traverses fishpasses better than many other species. Less mobile species are likely to be affected more severely.

Supported lipid bilayer/carbon nanotube hybrids

NASA Astrophysics Data System (ADS)

Zhou, Xinjian; Moran-Mirabal, Jose M.; Craighead, Harold G.; McEuen, Paul L.

2007-03-01

Carbon nanotube transistors combine molecular-scale dimensions with excellent electronic properties, offering unique opportunities for chemical and biological sensing. Here, we form supported lipid bilayers over single-walled carbon nanotube transistors. We first study the physical properties of the nanotube/supported lipid bilayer structure using fluorescence techniques. Whereas lipid molecules can diffuse freely across the nanotube, a membrane-bound protein (tetanus toxin) sees the nanotube as a barrier. Moreover, the size of the barrier depends on the diameter of the nanotube-with larger nanotubes presenting bigger obstacles to diffusion. We then demonstrate detection of protein binding (streptavidin) to the supported lipid bilayer using the nanotube transistor as a charge sensor. This system can be used as a platform to examine the interactions of single molecules with carbon nanotubes and has many potential applications for the study of molecular recognition and other biological processes occurring at cell membranes.

The political and social barriers for contraception in pest birds: a case study of Ovocontrol (nicarbazin).

PubMed

MacDonald, Alexander; Wolf, Erick

2013-12-01

In a joint program, Innolytics and the U.S. Department of Agriculture/Animal and Plant Health Inspection Service National Wildlife Research Center collaborated in the development of nicarbazin as an avian contraceptive, initially for resident Canada geese and subsequently for feral pigeons. Unfortunately, the introduction of the original goose product in 2005 was a commercial failure. Political and social barriers effectively thwarted attempts to establish the new technology with any meaningful market success. Although the market adoption of the pigeon contraceptive has been less difficult, the product still encounters significant social and political obstacles and opposition. Given the focus on instant results and gratification, the introduction of contraceptive technology for birds has been challenging and broad market acceptance remains elusive. Nevertheless, especially for short-lived and rapidly reproducing species, customers continue to replace outdated or ineffective techniques with the safer and more effective contraceptive tool.

Barriers to HIV Cure.

PubMed

Stein, J; Storcksdieck Genannt Bonsmann, M; Streeck, H

2016-10-01

Since the beginning of the epidemic, more than 70 million people have been infected with human immunodeficiency virus (HIV) and about 38 million have died from acquired immune deficiency syndrome (AIDS)-related illnesses. While the discovery of highly active antiretroviral therapy (HAART) in the mid 90's has saved millions of lives, a complete eradication of HIV is still not possible as HIV can persist for decades in a small reservoir of latently infected cells. Once reactivated, these latently infected cells can actively produce viral particles. Recent studies suggest that several sanctuaries exist within infected individuals where HIV can remain undetected by the immune system. These cellular, anatomical and microanatomical viral reservoirs represent a major obstacle for the eradication of HIV. Here we review recent findings on potential sanctuaries of HIV and address potential avenues to overcome these immunological barriers. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Tumor Restrictions to Oncolytic Virus

PubMed Central

Vähä-Koskela, Markus; Hinkkanen, Ari

2014-01-01

Oncolytic virotherapy has advanced since the days of its conception but therapeutic efficacy in the clinics does not seem to reach the same level as in animal models. One reason is premature oncolytic virus clearance in humans, which is a reasonable assumption considering the immune-stimulating nature of the oncolytic agents. However, several studies are beginning to reveal layers of restriction to oncolytic virotherapy that are present before an adaptive neutralizing immune response. Some of these barriers are present constitutively halting infection before it even begins, whereas others are raised by minute cues triggered by virus infection. Indeed, we and others have noticed that delivering viruses to tumors may not be the biggest obstacle to successful therapy, but instead the physical make-up of the tumor and its capacity to mount antiviral defenses seem to be the most important efficacy determinants. In this review, we summarize the constitutive and innate barriers to oncolytic virotherapy and discuss strategies to overcome them. PMID:28548066

Analytical and Biological Methods for Probing the Blood-Brain Barrier

PubMed Central

Sloan, Courtney D. Kuhnline; Nandi, Pradyot; Linz, Thomas H.; Aldrich, Jane V.; Audus, Kenneth L.; Lunte, Susan M.

2013-01-01

The blood-brain barrier (BBB) is an important interface between the peripheral and central nervous systems. It protects the brain against the infiltration of harmful substances and regulates the permeation of beneficial endogenous substances from the blood into the extracellular fluid of the brain. It can also present a major obstacle in the development of drugs that are targeted for the central nervous system. Several methods have been developed to investigate the transport and metabolism of drugs, peptides, and endogenous compounds at the BBB. In vivo methods include intravenous injection, brain perfusion, positron emission tomography, and microdialysis sampling. Researchers have also developed in vitro cell-culture models that can be employed to investigate transport and metabolism at the BBB without the complication of systemic involvement. All these methods require sensitive and selective analytical methods to monitor the transport and metabolism of the compounds of interest at the BBB. PMID:22708905

Adapting an evidence-based intervention for homeless women: engaging the community in shared decision-making.

PubMed

Cederbaum, Julie A; Song, Ahyoung; Hsu, Hsun-Ta; Tucker, Joan S; Wenzel, Suzanne L

2014-11-01

As interest grows in the diffusion of evidence-based interventions (EBIs), there is increasing concern about how to mitigate implementation challenges; this paper concerns adapting an EBI for homeless women. Complementing earlier focus groups with homeless women, homeless service providers (n = 32) were engaged in focus groups to assess capacity, needs, and barriers with implementation of EBIs. Deductive analyses of data led to the selection of four EBIs. Six consensus groups were then undertaken; three each with homeless women (n = 24) and homeless service providers (n = 21). The selected EBI was adapted and pretested with homeless women (n = 9) and service providers (n = 6). The structured consensus group process provided great utility and affirmed the expertise of homeless women and service providers as experts in their domain. Engaging providers in the selection process reduced the structural barriers within agencies as obstacles to diffusion.

Effect of subseabed salt domes on Tidal Residual currents in the Persian Gulf

NASA Astrophysics Data System (ADS)

Mashayekh Poul, Hossein; Backhaus, Jan; Dehghani, Ali; Huebner, Udo

2016-05-01

Geological studies in the Persian Gulf (PG) have revealed the existence of subseabed salt-domes. With suitable filtering of a high-resolution PG seabed topography, it is seen that the domes leave their signature in the seabed, i.e., numerous hills and valleys with amplitudes of several tens of meters and radii from a few up to tens of kilometers. It was suspected that the "shark skin" of the PG seabed may affect the tidal residual flow. The interaction of tidal dynamics and these obstacles was investigated in a nonlinear hydrodynamic numerical tidal model of the PG. The model was first used to characterize flow patterns of residual currents generated by a tidal wave passing over symmetric, elongated and tilted obstacles. Thereafter it was applied to the entire PG. The model was forced at its open boundary by the four dominant tidal constituents residing in the PG. Each tidal constituent was simulated separately. Results, i.e., tidal residual currents in the PG, as depicted by Lagrangian trajectories reveal a stationary flow that is very rich in eddies. Each eddy can be identified with a topographic obstacle. This confirms that the tidal residual flow field is strongly influenced by the nonlinear interaction of the tidal wave with the bottom relief which, in turn, is deformed by salt-domes beneath the seabed. Different areas of maximum residual current velocities are identified for major tidal constituents. The pattern of trajectories indicates the presence of two main cyclonic gyres and several adjacent gyres rotating in opposite directions and a strong coastal current in the northern PG.

Turbulence between two inline hemispherical obstacles under wave-current interactions

NASA Astrophysics Data System (ADS)

Barman, K.; Debnath, K.; Mazumder, B. S.

2016-02-01

This paper reports an experimental investigation of open channel turbulent flow between two inline surface mounted hemispherical obstacles in tandem arrangement. A series of experiments are performed under combined wave-current interaction with seven relative spacing L/h, where L is center to center spacing distance and h is the obstacle height for Reynolds number Re = 5.88 × 104. The observations are particularly focused on the changes induced in the mean velocity components, turbulence intensities and Reynolds shear stress due to superposition of surface waves on the ambient flow, and are compared to that of flat-surface and a single hemisphere. The paper also investigates the dominant turbulent bursting events that contribute to the Reynolds shear stress for different relative depth influenced by hemispheres. It is observed that the contributions to the total shear stress due to ejection and sweep are dominant at the wake region for single and double hemisphere near the bed, while towards the surface outward and inward interactions show significant effect for wave-current interactions which is largely different from that over the flat-surface case. Spectral analysis of the observed velocity fluctuations reveals the existence of two distinct power law scaling regime near the bed. At high frequency, an inertial sub-range of turbulence with -5/3 Kolmogorov scaling is observed for the flat-surface. The spectral slope is calculated to show the shifting of standard Kolmogorov scale for both only current and wave-induced tests.

Robotic guarded motion system and method

DOEpatents

Bruemmer, David J.

2010-02-23

A robot platform includes perceptors, locomotors, and a system controller. The system controller executes instructions for repeating, on each iteration through an event timing loop, the acts of defining an event horizon, detecting a range to obstacles around the robot, and testing for an event horizon intrusion. Defining the event horizon includes determining a distance from the robot that is proportional to a current velocity of the robot and testing for the event horizon intrusion includes determining if any range to the obstacles is within the event horizon. Finally, on each iteration through the event timing loop, the method includes reducing the current velocity of the robot in proportion to a loop period of the event timing loop if the event horizon intrusion occurs.

Complex behaviour in complex terrain - Modelling bird migration in a high resolution wind field across mountainous terrain to simulate observed patterns.

PubMed

Aurbach, Annika; Schmid, Baptiste; Liechti, Felix; Chokani, Ndaona; Abhari, Reza

2018-06-03

Crossing of large ecological barriers, such as mountains, is in terms of energy considered to be a demanding and critical step during bird migration. Besides forming a geographical barrier, mountains have a profound impact on the resulting wind flow. We use a novel framework of mathematical models to investigate the influences of wind and topography on nocturnal passerine bird behaviour, and to assess the energy costs for different flight strategies for crossing the Jura Mountains. The mathematical models include three biological models of bird behaviour: i) wind drift compensation; ii) adaptation of flight height for favourable winds; and, iii) avoidance of obstacles (cross over and/or circumvention of an obstacle following a minimum energy expenditure strategy), which are assessed separately and in combination. Further, we use a mesoscale weather model for high-resolution predictions of the wind fields. We simulate the broad front nocturnal passerine migration for autumn nights with peak migration intensities. The bird densities retrieved from a weather radar are used as the initial intensities and to specify the vertical distributions of the simulated birds. It is shown that migration over complex terrain represents the most expensive flight option in terms of energy expenditure, and wind is seen to be the main factor that influences the energy expenditure in the bird's preferred flight direction. Further, the combined effects of wind and orography lead to a high concentration of migratory birds within the favourable wind conditions of the Swiss lowlands and north of the Jura Mountains. Copyright © 2018 Elsevier Ltd. All rights reserved.

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

McDermott, Christa; Malone, Elizabeth L.

This report assesses the use of institutional change principles and the institutional impact of award-winning projects through interviews with 22 Department of Energy Federal Energy Management Program (DOE FEMP) award winners. Award winners identified institutional facilitators and barriers in their projects and programs as well as factors in their implementation processes, thus providing information that can guide other efforts. We found that award winners do use strategies based on eight principles of institutional change, most frequently in terms of making changes to infrastructure, engaging leadership, and capitalizing on multiple motivations for making an energy efficiency improvement. The principles drawn onmore » the least often were commitment and social empowerment. Award winners also faced five major types of obstacles that were institutional in nature: lack of resources, constraints of rules, psychological barriers, lack of information, and communication problems. We also used the seven categories of Energy Management Excellence (EME) as a lens to interpret the interview data and assess whether these categories relate to established institutional change principles. We found that the eight principles reflect strategies that have been found to be useful in improving energy efficiency in organizations, whereas the EME categories capture more of a blend of social contextual factors and strategies. The EME categories fill in some of the social context gaps that facilitate institutional change and energy management excellence, for example, personal persistence, a culture that supports creativity and innovation, regular engagement with tenants, contractors, and staff at all levels. Taking together the use of principles, EME criteria, and obstacles faced by interviewees, we make recommendations for how FEMP can better foster institutional change in federal agencies.« less

Patterns, determinants and barriers of health and social service utilization among young urban crack users in Brazil

PubMed Central

2013-01-01

Background Crack use is prevalent across the Americas, and specifically among marginalized urban street drug users in Brazil. Crack users commonly feature multiple physical and mental health problems, while low rates of and distinct barriers to help service use have been observed in these populations. This study examined profiles and determinants of social and health service utilization, and unmet service needs, in a two-city sample of young (18–24 years), marginalized crack users in Brazil. Methods N = 160 study participants were recruited by community-based methods from impoverished neighborhoods in the cities of Rio de Janeiro (n = 81) and Salvador (n = 79). A mixed methods protocol was used. Participants’ drug use, health, and social and health service utilization characteristics were assessed by an anonymous interviewer-administered questionnaire completed in a community setting; descriptive statistics on variables of interest were computed. Service needs and barriers were further assessed by way of several focus groups with the study population; narrative data were qualitatively analyzed. The study protocol was approved by institutional ethics review boards; data were collected between November 2010 and June 2011. Results The majority of the sample was male, without stable housing, and used other drugs (e.g., alcohol, marijuana). About half the sample reported physical and mental health problems, yet most had not received medical attention for these problems. Only small minorities had utilized locally available social or health services; utilization appeared to be influenced by sex, race and housing characteristics in both sites. Participants cited limited service resources, lack of needs-specific professional skills, bureaucratic barriers and stigma as obstacles to better service access. However, most respondents stated strong interest and need for general social, health and treatment services designed for the study population, for which various key features were emphasized as important. Conclusions The study contributes substantive evidence to current discussions about the development and utilization of health and treatment interventions for crack use in Brazil. Based on our data, crack users’ social, service needs are largely unmet; these gaps appear to partly root in systemic barriers of access to existing services, while improved targeted service offers for the target population seem to be needed also. PMID:24373346

Microfluidic manipulation of magnetic flux domains in type-I superconductors: droplet formation, fusion and fission.

PubMed

Berdiyorov, G R; Milošević, M V; Hernández-Nieves, A D; Peeters, F M; Domínguez, D

2017-09-21

The magnetic flux domains in the intermediate state of type-I superconductors are known to resemble fluid droplets, and their dynamics in applied electric current is often cartooned as a "dripping faucet". Here we show, using the time-depended Ginzburg-Landau simulations, that microfluidic principles hold also for the determination of the size of the magnetic flux-droplet as a function of the applied current, as well as for the merger or splitting of those droplets in the presence of the nanoengineered obstacles for droplet motion. Differently from fluids, the flux-droplets in superconductors are quantized and dissipative objects, and their pinning/depinning, nucleation, and splitting occur in a discretized form, all traceable in the voltage measured across the sample. At larger applied currents, we demonstrate how obstacles can cause branching of laminar flux streams or their transformation into mobile droplets, as readily observed in experiments.

Mine-hunting dolphins of the Navy

NASA Astrophysics Data System (ADS)

Moore, Patrick W.

1997-07-01

Current counter-mine and obstacle avoidance technology is inadequate, and limits the Navy's capability to conduct shallow water (SW) and very shallow water (VSW) MCM in support of beach assaults by Marine Corps forces. Without information as to the location or density of mined beach areas, it must be assumed that if mines are present in one area then they are present in all areas. Marine mammal systems (MMS) are an unusual, effective and unique solution to current problems of mine and obstacle hunting. In the US Navy Mine Warfare Plan for 1994-1995 Marine Mammal Systems are explicitly identified as the Navy's only means of countering buried mines and the best means for dealing with close-tethered mines. The dolphins in these systems possess a biological sonar specifically adapted for their shallow and very shallow water habitat. Research has demonstrated that the dolphin biosonar outperforms any current hardware system available for SW and VSW applications. This presentation will cover current Fleet MCM systems and future technology application to the littoral region.

Adverse Event Reporting: Harnessing Residents to Improve Patient Safety.

PubMed

Tevis, Sarah E; Schmocker, Ryan K; Wetterneck, Tosha B

2017-10-13

Reporting of adverse and near miss events are essential to identify system level targets to improve patient safety. Resident physicians historically report few events despite their role as front-line patient care providers. We sought to evaluate barriers to adverse event reporting in an effort to improve reporting. Our main outcomes were as follows: resident attitudes about event reporting and the frequency of event reporting before and after interventions to address reporting barriers. We surveyed first year residents regarding barriers to adverse event reporting and used this input to construct a fishbone diagram listing barriers to reporting. Barriers were addressed, and resident event reporting was compared before and after efforts were made to reduce obstacles to reporting. First year residents (97%) recognized the importance of submitting event reports; however, the majority (85%) had not submitted an event report in the first 6 months of residency. Only 7% of residents specified that they had not witnessed an adverse event in 6 months, whereas one third had witnessed 10 or more events. The main barriers were as follows: lack of knowledge about how to submit events (38%) and lack of time to submit reports (35%). After improving resident education around event reporting and simplifying the reporting process, resident event reporting increased 230% (68 to 154 annual reports, P = 0.025). We were able to significantly increase resident event reporting by educating residents about adverse events and near misses and addressing the primary barriers to event reporting. Moving forward, we will continue annual resident education about patient safety, focus on improving feedback to residents who submit reports, and empower senior residents to act as role models to junior residents in patient safety initiatives.

Mental health care for irregular migrants in Europe: Barriers and how they are overcome

PubMed Central

2012-01-01

Background Irregular migrants (IMs) are exposed to a wide range of risk factors for developing mental health problems. However, little is known about whether and how they receive mental health care across European countries. The aims of this study were (1) to identify barriers to mental health care for IMs, and (2) to explore ways by which these barriers are overcome in practice. Methods Data from semi-structured interviews with 25 experts in the field of mental health care for IMs in the capital cities of 14 European countries were analysed using thematic analysis. Results Experts reported a range of barriers to mental health care for IMs. These include the absence of legal entitlements to health care in some countries or a lack of awareness of such entitlements, administrative obstacles, a shortage of culturally sensitive care, the complexity of the social needs of IMs, and their fear of being reported and deported. These barriers can be partly overcome by networks of committed professionals and supportive services. NGOs have become important initial points of contact for IMs, providing mental health care themselves or referring IMs to other suitable services. However, these services are often confronted with the ethical dilemma of either acting according to the legislation and institutional rules or providing care for humanitarian reasons, which involves the risk of acting illegally and providing care without authorisation. Conclusions Even in countries where access to health care is legally possible for IMs, various other barriers remain. Some of these are common to all migrants, whilst others are specific for IMs. Attempts at improving mental health care for IMs should consider barriers beyond legal entitlement, including communicating information about entitlement to mental health care professionals and patients, providing culturally sensitive care and ensuring sufficient resources. PMID:22607386

Neural correlates of obstacle negotiation in older adults: An fNIRS study.

PubMed

Chen, Michelle; Pillemer, Sarah; England, Sarah; Izzetoglu, Meltem; Mahoney, Jeannette R; Holtzer, Roee

2017-10-01

Older adults are less efficient at avoiding obstacles compared to young adults, especially under attention-demanding conditions. Using functional near-infrared-spectroscopy (fNIRS), recent studies implicated the prefrontal cortex (PFC) in cognitive control of locomotion, notably under dual-task walking conditions. The neural substrates underlying Obstacle Negotiation (ON), however, have not been established. The current study determined the role of the PFC in ON during walking in seniors. Non-demented older adults (n=90; mean age=78.1±5.5years; %female=51) underwent fNIRS acquisition to assess changes in hemodynamic activity in the PFC during normal-walk [NW] and walk-while-talk [WWT] conditions with and without obstacles. Obstacles were presented as red elliptical shapes using advanced laser technology, which resemble potholes. Linear mixed effects models were used to determine differences in oxygenated hemoglobin (HbO 2 ) levels among the four task conditions. The presence of slow gait, a risk factor for dementia and falls, served as a predictor hypothesized to moderate the effect of obstacles on PFC HbO 2 levels. PFC HbO 2 levels were significantly higher in WWT compared to NW (p<0.001) irrespective of ON. Slow gait moderated the effect of obstacles on HbO 2 levels across task conditions. Specifically, compared to participants with normal gait, PFC HbO 2 levels were significantly increased in ON-NW relative to NW (p=0.017) and ON-WWT relative to WWT (p<0.001) among individuals with slow gait. Consistent with Compensatory Reallocation, ON required greater PFC involvement among individuals with mobility limitations. Copyright © 2017 Elsevier B.V. All rights reserved.

How obstacles and facilitators predict academic performance: the mediating role of study burnout and engagement.

PubMed

Salanova, Marisa; Schaufeli, Wilmar; Martinez, Isabel; Breso, Edgar

2010-01-01

Most people would agree with the maxim that "success breeds success." However, this is not the whole story. The current study investigated the additional impact of psychosocial factors (i.e., performance obstacles and facilitators) as well as psychological well-being (i.e., burnout and engagement) on success (i.e., academic performance). More specifically, our purpose was to show that, instead of directly affecting future performance, obstacles and facilitators exert an indirect effect via well-being. A total of 527 university students comprised the sample and filled out a questionnaire. We obtained their previous and future academic performance Grade Point Average (GPA) from the university's records. Structural equations modeling showed that the best predictor of future performance was the students' previous performance. As expected, study engagement mediated the relationship between performance obstacles and facilitators on the one hand, and future performance on the other. Contrary to expectations, burnout did not predict future performance, although, it is significantly associated with the presence of obstacles and the absence of facilitators. Our results illustrate that, although "success breeds success" (i.e., the best predictor of future performance is past performance), positive psychological states like study engagement are also important in explaining future performance, at least more so than negative states like study burnout.

Healthcare Communication Barriers and Self-Rated Health in Older Chinese American Immigrants.

PubMed

Tsoh, Janice Y; Sentell, Tetine; Gildengorin, Ginny; Le, Gem M; Chan, Elaine; Fung, Lei-Chun; Pasick, Rena J; Stewart, Susan; Wong, Ching; Woo, Kent; Burke, Adam; Wang, Jun; McPhee, Stephen J; Nguyen, Tung T

2016-08-01

Older Chinese immigrants are a growing population in the United States who experience multiple healthcare communication barriers such as limited English proficiency and low health literacy. Each of these obstacles has been associated with poor health outcomes but less is known about their effects in combination. This study examined the association between healthcare communication barriers and self-rated health among older Chinese immigrants. Cross-sectional survey data were obtained from 705 Chinese American immigrants ages 50-75 living in San Francisco, California. Communication barriers examined included spoken English proficiency, medical interpreter needs, and health literacy in written health information. The study sample (81 % females, mean age = 62) included 67 % who spoke English poorly or not at all, 34 % who reported needing a medical interpreter, and 37 % who reported "often" or "always" needing assistance to read health information. Two-thirds reported poor self-rated health; many reported having access to racial-concordant (74 %) and language-concordant (86 %) healthcare services. Both poor spoken English proficiency and low health literacy were associated with poor self-rated health, independent of other significant correlates (unemployment, chronic health conditions, and having a primary doctor who was ethnic Chinese). Results revealed that spoken English proficiency and print health literacy are independent communication barriers that are directly associated with health status among elderly Chinese American immigrants. Access to racial- or language-concordant health care services did not appear to resolve these barriers. These findings underscore the importance of addressing both spoken and written healthcare communication needs among older Chinese American immigrants.

Healthcare Communication Barriers and Self-Rated Health in Older Chinese American Immigrants

PubMed Central

Tsoh, Janice Y.; Sentell, Tetine; Gildengorin, Ginny; Le, Gem M.; Chan, Elaine; Fung, Lei-Chun; Pasick, Rena J.; Stewart, Susan; Wong, Ching; Woo, Kent; Burke, Adam; Wang, Jun; McPhee, Stephen J.; Nguyen, Tung T.

2016-01-01

Older Chinese immigrants are a growing population in the United States who experience multiple healthcare communication barriers such as limited English proficiency and low health literacy. Each of these obstacles has been associated with poor health outcomes but less is known about their effects in combination. This study examined the association between healthcare communication barriers and self-rated health among older Chinese immigrants. Cross-sectional survey data were obtained from 705 Chinese American immigrants ages 50-75 living in San Francisco, California. Communication barriers examined included spoken English proficiency, medical interpreter needs, and health literacy in written health information. The study sample (81% females, mean age = 62) included 67% who spoke English poorly or not at all, 34% who reported needing a medical interpreter, and 37% who reported “often” or “always” needing assistance to read health information. Two-thirds (66%) reported poor self-rated health; many reported having access to racial-concordant (74%) and language-concordant (86%) healthcare services. Both poor spoken English proficiency and low health literacy were associated with poor self-rated health, independent of other significant correlates (unemployment, chronic health conditions, and having a primary doctor who was ethnic Chinese). Results revealed that spoken English proficiency and print health literacy are independent communication barriers that directly associated with the health status among elderly Chinese American immigrants. Access to racial- or language-concordant health care services did not appear to resolve these barriers. These findings underscore the importance of addressing both spoken and written healthcare communication needs among older Chinese American immigrants. PMID:26746205

When access is an issue: exploring barriers to predictive testing for Huntington disease in British Columbia, Canada.

PubMed

Hawkins, Alice K; Creighton, Susan; Hayden, Michael R

2013-02-01

Predictive testing (PT) for Huntington disease (HD) requires several in-person appointments. This requirement may be a barrier to testing so that at risk individuals do not realize the potential benefits of PT. To understand the obstacles to PT in terms of the accessibility of services, as well as exploring mechanisms by which this issue may be addressed, we conducted an interview study of individuals at risk for HD throughout British Columbia, Canada. Results reveal that the accessibility of PT can be a barrier for two major reasons: distance and the inflexibility of the testing process. Distance is a structural barrier, and relates to the time and travel required to access PT, the financial and other opportunity costs associated with taking time away from work and family to attend appointments and the stress of navigating urban centers. The inflexibility of the testing process barrier relates to the emotional and psychological accessibility of PT. The results of the interview study reveal that there are access barriers to PT that deter individuals from receiving the support, information and counseling they require. What makes accessibility of PT services important is not just that it may result in differences in quality of life and care, but because these differences may be addressed with creative and adaptable solutions in the delivery of genetic services. The study findings underscore the need for us to rethink and personalize the way we deliver such services to improve access issues to prevent inequities in the health care system.

Barriers to mesalamine adherence in patients with inflammatory bowel disease: a qualitative analysis.

PubMed

Devlen, Jennifer; Beusterien, Kathleen; Yen, Linnette; Ahmed, Awais; Cheifetz, Adam S; Moss, Alan C

2014-03-01

The causes for nonadherence to mesalamine in patients with inflammatory bowel disease (IBD) have been characterized using mostly indirect methods. Patient-reported barriers are lacking in this population. To identify patient-reported barriers to mesalamine adherence through direct interviews. Focus groups and one-on-one interviews were undertaken in adult patients with IBD. Transcripts from the focus groups and interviews were analyzed to identify themes and links between these themes, assisted by qualitative data software MaxQDA. Of 27 patients participating, 21 (78%) had ulcerative colitis, and 6 (22%) had Crohn's disease. Their self-reported adherence ranged from complete adherence (n = 3) to intermittent nonadherence (n = 24). Patients frequently indicated that they were resistant to taking medications for their condition. The barriers to adherence that emerged from interviews could be categorized under a number of themes: competing priorities, social stigma, refill inconvenience, costs, efficacy values, side effects, and pill characteristics. Efficacy values reported to influence adherence included doubts about efficacy, consequences of missed doses, and doubts about need for maintenance medication. Pill characteristics reported as barriers included pill size and pill frequency. Despite use of electronic prescribing, obtaining refills was reported as an obstacle to adherence in this cohort. Decanting of pills to multiple containers to increase accessibility was also reported. Patients with both ulcerative colitis and Crohn's disease report a number of common barriers to mesalamine adherence. Factors in medication-taking behavior and beliefs were reported in this study that may have implications for strategies to improve adherence by health care providers.

Computer vision techniques for rotorcraft low altitude flight

NASA Technical Reports Server (NTRS)

Sridhar, Banavar

1990-01-01

Rotorcraft operating in high-threat environments fly close to the earth's surface to utilize surrounding terrain, vegetation, or manmade objects to minimize the risk of being detected by an enemy. Increasing levels of concealment are achieved by adopting different tactics during low-altitude flight. Rotorcraft employ three tactics during low-altitude flight: low-level, contour, and nap-of-the-earth (NOE). The key feature distinguishing the NOE mode from the other two modes is that the whole rotorcraft, including the main rotor, is below tree-top whenever possible. This leads to the use of lateral maneuvers for avoiding obstacles, which in fact constitutes the means for concealment. The piloting of the rotorcraft is at best a very demanding task and the pilot will need help from onboard automation tools in order to devote more time to mission-related activities. The development of an automation tool which has the potential to detect obstacles in the rotorcraft flight path, warn the crew, and interact with the guidance system to avoid detected obstacles, presents challenging problems. Research is described which applies techniques from computer vision to automation of rotorcraft navigtion. The effort emphasizes the development of a methodology for detecting the ranges to obstacles in the region of interest based on the maximum utilization of passive sensors. The range map derived from the obstacle-detection approach can be used as obstacle data for the obstacle avoidance in an automatic guidance system and as advisory display to the pilot. The lack of suitable flight imagery data presents a problem in the verification of concepts for obstacle detection. This problem is being addressed by the development of an adequate flight database and by preprocessing of currently available flight imagery. The presentation concludes with some comments on future work and how research in this area relates to the guidance of other autonomous vehicles.

Air Pollution: Current and Future Challenges

EPA Pesticide Factsheets

Despite the dramatic progress to date, air pollution continues to threaten Americans’ health and welfare. The main obstacles are climate change, conventional air pollution, and ozone layer depletion.

The Experiences of Female Athletic Trainers in the Role of the Head Athletic Trainer

PubMed Central

Mazerolle, Stephanie M.; Burton, Laura; Cotrufo, Raymond J.

2015-01-01

Context: Very few women have leadership positions in athletic training (ie, head athletic training positions) in intercollegiate athletics. Research exists on the barriers to attaining the role; however, our understanding about the experiences of those currently engaged in the role is limited. Objective: To examine the experiences of female head athletic trainers as they worked toward and attained the position of head athletic trainer. Design: Qualitative study. Setting: National Collegiate Athletic Association Division I setting. Patients or Other Participants: Eight female athletic trainers serving in the role of head athletic trainer participated in our study. The mean age of the participants was 45 ± 12 years, with 5 ± 1.5 years of experience in the role of head athletic trainer and 21 ± 10 years of experience as athletic trainers. Data Collection and Analysis: We conducted phone interviews with the 8 participants following a semistructured format. Interviews were transcribed verbatim and analyzed following a general inductive approach as described by Thomas. To establish credibility, we used a peer reviewer, member checks, and multiple-analyst triangulation. Results: Six major themes emerged from our analysis regarding the experiences of female head athletic trainers. Opportunities to become a head athletic trainer, leadership qualities, and unique personal characteristics were discussed as factors leading to the assumption of the role of the head athletic trainer. Where women hold back, family challenges, and organizational barriers speak to the potential obstacles to assuming the role of head athletic trainer. Conclusions: Female head athletic trainers did not seek the role, but through persistence and encouragement, they find themselves assuming the role. Leadership skills were discussed as important for success in the role of head athletic trainer. Life balancing and parenting were identified as barriers to women seeking the role of head athletic trainer. PMID:25275423

A national minority transplant program for increasing donation rates.

PubMed

Callender, C; Burston, B; Yeager, C; Miles, P

1997-01-01

Since 1982, our group efforts demonstrated statistically significant improvements in minority donation rates which have applicability to all minority populations. As we continue to reach out to the various ethnic communities, we must listen to the needs of the community understanding that all ethnic communities have various beliefs and cultural barriers that will need to be addressed. For instance, the African-American population revealed the previously mentioned five obstacles to donation. The Hispanic population has revealed relatively the same fears to donation as the African-American population. In addition, the tribes within the Native-American population each have their own belief systems which will have to be addressed appropriately. The fears and obstacles toward donation within the Asians and Pacific Islanders and the Alaska Native groups are being defined. However, initial research reveals that all of the minority groups have very similar, if not the same, fears that were identified with the initial focus group in 1978. This simple methodology that has been established can ultimately help achieve the overall desired goal--an increase in minority donation rates.

Special report: the truth about condoms. Barriers to better condom "killing people"; regulatory, political hurdles stifle development.

PubMed

1995-01-01

The condom industry in the US is dominated by Carter Wallace and the London International Group. They offer very little product differentiation. Ten years ago, however, two engineers in a small California laboratory began working on a nonlatex condom which would be both stronger and more sensitive than the traditional male latex condom. Their efforts resulted in the development of the polyurethane Avanti condom currently being marketed in thirteen states of the Western US. Made by London International Group plc in Cambridge, England, Avanti should be available nationwide as of April 1995. The public, however, has received only very little information about the product and the US Food and Drug Administration (FDA) is concerned about the safety and efficacy of polyurethane/plastic condoms. Six other condom manufacturers are developing plastic condoms, with at least five such condoms awaiting FDA premarket clearance to be marketed. Recent delays in marketing Avanti are due to disagreements between the manufacturer and the FDA over labeling. Other delays have involved safety and efficacy concerns. Bob Kohmescher, public health analyst with the US Centers for Disease Control office of the assistant director of HIV/AIDS, notes that even his agency is moving slower than expected on the polyurethane condom and has not reached a consensus over how to describe them. In the effort to protect themselves, FDA officials have insisted upon labeling which recommends plastic condoms for use by only people who are allergic to latex. These labeling guidelines, finalized in November, are so restrictive that some manufacturers cannot take their products to market. Despite these current FDA obstacles to bringing a higher quality condom to the US market, industry experts and health officials hope that the polyurethane and other plastic condoms will expand the practice of safer sex, while providing an alternative method of barrier protection for the estimated 1-2 million American adults who are allergic to latex.

Barriers to and Facilitators of Research Utilization among Iranian Nurses: a Literature Review.

PubMed

Heydari, Abbas; Emami Zeydi, Amir

2014-12-01

Research utilization (RU), is an important strategy to promote the quality of patient care. The aim of this study was to present a comprehensive literature review describing barriers and facilitators of RU among Iranian nurses. Literature review was undertaken using the international databases including Pub Med/Medline, Scopus, Science Direct, and Google Scholar. Also, Persian electronic databases such as Magiran, SID and Iran Medex were searched up to May 2014. The search was limited to articles in the English and Persian languages that evaluate the barriers or facilitators of RU among Iranian nurses. A total of 11 articles were in the final dataset. The most important barriers to RU among Iranian nurses were related to the organization factors such as inadequate facilities; insufficient time on the job, lack of authority, physician cooperation, and administrative support. The most frequent facilitators of RU were education in enhancing nurses knowledge and skills in research evaluation, support from knowledgeable nursing colleagues and nursing faculty in the clinical setting, access to an expert committee for clinical appraisal, improving skills in English language and searching for articles, sufficient economic resources to carry out research, and having access to more facilities such as internet. Iranian nurses encounter with the same difficulties as to other countries regarding RU; while setting related barriers were the predominant obstacles to RU among them. Therefore, health managers are expected to plan appropriate strategies to smooth the progress of RU by nurses in their practice.

Barriers to and Facilitators of Research Utilization among Iranian Nurses: a Literature Review

PubMed Central

Heydari, Abbas; Emami Zeydi, Amir

2014-01-01

Introduction: Research utilization (RU), is an important strategy to promote the quality of patient care. The aim of this study was to present a comprehensive literature review describing barriers and facilitators of RU among Iranian nurses. Methods: Literature review was undertaken using the international databases including Pub Med/Medline, Scopus, Science Direct, and Google Scholar. Also, Persian electronic databases such as Magiran, SID and Iran Medex were searched up to May 2014. The search was limited to articles in the English and Persian languages that evaluate the barriers or facilitators of RU among Iranian nurses. Results: A total of 11 articles were in the final dataset. The most important barriers to RU among Iranian nurses were related to the organization factors such as inadequate facilities; insufficient time on the job, lack of authority, physician cooperation, and administrative support. The most frequent facilitators of RU were education in enhancing nurses knowledge and skills in research evaluation, support from knowledgeable nursing colleagues and nursing faculty in the clinical setting, access to an expert committee for clinical appraisal, improving skills in English language and searching for articles, sufficient economic resources to carry out research, and having access to more facilities such as internet. Conclusion: Iranian nurses encounter with the same difficulties as to other countries regarding RU; while setting related barriers were the predominant obstacles to RU among them. Therefore, health managers are expected to plan appropriate strategies to smooth the progress of RU by nurses in their practice. PMID:25717456

"Bureaucracy & Beliefs": Assessing the Barriers to Accessing Opioid Substitution Therapy by People Who Inject Drugs in Ukraine.

PubMed

Bojko, Martha J; Mazhnaya, Alyona; Makarenko, Iuliia; Marcus, Ruthanne; Dvoriak, Sergii; Islam, Zahedul; Altice, Frederick L

Opioid substitution therapy (OST) is an evidence-based HIV prevention strategy for people who inject drugs (PWIDs). Yet, only 2.7% of Ukraine's estimated 310,000 PWIDs receive it despite free treatment since 2004. The multi-level barriers to entering OST among opioid dependent PWIDs have not been examined in Ukraine. A multi-year mixed methods implementation science project included focus group discussions with 199 PWIDs in 5 major Ukrainian cities in 2013 covering drug treatment attitudes and beliefs and knowledge of and experiences with OST. Data were transcribed, translated into English and coded. Coded segments related to OST access, entry, knowledge, beliefs and attitudes were analyzed among 41 PWIDs who were eligible for but had never received OST. A number of programmatic and structural barriers were mentioned by participants as barriers to entry to OST, including compulsory drug user registration, waiting lists, and limited number of treatment slots. Participants also voiced strong negative attitudes and beliefs about OST, especially methadone. Their perceptions about methadone's side effects as well as the stigma of being a methadone client were expressed as obstacles to treatment. Despite expressed interest in treatment, Ukrainian OST-naïve PWIDs evade OST for reasons that can be addressed through changes in program-level and governmental policies and social-marketing campaigns. Voiced OST barriers can effectively inform public health and policy directives related to HIV prevention and treatment in Ukraine to improve evidence-based treatment access and availability.

Shape-assisted body reorientation enhances trafficability through cluttered terrain

NASA Astrophysics Data System (ADS)

Li, Chen; Pullin, Andrew; Haldane, Duncan; Fearing, Ronald; Full, Robert

2014-11-01

Many birds and fishes have slender, streamlined bodies that reduce fluid dynamic drag and allow fast and efficient locomotion. Similarly, numerous terrestrial animals run through cluttered terrain where 3-D, multi-component obstacles like grass, bushes, trees, walls, doors, and pillars also resist motion, but it is unknown whether their body shape plays a major role. Here, we challenged discoid cockroaches that possess a rounded, thin, nearly ellipsoidal body to run through tall, narrowly spaced, grass-like beams. The animals primarily rolled their body to the side to maneuver through the obstacle gaps. Reduction of body roundness by artificial shells inhibited this side roll maneuver, resulting in a lower traversal probability and a longer traversal time (P < 0.001, ANOVA). Inspired by this discovery, we added a cockroach-like, rounded exoskeleton shell to a legged robot of a nearly cuboidal body. The rounded shell enabled the robot to use passive side rolling to maneuver through beams. To explain the mechanism, we developed a simple physics model to construct an energy landscape of the body-terrain interaction, which allowed estimation of body forces and torques exerted by the beams. Our model revealed that, by passive interaction with the terrain, a rounded body (ellipsoid) rolled more easily than an angular body (cuboid) to access energy valleys between energy barriers caused by obstacles. Our study is the first to demonstrate that a terradynamically ``streamlined'' shape can reduce terrain resistance and enhance trafficability by assisting body reorientation.

Drug Delivery to CNS: Challenges and Opportunities with Emphasis on Biomaterials Based Drug Delivery Strategies.

PubMed

Khambhla, Ekta; Shah, Viral; Baviskar, Kalpesh

2016-01-01

The current epoch has witnessed a lifestyle impregnated with stress, which is a major cause of several neurological disorders. High morbidity and mortality rate due to neurological diseases and disorders have generated a huge social impact. Despite voluminous research, patients suffering from fatal and/or debilitating CNS diseases such as brain tumors, HIV, encephalopathy, Alzheimer's, epilepsy, Parkinson's, migraine and multiple sclerosis outnumbered those suffering from systemic cancer or heart diseases. The brain being a highly sensitive neuronal organ, has evolved with vasculature barriers, which regulates the efflux and influx of substances to CNS. Treatment of CNS diseases/disorders is challenging because of physiologic, metabolic and biochemical obstacles created by these barriers which comprise mainly of BBB and BCFB. The inability of achieving therapeutically active concentration has become the bottleneck level difficulty, hampering the therapeutic efficiency of several promising drug candidates for CNS related disorders. Parallel maturation of an effective CNS drug delivery strategy with CNS drug discovery is the need of the hour. Recently, the focus of the pharmaceutical community has aggravated in the direction of developing novel and more efficient drug delivery systems, giving the potential of more effective and safer CNS therapies. The present review outlines several hurdles in drug delivery to the CNS along with ideal physicochemical properties desired in drug substance/formulation for CNS delivery. The review also focuses on different conventional and novel strategies for drug delivery to the CNS. The article also assesses and emphasizes on possible benefits of biomaterial based formulations for drug delivery to the CNS.

Barred from better medicine? Reexamining regulatory barriers to the inclusion of prisoners in research.

PubMed

Huang, Elaine; Cauley, Jacqueline; Wagner, Jennifer K

2017-04-01

In 2015, President Obama announced plans for the Precision Medicine Initiative ® (PMI), an ambitious longitudinal project aimed at revolutionizing medicine. Integral to this Initiative is the recruitment of over one million Americans into a volunteer research cohort, the All of Us SM Research Program. The announcement has generated much excitement but absent is a discussion of how the All of Us Research Program-to be implemented within the context of social realities of mass incarcerations and racial disparities in criminal justice and healthcare-might excaberate health disparities. We examine how attainment of Initiative's stated goals of reflecting the diversity of the American population and including all who are interested in participating might be impeded by regulatory and administrative barriers to the involvement of participants who become incarcerated during longitudinal studies. Changes have been proposed to the federal policy for human subjects research protections, but current regulations and administrative policies-developed under a protectionist paradigm in response to scandalous research practices with confined populations-dramatically limit research involving prisoners. Our review provides rationale for the development of Initiative policies that anticipate recruitment and retention obstacles that might frustrate inclusivity and exacerbate health disparities. Furthermore, we question the effective ban on biomedical and behavioral research involving prisoners and advocate for regulatory reforms that restore participatory research rights of prisoners. Disparities in health and justice are intertwined, and without regulatory reforms to facilitate participatory research rights of prisoners and careful planning of viable and responsible recruitment, engagement, and retention strategies, Initiative could miss discovery opportunities, exacerbate health disparities, and increase levels of distrust in science.

The Buffering Effect of Hope on Clinicians’ Behavior: A Test in Pediatric Primary Care

PubMed Central

Tennen, Howard; Cloutier, Michelle M.; Wakefield, Dorothy B.; Hall, Charles B.; Brazil, Kevin

2009-01-01

Although trait hope is thought to motivate goal directed actions in the face of impediments, few studies have examined directly hope’s role in overcoming obstacles, and none have done so while accounting for related goal constructs. We describe a study of 127 pediatric primary care providers who over the course of a year were asked to identify new cases of asthma and confirm previously diagnosed active disease by completing for each of their patients a brief survey validated for this purpose. These clinicians also completed measures of hope, self-efficacy, conscientiousness, and perceived obstacles to implementing a pediatric asthma management program. As predicted by hope theory, the agency component of hope buffered clinicians from perceived obstacles by facilitating the identification of asthma cases among high hope clinicians in the face of obstacles. This buffering effect remained after controlling for self-efficacy and conscientiousness. We discuss the study findings in terms of current theories of goal directed behavior and implications for delivering hope-related interventions, and we offer a testable hypothesis regarding when agency and pathways thinking facilitate goal-related behavior. PMID:20161067

Analysis of high reverse currents of 4H-SiC Schottky-barrier diodes

NASA Astrophysics Data System (ADS)

Okino, Hiroyuki; Kameshiro, Norifumi; Konishi, Kumiko; Shima, Akio; Yamada, Ren-ichi

2017-12-01

Nickel (Ni), titanium (Ti), and molybdenum (Mo) 4H-silicon carbide Schottky-barrier diodes (SiC SBDs) were fabricated and used to investigate the relation between forward and reverse currents. Temperature dependence of reverse current follows a theory that includes tunneling in regard to thermionic emission, namely, temperature dependence is weak at low temperature but strong at high temperatures. On the other hand, the reverse currents of the Ni and Mo SBDs are higher than their respective currents calculated from their Schottky barrier heights (SBHs), whereas the reverse current of the Ti SBD agrees well with that calculated from its SBH. The cause of the high reverse currents was investigated from the viewpoints of low barrier patch, Gaussian distribution of barrier height (GD), thin surface barrier, and electron effective mass. The high reverse current of the Ni and Mo SBDs can be explained not in terms of a low-barrier patch, GD, or thin surface barrier but in terms of small effective masses. Investigation of crystal structures at the Schottky interface revealed a large lattice mismatch between the metals (Ni, Ti, or Mo) and SiC for the Ni and Mo SBDs. The small effective mass is possibly attributed to the large lattice mismatch, which might generate transition layers at the Schottky interface. It is concluded from these results that the lattice constant as well as the work function is an important factor in selecting the metal species as the Schottky metal for wide band-gap SBDs, for which tunneling current dominates reverse current.

Current collectors for improved safety

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

Abdelmalak, Michael Naguib; Allu, Srikanth; Dudney, Nancy J.

A battery electrode assembly includes a current collector with conduction barrier regions having a conductive state in which electrical conductivity through the conduction barrier region is permitted, and a safety state in which electrical conductivity through the conduction barrier regions is reduced. The conduction barrier regions change from the conductive state to the safety state when the current collector receives a short-threatening event. An electrode material can be connected to the current collector. The conduction barrier regions can define electrical isolation subregions. A battery is also disclosed, and methods for making the electrode assembly, methods for making a battery, andmore » methods for operating a battery.« less

In the patient's best interest--a call to action, a call to balance.

PubMed

Hirsch, Norma J

2002-01-01

Nurses, physicians, and other healthcare professionals often complain that a loss of freedom or other obstacles hinder their ability to act in the best interest of the patient. These barriers cause professional burnout and moral outrage, and may contribute to a migration away from medicine or, more broadly, healthcare. Understanding the historical underpinnings of the phrase "in the patient's best interest," and realizing that healthcare, which is fundamentally a moral enterprise must be built on sound business principles can help healthcare professionals reframe the issue, and reclaim their original commitment to a difficult path.

The politics of health reform: why do bad things happen to good plans?

PubMed

Oberlander, Jonathan

2003-01-01

This paper examines political feasibility and its implications for health reform. I discuss the political obstacles to health reform in the United States, disentangling perennial barriers from contemporary constraints. I then explore major reform options and their political prospects. I argue that while incremental reform now appears to be the most feasible option, the political climate may change in a way that permits a bolder vision. Moreover, incremental reform may not be sustainable in the long run, for the same reason that makes it politically popular now: It does not change the status quo in the health system.

Policy analysis for prenatal genetic diagnosis.

PubMed

Thompson, M; Milunsky, A

1979-01-01

Consideration of the analytic difficulties faced in estimating the benefits and costs of prenatal genetic diagnosis, coupled with a brief review of existing benefit-cost studies, leads to the conclusion that public subsidy of prenatal testing can yield benefits substantially in excess of costs. The practical obstacles to such programs include the attitudes of prospective parents, a lack of knowledge, monetary barriers, inadequately organized medical resources, and the political issue of abortion. Policy analysis can now nevertheless formulate principles and guide immediate actions to improve present utilization of prenatal testing and to facilitate possible future expansion of these diagnostic techniques.

Kelvin-Helmholtz instability of the Dirac fluid of charge carriers on graphene

NASA Astrophysics Data System (ADS)

Coelho, Rodrigo C. V.; Mendoza, Miller; Doria, Mauro M.; Herrmann, Hans J.

2017-11-01

We provide numerical evidence that a Kelvin-Helmholtz instability occurs in the Dirac fluid of electrons in graphene and can be detected in current experiments. This instability appears for electrons in the viscous regime passing though a micrometer-scale obstacle and affects measurements on the time scale of nanoseconds. A possible realization with a needle-shaped obstacle is proposed to produce and detect this instability by measuring the electric potential difference between contact points located before and after the obstacle. We also show that, for our setup, the Kelvin-Helmholtz instability leads to the formation of whirlpools similar to the ones reported in Bandurin et al. [Science 351, 1055 (2016), 10.1126/science.aad0201]. To perform the simulations, we develop a lattice Boltzmann method able to recover the full dissipation in a fluid of massless particles.

A parallel implementation of a multisensor feature-based range-estimation method

NASA Technical Reports Server (NTRS)

Suorsa, Raymond E.; Sridhar, Banavar

1993-01-01

There are many proposed vision based methods to perform obstacle detection and avoidance for autonomous or semi-autonomous vehicles. All methods, however, will require very high processing rates to achieve real time performance. A system capable of supporting autonomous helicopter navigation will need to extract obstacle information from imagery at rates varying from ten frames per second to thirty or more frames per second depending on the vehicle speed. Such a system will need to sustain billions of operations per second. To reach such high processing rates using current technology, a parallel implementation of the obstacle detection/ranging method is required. This paper describes an efficient and flexible parallel implementation of a multisensor feature-based range-estimation algorithm, targeted for helicopter flight, realized on both a distributed-memory and shared-memory parallel computer.

Neuroepigenomics: Resources, Obstacles, and Opportunities

PubMed Central

Satterlee, John S.; Beckel-Mitchener, Andrea; Little, Roger; Procaccini, Dena; Rutter, Joni L.; Lossie, Amy C.

2014-01-01

Long-lived post-mitotic cells, such as the majority of human neurons, must respond effectively to ongoing changes in neuronal stimulation or microenvironmental cues through transcriptional and epigenomic regulation of gene expression. The role of epigenomic regulation in neuronal function is of fundamental interest to the neuroscience community, as these types of studies have transformed our understanding of gene regulation in post-mitotic cells. This perspective article highlights many of the resources available to researchers interested in neuroepigenomic investigations and discusses some of the current obstacles and opportunities in neuroepigenomics. PMID:25722961

Towards the Goal of Full Employment: Trends, Obstacles and Policies.

ERIC Educational Resources Information Center

Richards, Peter

Expanding upon a report presented to the International Labor Organization (ILO), this book documents the current world employment situation, including how it has fallen short, how current economic policies interact with world employment, and how improvements can be made. Chapter one, "The Commitment to Full Employment," describes how the…

Obstacles facing Africa's young climate scientists

NASA Astrophysics Data System (ADS)

Dike, Victor Nnamdi; Addi, Martin; Andang'o, Hezron Awiti; Attig, Bahar Faten; Barimalala, Rondrotiana; Diasso, Ulrich Jacques; Du Plessis, Marcel; Lamine, Salim; Mongwe, Precious N.; Zaroug, Modathir; Ochanda, Valentine Khasenye

2018-06-01

Current and future climate change poses a substantial threat to the African continent. Young scientists are needed to advance Earth systems science on the continent, but they face significant challenges.

Adoptive T cell therapy: An overview of obstacles and opportunities.

PubMed

Baruch, Erez Nissim; Berg, Amy Lauren; Besser, Michal Judith; Schachter, Jacob; Markel, Gal

2017-06-01

The therapeutic potential of adoptive cell therapy (ACT) in cancer patients was first acknowledged 3 decades ago, but it was an esoteric approach at the time. In recent years, technological advancements have transformed ACT into a viable therapeutic option that can be curative in some patients. In fact, current ACT response rates are 80% to 90% for hematological malignancies and 30% for metastatic melanoma refractory to multiple lines of therapy. Although these results are encouraging, there is still much to be done to fulfill ACT's potential, specifically with regard to improving clinical efficacy, expanding clinical indications, reducing toxicity, and increasing production and cost-effectiveness. This review addresses the current major obstacles to ACT and presents potential solutions. Cancer 2017;123:2154-62. © 2017 American Cancer Society. © 2017 American Cancer Society.

Superlattice barrier varactors

NASA Technical Reports Server (NTRS)

Raman, C.; Sun, J. P.; Chen, W. L.; Munns, G.; East, J.; Haddad, G.

1992-01-01

SBV (Single Barrier Varactor) diodes have been proposed as alternatives to Schottky barrier diodes for harmonic multiplier applications. However, these show a higher current than expected. The excess current is due to X valley transport in the barrier. We present experimental results showing that the use of a superlattice barrier and doping spikes in the GaAs depletion regions on either side of the barrier can reduce the excess current and improve the control of the capacitance vs. voltage characteristic. The experimental results consist of data taken from two types of device structures. The first test structure was used to study the performance of AlAs/GaAs superlattice barriers. The wafer was fabricated into 90 micron diameter mesa diodes and the resulting current vs. voltage characteristics were measured. A 10 period superlattice structure with a total thickness of approximately 400 A worked well as an electron barrier. The structure had a current density of about one A/sq cm at one volt at room temperature. The capacitance variation of these structures was small because of the design of the GaAs cladding layers. The second test structure was used to study cladding layer designs. These wafers were InGaAs and InAlAs layers lattice matched to an InP substrate. The layers have n(+) doping spikes near the barrier to increase the zero bias capacitance and control the shape of the capacitance vs. voltage characteristic. These structures have a capacitance ratio of 5:1 and an abrupt change from maximum to minimum capacitance. The measurements were made at 80 K. Based on the information obtained from these two structures, we have designed a structure that combines the low current density barrier with the improved cladding layers. The capacitance and current-voltage characteristics from this structure are presented.

Intrathecal delivery of protein therapeutics to the brain: a critical reassessment.

PubMed

Calias, Pericles; Banks, William A; Begley, David; Scarpa, Maurizio; Dickson, Patricia

2014-11-01

Disorders of the central nervous system (CNS), including stroke, neurodegenerative diseases, and brain tumors, are the world's leading causes of disability. Delivery of drugs to the CNS is complicated by the blood-brain barriers that protect the brain from the unregulated leakage and entry of substances, including proteins, from the blood. Yet proteins represent one of the most promising classes of therapeutics for the treatment of CNS diseases. Many strategies for overcoming these obstacles are in development, but the relatively straightforward approach of bypassing these barriers through direct intrathecal administration has been largely overlooked. Originally discounted because of its lack of usefulness for delivering small, lipid-soluble drugs to the brain, the intrathecal route has emerged as a useful, in some cases perhaps the ideal, route of administration for certain therapeutic protein and targeted disease combinations. Here, we review blood-brain barrier functions and cerebrospinal fluid dynamics and their relevance to drug delivery via the intrathecal route, discuss animal and human studies that have investigated intrathecal delivery of protein therapeutics, and outline several characteristics of protein therapeutics that can allow them to be successfully delivered intrathecally. Copyright © 2014 Elsevier Inc. All rights reserved.

Social isolation and perceived barriers to establishing social networks among Latina immigrants.

PubMed

Hurtado-de-Mendoza, Alejandra; Gonzales, Felisa A; Serrano, Adriana; Kaltman, Stacey

2014-03-01

Research has identified numerous mechanisms through which perceived social isolation and lack of social support negatively impact health. Little research attention has been dedicated to factors that influence the development of social networks, which have the potential to decrease perceptions of social isolation and provide social support. There is mixed evidence concerning the availability of supportive social networks for Latinos in the US. This study explores trauma-exposed Latina immigrants' experiences of social isolation in the US and its perceived causes. Twenty-eight Latina immigrant women participated in an interview about traumatic experiences. Informal help seeking and the availability of friendships in the US were also queried. Frequent comparisons between experiences in their home countries and in the US shaped the emerging themes of social isolation and lack of social support. Women reported feeling lonely, isolated, closed-in, and less free in the US due to family separation and various obstacles to developing and maintaining relationships. Socioeconomic, environmental, and psychosocial barriers were offered as explanations for their limited social networks in the US. Understanding experiences of social isolation as well as barriers to forging social networks can help inform the development of social support interventions that can contribute to improved health among Latinos.

Exploring the Barriers: A Qualitative Study about the Experiences of Mid-SES Roma Navigating the Spanish Healthcare System

PubMed Central

2018-01-01

Whereas the topic of the ‘cultural sensitivity’ of healthcare systems has been addressed extensively in the US and the UK, literature on the subject in most European countries, specifically looking at the situation of Roma, is still scarce. Drawing on qualitative research conducted mainly in the city of Barcelona under the communicative approach with Roma subjects who have stable socioeconomic positions and higher cultural capitals (end-users, professionals of the healthcare system, and key informants of a regional policy oriented to the improvement of Roma living conditions), the present study aims to fill this gap. We explore the barriers that the Roma face in accessing the healthcare system, reflecting on how these barriers are accentuated by the existing anti-Roma prejudices and institutional arrangements that do not account for minority cultures. Our results point out a series of obstacles at two levels, in the interaction with healthcare professionals, and in relation to existing institutional arrangements, which prevent Roma families from having equal access to the healthcare system. Education stands up as a mechanism to contest anti-Roma sentiments among healthcare professionals. PMID:29470450

Mechanisms of CNS invasion and damage by parasites.

PubMed

Kristensson, Krister; Masocha, Willias; Bentivoglio, Marina

2013-01-01

Invasion of the central nervous system (CNS) is a most devastating complication of a parasitic infection. Several physical and immunological barriers provide obstacles to such an invasion. In this broad overview focus is given to the physical barriers to neuroinvasion of parasites provided at the portal of entry of the parasites, i.e., the skin and epithelial cells of the gastrointestinal tract, and between the blood and the brain parenchyma, i.e., the blood-brain barrier (BBB). A description is given on how human pathogenic parasites can reach the CNS via the bloodstream either as free-living or extracellular parasites, by embolization of eggs, or within red or white blood cells when adapted to intracellular life. Molecular mechanisms are discussed by which parasites can interact with or pass across the BBB. The possible targeting of the circumventricular organs by parasites, as well as the parasites' direct entry to the brain from the nasal cavity through the olfactory nerve pathway, is also highlighted. Finally, examples are given which illustrate different mechanisms by which parasites can cause dysfunction or damage in the CNS related to toxic effects of parasite-derived molecules or to immune responses to the infection. Copyright © 2013 Elsevier B.V. All rights reserved.

Can evidence-based health policy from high-income countries be applied to lower-income countries: considering barriers and facilitators to an organ donor registry in Mumbai, India.

PubMed

Vania, Diana K; Randall, Glen E

2016-01-13

Organ transplantation has become an effective means to extend lives; however, a major obstacle is the lack of availability of cadaveric organs. India has one of the lowest cadaver organ donation rates in the world. If India could increase the donor rate, the demand for many organs could be met. Evidence from high-income countries suggests that an organ donor registry can be a valuable tool for increasing donor rates. The purpose of this study is to determine whether the implementation of an organ donor registry is a feasible and appropriate policy option to enhance cadaver organ donation rates in a lower-income country. This qualitative policy analysis employs semi-structured interviews with physicians, transplant coordinators, and representatives of organ donation advocacy groups in Mumbai. Interviews were designed to better understand current organ donation procedures and explore key informants' perceptions about Indian government health priorities and the likelihood of an organ donor registry in Mumbai. The 3-i framework (ideas, interests, and institutions) is used to examine how government decisions surrounding organ donation policies are shaped. Findings indicate that organ donation in India is a complex issue due to low public awareness, misperceptions of religious doctrines, the need for family consent, and a nation-wide focus on disease control. Key informants cite social, political, and infrastructural barriers to the implementation of an organ donor registry, including widely held myths about organ donation, competing health priorities, and limited hospital infrastructure. At present, both the central government and Maharashtra state government struggle to balance international pressures to improve overall population health with the desire to also enhance individual health. Implementing an organ donor registry in Mumbai is not a feasible or appropriate policy option in India's current political and social environment, as the barriers, identified through the 3-i framework lens, may be too difficult to overcome. Despite the evidence supporting the use of donor registries as a means to enhance organ donation rates, it is clear that context is critical and that it is not always practical to apply evidence-based policy solutions from high-income countries to lower-income settings.

Current-induced changes of migration energy barriers in graphene and carbon nanotubes

NASA Astrophysics Data System (ADS)

Obodo, J. T.; Rungger, I.; Sanvito, S.; Schwingenschlögl, U.

2016-05-01

An electron current can move atoms in a nanoscale device with important consequences for the device operation and breakdown. We perform first principles calculations aimed at evaluating the possibility of changing the energy barriers for atom migration in carbon-based systems. In particular, we consider the migration of adatoms and defects in graphene and carbon nanotubes. Although the current-induced forces are large for both the systems, in graphene the force component along the migration path is small and therefore the barrier height is little affected by the current flow. In contrast, the same barrier is significantly reduced in carbon nanotubes as the current increases. Our work also provides a real-system numerical demonstration that current-induced forces within density functional theory are non-conservative.An electron current can move atoms in a nanoscale device with important consequences for the device operation and breakdown. We perform first principles calculations aimed at evaluating the possibility of changing the energy barriers for atom migration in carbon-based systems. In particular, we consider the migration of adatoms and defects in graphene and carbon nanotubes. Although the current-induced forces are large for both the systems, in graphene the force component along the migration path is small and therefore the barrier height is little affected by the current flow. In contrast, the same barrier is significantly reduced in carbon nanotubes as the current increases. Our work also provides a real-system numerical demonstration that current-induced forces within density functional theory are non-conservative. Electronic supplementary information (ESI) available. See DOI: 10.1039/C6NR00534A

Insulin initiation status of primary care physicians in Turkey, barriers to insulin initiation and knowledge levels about insulin therapy: A multicenter cross-sectional study.

PubMed

Ates, Elif; Set, Turan; Saglam, Zuhal; Tekin, Nil; Karatas Eray, Irep; Yavuz, Erdinc; Sahin, Mustafa Kursat; Selcuk, Engin Burak; Cadirci, Dursun; Cubukcu, Mahcube

2017-10-01

Our aim was to evaluate the insulin initiation status, barriers to insulin initiation and knowledge levels about treatment administered by primary care physicians (PCP). We conducted our study in accordance with a multicenter, cross-sectional design in Turkey, between July 2015 and July 2016. A questionnaire inquiring demographic features, status of insulin initiation, obstacles to insulin initiation and knowledge about therapy of the PCPs was administered during face-to-face interviews. 84 PCPs (19%) (n=446, mean age=41.5±8.4years, 62.9% male and 90.0% ministry certified family physicians) initiated insulin therapy in the past. Most of the stated primary barriers (51.9%, n=230) were due to the physicians. The most relevant barrier was "lack of clinical experience" with a rate of 19% (n=84 of the total). The average total knowledge score was 5.7±2.0 for the family medicine specialist, and 3.8±2.1 for the ministry certified family physicians (p=0.000, maximum knowledge score could be 10). The status of insulin initiation in Turkey by the primary care physicians is inadequate. Medical education programs and health care systems may require restructuring to facilitate insulin initiation in primary care. Copyright © 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Older people's adoption of e-learning services: a qualitative study of facilitators and barriers.

PubMed

Bai, Xue; He, Yiqin; Kohlbacher, Florian

2018-05-14

This research investigates the facilitators and barriers for older people to adopt e-learning services using qualitative data of older people in a Chinese city. A qualitative approach was applied to explore the perceived facilitators and obstacles toward e-learning adoption with 10 older Chinese aged over 50. The results indicate the following: (1a) Age-related changes and cohort effects were found to be the internal barriers for the adoption of e-learning. (1b) Equipment problems, lack of time, and the availability of alternatives were found to have negative effects on the acceptance of e-learning services. It is notable that alternatives including the University of the Third Age (U3A) were found to be more attractive for older Chinese. (2a) Work requirements and flexibility of e-learning services were found to have direct effects on the acceptance of services. (2b) User-friendly design and stimulation from family would facilitate older people to adopt. Practical implications of this research include that policymakers should consider investing more in education in later life and introducing e-learning services in public lectures and tutorials and that the age-related barrier should be taken into consideration in the design phase of e-learning services. U3As should consider integrating e-learning approaches and cooperating with the community.

Specific Binding, Uptake, and Transport of ICAM-1-Targeted Nanocarriers Across Endothelial and Subendothelial Cell Components of the Blood-Brain Barrier

PubMed Central

Hsu, Janet; Rappaport, Jeff; Muro, Silvia

2014-01-01

Purpose The blood-brain barrier (BBB) represents a target for therapeutic intervention and an obstacle for brain drug delivery. Targeting endocytic receptors on brain endothelial cells (ECs) helps transporting drugs and carriers into and across this barrier. While most receptors tested are associated with clathrin-mediated pathways, clathrin-independent routes are rather unexplored. We have examined the potential for one of these pathways, cell adhesion molecule (CAM)-mediated endocytosis induced by targeting intercellular adhesion molecule 1 (ICAM-1), to transport drug carriers into and across BBB models. Methods Model polymer nanocarriers (NCs) coated with control IgG or antibodies against ICAM-1 (IgG NCs vs. anti-ICAM NCs; ~250-nm) were incubated with human brain ECs, astrocytes (ACs), or pericytes (PCs) grown as monocultures or bilayered (endothelial+subendothelial) co-cultures. Results ICAM-1 was present and overexpressed in disease-like conditions on ECs and, at a lesser extent, on ACs and PCs which are BBB subendothelial components. Specific targeting and CAM-mediated uptake of anti-ICAM NCs occurred in these cells, although this was greater for ECs. Anti-ICAM NCs were transported across endothelial monolayers and endothelial+subendothelial co-cultures modeling the BBB. Conclusions CAM-mediated transport induced by ICAM-1 targeting operates in endothelial and subendothelial cellular components of the BBB, which may provide an avenue to overcome this barrier. PMID:24558007

Specific binding, uptake, and transport of ICAM-1-targeted nanocarriers across endothelial and subendothelial cell components of the blood-brain barrier.

PubMed

Hsu, Janet; Rappaport, Jeff; Muro, Silvia

2014-07-01

The blood-brain barrier (BBB) represents a target for therapeutic intervention and an obstacle for brain drug delivery. Targeting endocytic receptors on brain endothelial cells (ECs) helps transport drugs and carriers into and across this barrier. While most receptors tested are associated with clathrin-mediated pathways, clathrin-independent routes are rather unexplored. We have examined the potential for one of these pathways, cell adhesion molecule (CAM)-mediated endocytosis induced by targeting intercellular adhesion molecule -1 (ICAM-1), to transport drug carriers into and across BBB models. Model polymer nanocarriers (NCs) coated with control IgG or antibodies against ICAM-1 (IgG NCs vs. anti-ICAM NCs; ~250-nm) were incubated with human brain ECs, astrocytes (ACs), or pericytes (PCs) grown as monocultures or bilayered (endothelial+subendothelial) co-cultures. ICAM-1 was present and overexpressed in disease-like conditions on ECs and, at a lesser extent, on ACs and PCs which are BBB subendothelial components. Specific targeting and CAM-mediated uptake of anti-ICAM NCs occurred in these cells, although this was greater for ECs. Anti-ICAM NCs were transported across endothelial monolayers and endothelial+subendothelial co-cultures modeling the BBB. CAM-mediated transport induced by ICAM-1 targeting operates in endothelial and subendothelial cellular components of the BBB, which may provide an avenue to overcome this barrier.

[Barriers and facilitators to increase consumption of fruits and vegetables in six countries in Latin America].

PubMed

Olavarría, Susana; Zacarías, Isabel

2011-06-01

Low intake of fruits and vegetables is among the risk factors for cardiovascular disease and some cancers. The countries have implemented policies to promote food consumption. Identifying the barriers perceived by people to consume it helps to recognize the resources that would be willing to exchange for benefits. The objectives of this study are to determine what factors are facilitators and barriers to increasing consumption of fruits and vegetables in six countries in Latin America, and a possible relationship between the 5 a day program and the food based dietary guidelines. This is a qualitative and field study. Techniques used were group interviews with health professionals and the media, and interviews with experts in food policy. The outstanding facilitators were television advertising campaigns promoting their use, and the existence of fruits and vegetables markets in the neighborhoods. Highlighted those obstacles were lack of public policies of advertising regulations and trade hooks of food, of self-sustainability, of funding for related programs, and of sociological research of the topic. The main barrier to the consumption of fruits and vegetables in these countries was the lack of policy support and related public policy, being a good advertising campaign vital to the success of programs that encourage consumption. The main relationship between the Dietary Guidelines and the 5 A Day Program is to both promote the consumption of vegetables and fruits.

Investigation of obstacle effect to improve conjugate heat transfer in backward facing step channel using fast simulation of incompressible flow

NASA Astrophysics Data System (ADS)

Nouri-Borujerdi, Ali; Moazezi, Arash

2018-01-01

The current study investigates the conjugate heat transfer characteristics for laminar flow in backward facing step channel. All of the channel walls are insulated except the lower thick wall under a constant temperature. The upper wall includes a insulated obstacle perpendicular to flow direction. The effect of obstacle height and location on the fluid flow and heat transfer are numerically explored for the Reynolds number in the range of 10 ≤ Re ≤ 300. Incompressible Navier-Stokes and thermal energy equations are solved simultaneously in fluid region by the upwind compact finite difference scheme based on flux-difference splitting in conjunction with artificial compressibility method. In the thick wall, the energy equation is obtained by Laplace equation. A multi-block approach is used to perform parallel computing to reduce the CPU time. Each block is modeled separately by sharing boundary conditions with neighbors. The developed program for modeling was written in FORTRAN language with OpenMP API. The obtained results showed that using of the multi-block parallel computing method is a simple robust scheme with high performance and high-order accurate. Moreover, the obtained results demonstrated that the increment of Reynolds number and obstacle height as well as decrement of horizontal distance between the obstacle and the step improve the heat transfer.

Design and evaluation of an autonomous, obstacle avoiding, flight control system using visual sensors

NASA Astrophysics Data System (ADS)

Crawford, Bobby Grant

In an effort to field smaller and cheaper Uninhabited Aerial Vehicles (UAVs), the Army has expressed an interest in an ability of the vehicle to autonomously detect and avoid obstacles. Current systems are not suitable for small aircraft. NASA Langley Research Center has developed a vision sensing system that uses small semiconductor cameras. The feasibility of using this sensor for the purpose of autonomous obstacle avoidance by a UAV is the focus of the research presented in this document. The vision sensor characteristics are modeled and incorporated into guidance and control algorithms designed to generate flight commands based on obstacle information received from the sensor. The system is evaluated by simulating the response to these flight commands using a six degree-of-freedom, non-linear simulation of a small, fixed wing UAV. The simulation is written using the MATLAB application and runs on a PC. Simulations were conducted to test the longitudinal and lateral capabilities of the flight control for a range of airspeeds, camera characteristics, and wind speeds. Results indicate that the control system is suitable for obstacle avoiding flight control using the simulated vision system. In addition, a method for designing and evaluating the performance of such a system has been developed that allows the user to easily change component characteristics and evaluate new systems through simulation.

Barriers to health care for undocumented immigrants: a literature review

PubMed Central

Hacker, Karen; Anies, Maria; Folb, Barbara L; Zallman, Leah

2015-01-01

With the unprecedented international migration seen in recent years, policies that limit health care access have become prevalent. Barriers to health care for undocumented immigrants go beyond policy and range from financial limitations, to discrimination and fear of deportation. This paper is aimed at reviewing the literature on barriers to health care for undocumented immigrants and identifying strategies that have or could be used to address these barriers. To address study questions, we conducted a literature review of published articles from the last 10 years in PubMed using three main concepts: immigrants, undocumented, and access to health care. The search yielded 341 articles of which 66 met study criteria. With regard to barriers, we identified barriers in the policy arena focused on issues related to law and policy including limitations to access and type of health care. These varied widely across countries but ultimately impacted the type and amount of health care any undocumented immigrant could receive. Within the health system, barriers included bureaucratic obstacles including paperwork and registration systems. The alternative care available (safety net) was generally limited and overwhelmed. Finally, there was evidence of widespread discriminatory practices within the health care system itself. The individual level focused on the immigrant’s fear of deportation, stigma, and lack of capital (both social and financial) to obtain services. Recommendations identified in the papers reviewed included advocating for policy change to increase access to health care for undocumented immigrants, providing novel insurance options, expanding safety net services, training providers to better care for immigrant populations, and educating undocumented immigrants on navigating the system. There are numerous barriers to health care for undocumented immigrants. These vary by country and frequently change. Despite concerns that access to health care attracts immigrants, data demonstrates that people generally do not migrate to obtain health care. Solutions are needed that provide for noncitizens’ health care. PMID:26586971

Refugee Policy Implications of U.S. Immigration Medical Screenings: A New Era of Inadmissibility on Health-Related Grounds

PubMed Central

Hong, Mi-Kyung; Varghese, Reshma E.; Jindal, Charulata; Efird, Jimmy T.

2017-01-01

Refugees frequently face extended delays in their efforts to enter the United States (U.S.) and those who are successful, in many cases, encounter overwhelming obstacles, inadequate resources, and a complex system of legal barriers. Travel restrictions based on equivocal health concerns and a drop in refugee admittance ceilings have complicated the situation. The authors retrieved and analyzed peer-reviewed journal articles, government agency press releases, media postings, epidemiologic factsheets, and relevant lay publications to critically assess U.S. policy regarding refugee resettlement based on health-related grounds. While refugees arguably exhibit an increased incidence of measles and tuberculosis compared with the U.S. population, the legitimacy of the medical examination will be undermined if other diseases that are endemic to refugee populations, yet currently deemed admissible, are used to restrict refugees from entering the U.S. This paper addressees the historic refugee policy of the U.S. and its consequent effect on the health of this vulnerable population. The needs of refugees should be carefully considered in the context of increased disease burden and the associated health care challenges of the country as a whole. PMID:28946650

Power mobility with collision avoidance for older adults: user, caregiver, and prescriber perspectives.

PubMed

Wang, Rosalie H; Korotchenko, Alexandra; Hurd Clarke, Laura; Mortenson, W Ben; Mihailidis, Alex

2013-01-01

Collision avoidance technology has the capacity to facilitate safer mobility among older power mobility users with physical, sensory, and cognitive impairments, thus enabling independence for more users. Little is known about consumers' perceptions of collision avoidance. This article draws on interviews (29 users, 5 caregivers, and 10 prescribers) to examine views on design and utilization of this technology. Data analysis identified three themes: "useful situations or contexts," "technology design issues and real-life application," and "appropriateness of collision avoidance technology for a variety of users." Findings support ongoing development of collision avoidance for older adult users. The majority of participants supported the technology and felt that it might benefit current users and users with visual impairments, but might be unsuitable for people with significant cognitive impairments. Some participants voiced concerns regarding the risk for injury with power mobility use and some identified situations where collision avoidance might be beneficial (driving backward, avoiding dynamic obstacles, negotiating outdoor barriers, and learning power mobility use). Design issues include the need for context awareness, reliability, and user interface specifications. User desire to maintain driving autonomy supports development of collaboratively controlled systems. This research lays the groundwork for future development by illustrating consumer requirements for this technology.

Japan Fulbright Memorial Fund Program Opens New Avenues for Effective Technology Integration into Education

NASA Astrophysics Data System (ADS)

Paoletti, Franco; Carlucci, Lisa Marie

2006-04-01

Technology is increasingly playing a major role in today's education often integrated into instruction to become one of the teacher's most effective and often indispensable tools used in the classroom. It can be said that the use of technology at the beginning of this new millennium is affecting the instructional process and it is changing some of its basic connotations. The presented work analyzes the impact of various technologies on education emphasizing the advantages provided by a successful integration, the obstacles encountered along the way, and the methodologies currently used in the process. ``Educational exchange can turn nations into people, contributing as no other form of communication can to the humanizing of international relations'' (Senator J.M. Fulbright). Technology of this modern era is providing the indispensable tool to achieve this superior level of communication overcoming historical, cultural, and language barriers. In the context of the Japan Fulbright Memorial Fund (JFMF) Teacher Program, we analyze the impact of technology on educational cross-cultural exchanges to raise awareness and interest of the scientific/educational community on the need of establishing stronger international relations promoting world peace and global prosperity.

Plasma Entry from Tail into the Dipolar Magnetosphere During Substorms

NASA Astrophysics Data System (ADS)

Haerendel, Gerhard

Plasma entering the dipolar magnetosphere from the tail has to overcome the obstacle presented by the conductivity enhancements caused by the poleward arc(s). While the arcs move poleward, the plasma proceeds equatorward as testified by the existence of a westward electric field. The arcs break into smaller-scale structures and loops with a tendency of eastward growth and expansion, although the basic driving force is directed earthward/equatorward. The likely reason is that the arc-related conductivity enhancements act as flow barriers and convert normal into shear stresses. The energy derived from the release of the shear stresses and dissipated in the arcs lowers the entropy content of the flux tubes and enables their earthward progression. In addition, poleward jumps of the breakup arcs are quite common. They result from refreshments of the generator plasma by the sequential arrival of flow bursts from the near-Earth neutral line. Once inside the oval, the plasma continues to move equatorward as manifested through north-south aligned auroral forms. Owing to the existence of an inner border of the oval, marked by the Region 2 currents, all flows are eventually diverted sunward.

Overcoming immune tolerance in chronic hepatitis B by therapeutic vaccination.

PubMed

Dembek, Claudia; Protzer, Ulrike; Roggendorf, Michael

2018-05-08

The currently used nucleoside analogs (i.e. entecavir and tenofovir) with high barrier-to-resistance efficiently suppress viral replication, limit inflammation and reduce the sequelae of chronic hepatitis B, but cannot cure the disease and thus have to be applied long-term. Therapeutic vaccination as an approach to cure chronic hepatitis B has shown promising pre-clinical results, nevertheless the proof of its efficacy in clinical trials is still missing. This may be partially due to suboptimal vaccine design. A main obstacle in chronic hepatitis B, however, is the high load of viral antigens expressed and secreted, which has been proposed to cause antigen-specific immune tolerance. Reduction of the viral antigen load is therefore considered a key factor for success of immune-based therapies. Although nucleoside analogs do not reduce viral antigen expression, new antiviral strategies are becoming available. Targeting viral translation by siRNA or targeting release of HBsAg from infected hepatocytes by nucleic acid polymers both reduce the antigen load. They may be considered as pre-treatment for therapeutic vaccination to increase the potential to elicit an HBV-specific immune response able to control and cure chronic HBV infection. Copyright © 2018 Elsevier B.V. All rights reserved.

Refugee Policy Implications of U.S. Immigration Medical Screenings: A New Era of Inadmissibility on Health-Related Grounds.

PubMed

Hong, Mi-Kyung; Varghese, Reshma E; Jindal, Charulata; Efird, Jimmy T

2017-09-24

Refugees frequently face extended delays in their efforts to enter the United States (U.S.) and those who are successful, in many cases, encounter overwhelming obstacles, inadequate resources, and a complex system of legal barriers. Travel restrictions based on equivocal health concerns and a drop in refugee admittance ceilings have complicated the situation. The authors retrieved and analyzed peer-reviewed journal articles, government agency press releases, media postings, epidemiologic factsheets, and relevant lay publications to critically assess U.S. policy regarding refugee resettlement based on health-related grounds. While refugees arguably exhibit an increased incidence of measles and tuberculosis compared with the U.S. population, the legitimacy of the medical examination will be undermined if other diseases that are endemic to refugee populations, yet currently deemed admissible, are used to restrict refugees from entering the U.S. This paper addressees the historic refugee policy of the U.S. and its consequent effect on the health of this vulnerable population. The needs of refugees should be carefully considered in the context of increased disease burden and the associated health care challenges of the country as a whole.

Control of tunnel barriers in multi-wall carbon nanotubes using focused ion beam irradiation

NASA Astrophysics Data System (ADS)

Tomizawa, H.; Suzuki, K.; Yamaguchi, T.; Akita, S.; Ishibashi, K.

2017-04-01

We have formed tunnel barriers in individual multi-wall carbon nanotubes using the Ga focused ion beam irradiation. The barrier height was estimated by the temperature dependence of the current (Arrhenius plot) and the current-voltage curves (Fowler-Nordheim plot). It is shown that the barrier height has a strong correlation with the barrier resistance that is controlled by the dose. Possible origins for the variation in observed barrier characteristics are discussed. Finally, the single electron transistor with two barriers is demonstrated.

[Development of a portable fall risk index for elderly people living in the community].

PubMed

Toba, Kenji; Okochi, Jiro; Takahashi, Tai; Matsubayashi, Kozo; Nishinaga, Masanori; Yamada, Shizuru; Takahashi, Ryutaro; Nishijima, Reiko; Kobayashi, Yoshio; Machida, Ayako; Akishita, Masahiro; Sasaki, Hidetada

2005-05-01

To develop a portable risk index for falls. Risk factors were chosen from previously established factors then we added several environmental factors to the risk index; previous falls in the last 12 month, trippig or stumbling, inability to ascend or descend stairs without help, decreased walking speed, inability to cross a road within the green signal interval, inability to walk 1km without a break, inability to stand on one leg for 5 seconds (eyes open), using a cane, inability to wring out a towel, dizziness or faintness, stooped or rounded back, knee joint pain, visual disturbance, hearing disturbance, cognitive decline, fear of falling, receiving 5 or more prescribed drugs, sensation of darkness at home, obstacles inside, barrier on the carpet or floor, using steps daily at home, steep slopes around home. The questionnaire sheet was completed by 2,439 community-dwelling elderly subjects (76.3 +/- 7.4 years old). The frequency of each items of fall risk index was compared between fallers (history of fall within one year) and non-fallers. Multiple regression analysis was performed to identify independent risk factors for previous falls. Except barrier, step use and steep slope around home, all items in the fall risk index were more frequent in fallers. Multivariate analysis revealed that tripping or stumbling, inability to cross a road within the green signal interval, dizziness or faintness, obstacles inside, inability to wring out a towel, cane use and knee joint pain were independent risk factors for previous falls. These 7 selected items were further analyzed as predictors. The maximum sum of sensitivity and specificity was reached at the cut-off point of 2/3 (sensitivity 0.65, specificity 0.72) by receiver operating curve. Portable fall risk index is useful for clinical settings to identify high-risk subjects.

Improving access to health care for chronic hepatitis B among migrant Chinese populations: A systematic mixed methods review of barriers and enablers.

PubMed

Vedio, A; Liu, E Z H; Lee, A C K; Salway, S

2017-07-01

Migrant Chinese populations in Western countries have a high prevalence of chronic hepatitis B but often experience poor access to health care and late diagnosis. This systematic review aimed to identify obstacles and supports to timely and appropriate health service use among these populations. Systematic searches resulted in 48 relevant studies published between 1996 and 2015. Data extraction and synthesis were informed by models of healthcare access that highlight the interplay of patient, provider and health system factors. There was strong consistent evidence of low levels of knowledge among patients and community members; but interventions that were primarily focused on increasing knowledge had only modest positive effects on testing and/or vaccination. There was strong consistent evidence that Chinese migrants tend to misunderstand the need for health care for hepatitis B and have low satisfaction with services. Stigma was consistently associated with hepatitis B, and there was weak but consistent evidence of stigma acting as a barrier to care. However, available evidence on the effects of providing culturally appropriate services for hepatitis B on increasing uptake is limited. There was strong consistent evidence that health professionals miss opportunities for testing and vaccination. Practitioner education interventions may be important, but evidence of effectiveness is limited. A simple prompt in patient records for primary care physicians improved the uptake of testing, and a dedicated service increased targeted vaccination coverage for newborns. Further development and more rigorous evaluation of more holistic approaches that address patient, provider and system obstacles are needed. © 2017 The Authors. Journal of Viral Hepatitis Published by John Wiley & Sons Ltd.

Barriers to the effective treatment and prevention of malaria in Africa: A systematic review of qualitative studies

PubMed Central

2009-01-01

Background In Africa, an estimated 300-500 million cases of malaria occur each year resulting in approximately 1 million deaths. More than 90% of these are in children under 5 years of age. To identify commonly held beliefs about malaria that might present barriers to its successful treatment and prevention, we conducted a systematic review of qualitative studies examining beliefs and practices concerning malaria in sub-Saharan African countries. Methods We searched Medline and Scopus (1966-2009) and identified 39 studies that employed qualitative methods (focus groups and interviews) to examine the knowledge, attitudes, and practices of people living in African countries where malaria is endemic. Data were extracted relating to study characteristics, and themes pertaining to barriers to malaria treatment and prevention. Results The majority of studies were conducted in rural areas, and focused mostly or entirely on children. Major barriers to prevention reported included a lack of understanding of the cause and transmission of malaria (29/39), the belief that malaria cannot be prevented (7/39), and the use of ineffective prevention measures (12/39). Thirty-seven of 39 articles identified barriers to malaria treatment, including concerns about the safety and efficacy of conventional medicines (15/39), logistical obstacles, and reliance on traditional remedies. Specific barriers to the treatment of childhood malaria identified included the belief that a child with convulsions could die if given an injection or taken to hospital (10/39). Conclusion These findings suggest that large-scale malaria prevention and treatment programs must account for the social and cultural contexts in which they are deployed. Further quantitative research should be undertaken to more precisely measure the impact of the themes uncovered by this exploratory analysis. PMID:19852857

Wakes from submerged obstacles in an open channel flow

NASA Astrophysics Data System (ADS)

Smith, Geoffrey B.; Marmorino, George; Dong, Charles; Miller, W. D.; Mied, Richard

2015-11-01

Wakes from several submerged obstacles are examined via airborne remote sensing. The primary focus will be bathymetric features in the tidal Potomac river south of Washington, DC, but others may be included as well. In the Potomac the water depth is nominally 10 m with an obstacle height of 8 m, or 80% of the depth. Infrared imagery of the water surface reveals thermal structure suitable both for interpretation of the coherent structures and for estimating surface currents. A novel image processing technique is used to generate two independent scenes with a known time offset from a single overpass from the infrared imagery, suitable for velocity estimation. Color imagery of the suspended sediment also shows suitable texture. Both the `mountain wave' regime and a traditional turbulent wake are observed, depending on flow conditions. Results are validated with in-situ ADCP transects. A computational model is used to further interpret the results.

Factitious prey and artificial diets for predatory lady beetles: current situation, obstacles, and approaches for improvement

USDA-ARS?s Scientific Manuscript database

Predatory lady beetles (Coleoptera: Coccinellidae) are important natural enemies of many pests in crop ecosystems throughout the world. Although several species are currently mass-reared and sold by biocontrol companies, there is an urgent need to reduce rearing costs. Cost effective mass rearing of...

"Nobody Told Us about What Happened": The Current State of Holocaust Education in Romania

ERIC Educational Resources Information Center

Misco, Tomas

2008-01-01

This research study sought to understand the current state of Holocaust education in Romanian classrooms and how sociocultural and institutional forces influence its treatment. By identifying the obstacles, challenges, and successes of Holocaust education in Romania, this study can both disseminate the techniques and conditions that bring about…

Context and Opportunity: Multiple Perspectives on Parenting by Women With a Severe Mental Illness

PubMed Central

Barrow, Susan M.; Alexander, Mary Jane; McKinney, Jacki; Lawinski, Terese; Pratt, Christina

2014-01-01

Objective The capabilities framework and a community-based participatory research (CBPR) approach frame this study. We consider the real opportunities for parenting available for women with serious mental health diagnoses, despite complications posed by their own capacity, material constraints, social network disruptions, and, by law, custom and policy related to mental health conditions and child custody decisions. Method We convened focus groups with mothers currently living in shelters apart from their children, service providers in supported housing programs, grandmothers caring for children of mothers with mental health and substance use problems, and a policy discussion with mental health administrators. Qualitative analyses explored common and divergent perspectives on parenting experiences and aspirations of particularly marginalized mothers. Results Perspectives of mothers and other stakeholders converged in recognizing the parenting challenges facing mothers experiencing homelessness and mental health and substance use problems, but their views on the implications of this diverged sharply. Mothers’ current aspirations were limited by contextual obstacles to maintaining contact with children; other stakeholders saw contact as risky and reunification as improbable. All stakeholders described systemic barriers to supporting contact and ongoing mothering roles. Conclusions and Implications for Practice Evidence-based parenting interventions require facilitating policy contexts that do not foreclose parenting possibilities for mothers whose current challenges dictate modest immediate parenting goals. CBPR amplifies voices of lived experience to demonstrate what is possible over time for mothers with complex lives and histories. These become possibilities that a person can imagine for herself and are essential to inform the evidence base for practice and policy. PMID:24978622

Context and opportunity: multiple perspectives on parenting by women with a severe mental illness.

PubMed

Barrow, Susan M; Alexander, Mary Jane; McKinney, Jacki; Lawinski, Terese; Pratt, Christina

2014-09-01

The capabilities framework and a community-based participatory research (CBPR) approach frame this study. We consider the real opportunities for parenting available for women with serious mental health diagnoses, despite complications posed by their own capacity, material constraints, social network disruptions, and, by law, custom and policy related to mental health conditions and child custody decisions. We convened focus groups with mothers currently living in shelters apart from their children, service providers in supported housing programs, grandmothers caring for children of mothers with mental health and substance use problems, and a policy discussion with mental health administrators. Qualitative analyses explored common and divergent perspectives on parenting experiences and aspirations of particularly marginalized mothers. Perspectives of mothers and other stakeholders converged in recognizing the parenting challenges facing mothers experiencing homelessness and mental health and substance use problems, but their views on the implications of this diverged sharply. Mothers' current aspirations were limited by contextual obstacles to maintaining contact with children; other stakeholders saw contact as risky and reunification as improbable. All stakeholders described systemic barriers to supporting contact and ongoing mothering roles. Evidence-based parenting interventions require facilitating policy contexts that do not foreclose parenting possibilities for mothers whose current challenges dictate modest immediate parenting goals. CBPR amplifies voices of lived experience to demonstrate what is possible over time for mothers with complex lives and histories. These become possibilities that a person can imagine for herself and are essential to inform the evidence base for practice and policy. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Effectiveness of cable barriers, guardrails, and concrete barrier walls in reducing the risk of injury.

PubMed

Zou, Yaotian; Tarko, Andrew P; Chen, Erdong; Romero, Mario A

2014-11-01

Roadway departure crashes tend to be severe, especially when the roadside exposes the occupants of errant vehicles to excessive injury hazards. As a cost-effective method when the clear zone width is insufficient, road barriers are often installed to prevent errant vehicles from colliding with dangerous obstacles or traversing steep slopes. This paper focuses on the safety performance of road barriers in Indiana in reducing the risk of injury. The objective of the study presented here is to compare the risk of injury among different hazardous events faced by an occupant in a single-vehicle crash. The studied hazardous events include rolling over, striking three types of barriers (guardrails, concrete barrier walls, and cable barriers) with different barrier offsets to the edge of the travelled way, and striking various roadside objects. A total of 2124 single-vehicle crashes (3257 occupants) that occurred between 2008 and 2012 on 517 pair-matched homogeneous barrier and non-barrier segments were analyzed. A binary logistic regression model with mixed effects was estimated for vehicle occupants. The segment pairing process and the use of random effects were able to handle the commonality within the same segment pair as well as the heterogeneity across segment pairs. The modeling results revealed that hitting a barrier is associated with lower risk of injury than a high-hazard event (hitting a pole, rollover, etc.). The odds of injury are reduced by 39% for median concrete barrier walls offset 15-18ft from the travelled way, reduced by 65% for a guardrail face offset 5-55ft, reduced by 85% for near-side median cable barriers (offset between 10ft and 29ft), and reduced by 78% with far-side median cable barriers (offset at least 30ft). Comparing different types of barriers is useful where some types of barriers can be used alternatively. This study found that the odds of injury are 43% lower when striking a guardrail instead of a median concrete barrier offset 15-18ft and 65% lower when striking a median concrete barrier offset 7-14ft. The odds of injury when striking a near-side median cable barrier is 57% lower than the odds for a guardrail face. This reduction for a far side median cable barrier is 37%. Thus, a guardrail should be preferred over a concrete wall and a cable barrier should be preferred over a guardrail where the road and traffic conditions allow. In the light of the results, installing median cable barriers on both sides of the median to reduce their lateral offset is beneficial for safety. The study also found that the unexplained heterogeneity across vehicles is much larger than it was across matched segment pairs. Copyright © 2014 Elsevier Ltd. All rights reserved.

Small Barriers Trigger Liftoff of Unconfined Dilute Heated Laboratory Density Currents

NASA Astrophysics Data System (ADS)

Fauria, K.; Andrews, B. J.; Manga, M.

2015-12-01

Dilute pyroclastic density currents (PDCs) are hot, turbulent, particle-laden flows that propagate because they are denser than air. PDCs can traverse tens to hundreds of kilometers and surmount ridges 100s of m tall, yet the effects of complex topography on PDC liftoff and runout distance are uncertain. Here we used scaled laboratory experiments to explore how barriers affect dilute density current dynamics and the occurrence of liftoff. We created dilute density currents by heating and suspending 20 μm diameter talc in air in an 8.5 x 6.1 x 2.6 m tank. We scaled the currents with respect to Froude, densimetric and thermal Richardson, particle Stokes and Settling numbers such that they were dynamically similar to natural PDCs. While currents were fully turbulent, their Reynolds numbers were not as high as those for natural PDCs. We performed the first set of experiments in a laterally unconfined volume, used laser sheets to illuminate the currents, measured bulk sedimentation rates down the current centerlines, and positioned four to twenty-four cm tall ridge-like barriers in the path of the currents. We found that relatively small barriers (~ half the current height) caused PDC liftoff. By comparison, conservation of kinetic and potential energy predicts that incompressible density currents are able to surmount barriers twice their height. Furthermore, we observed increased sedimentation immediately upstream of barriers and conclude that small barriers initiated buoyancy reversal through a combination of increased air entrainment and sedimentation. We conducted a second set of experiments with the same thermal scaling and mass flux rates but where the currents were laterally confined within a 0.6 m wide channel. We found that small barriers also triggered liftoff of confined currents, but that the body of these currents reattached after liftoff. Those results suggest that lateral confinement inhibits buoyancy reversal by limiting the surface area of the current-air interface and air entrainment. Real dilute PDCs that originate in confined valleys may therefore have different fates and longer runout distances than those on unconfined planes.

U.S. intermodal freight transportation : opportunities and obstacles

DOT National Transportation Integrated Search

1996-08-01

This study offers background information on, definition and system architecture of, and stakeholders and impediments of intermodal freight transportation. The research also provides brief information on the current and future freight movement, domest...

Utilizing Schottky barriers to suppress short-channel effects in organic transistors

NASA Astrophysics Data System (ADS)

Fernández, Anton F.; Zojer, Karin

2017-10-01

Transistors with short channel lengths exhibit profound deviations from the ideally expected behavior. One of the undesired short-channel effects is an enlarged OFF current that is associated with a premature turn on of the transistor. We present an efficient approach to suppress the OFF current, defined as the current at zero gate source bias, in short-channel organic transistors. We employ two-dimensional device simulations based on the drift-diffusion model to demonstrate that intentionally incorporating a Schottky barrier for injection enhances the ON-OFF ratio in both staggered and coplanar transistor architectures. The Schottky barrier is identified to directly counteract the origin of enlarged OFF currents: Short channels promote a drain-induced barrier lowering. The latter permits unhindered injection of charges even at reverse gate-source bias. An additional Schottky barrier hampers injection for such points of operations. We explain how it is possible to find the Schottky barrier of the smallest height necessary to exactly compensate for the premature turn on. This approach offers a substantial enhancement of the ON-OFF ratio. We show that this roots in the fact that such optimal barrier heights offer an excellent compromise between an OFF current diminished by orders of magnitude and an only slightly reduced ON current.

[Quality improvement potential in the pharmaceutical industry].

PubMed

Nusser, Michael

2007-01-01

The performance of the German pharmaceutical industry, future challenges and obstacles to quality improvement are assessed from a systems-of-innovation perspective, using appropriate innovation indicators. The current close-to-market performance indicators paint an unfavourable picture. Early R&D indicators (e.g., publications, patents), however, reveal a positive trend. A lot of obstacles to quality improvements are identified with respect to knowledge base, knowledge/technology transfer, industrial R&D processes, capital markets, market attractiveness and both regulatory and political framework conditions. On this basis, recommendations will finally be derived to improve quality in the pharmaceutical industry.

Blood-Brain Barrier Permeable Gold Nanoparticles: An Efficient Delivery Platform for Enhanced Malignant Glioma Therapy and Imaging

PubMed Central

Cheng, Yu; Dai, Qing; Morshed, Ramin; Fan, Xiaobing; Wegscheid, Michelle L.; Wainwright, Derek A.; Han, Yu; Zhang, Lingjiao; Auffinger, Brenda; Tobias, Alex L.; Rincón, Esther; Thaci, Bart; Ahmed, Atique U.; Warnke, Peter; He, Chuan

2014-01-01

The blood-brain barrier (BBB) remains a formidable obstacle in medicine, preventing efficient penetration of chemotherapeutic and diagnostic agents to malignant gliomas. Here, we demonstrate that a transactivator of transcription (TAT) peptide-modified gold nanoparticle platform (TAT-Au NP) with a 5 nm core size is capable of crossing the BBB efficiently and delivering cargoes such as the anticancer drug doxorubicin (Dox) and Gd3+ contrast agents to brain tumor tissues. Treatment of mice bearing intracranial glioma xenografts with pH-sensitive Dox-conjugated TAT-Au NPs via a single intravenous administration leads to significant survival benefit when compared to the free Dox. Furthermore, we demonstrate that TAT-Au NPs are capable of delivering Gd3+ chelates for enhanced brain tumor imaging with a prolonged retention time of Gd3+ when compared to the free Gd3+ chelates. Collectively, these results show promising applications of the TAT-Au NPs for enhanced malignant brain tumor therapy and non-invasive imaging. PMID:25104165

Social media in clinical trials.

PubMed

Thompson, Michael A

2014-01-01

Social media has potential in clinical trials for pointing out trial issues, addressing barriers, educating, and engaging multiple groups involved in cancer clinical research. Social media is being used in clinical trials to highlight issues such as poor accrual and barriers; educate potential participants and physicians about clinical trial options; and is a potential indirect or direct method to improve accrual. We are moving from a passive "push" of information to patients to a "pull" of patients requesting information. Patients and advocates are often driving an otherwise reluctant health care system into communication. Online patient communities are creating new information repositories. Potential clinical trial participants are using the Twittersphere and other sources to learn about potential clinical trial options. We are seeing more organized patient-centric and patient-engaged forums with the potential to crowd source to improve clinical trial accrual and design. This is an evolving process that will meet many individual, institutional, and regulatory obstacles as we move forward in a changed research landscape.

Brain metastases of breast cancer.

PubMed

Palmieri, Diane; Smith, Quentin R; Lockman, Paul R; Bronder, Julie; Gril, Brunilde; Chambers, Ann F; Weil, Robert J; Steeg, Patricia S

Central nervous system or brain metastases traditionally occur in 10-16% of metastatic breast cancer patients and are associated with a dismal prognosis. The development of brain metastases has been associated with young age, and tumors that are estrogen receptor negative, Her-2+ or of the basal phenotype. Treatment typically includes whole brain irradiation, or either stereotactic radiosurgery or surgery with whole brain radiation, resulting in an approximately 20% one year survival. The blood-brain barrier is a formidable obstacle to the delivery of chemotherapeutics to the brain. Mouse experimental metastasis model systems have been developed for brain metastasis using selected sublines of human MDA-MB-231 breast carcinoma cells. Using micron sized iron particles and MRI imaging, the fate of MDA-MB-231BR cells has been mapped: Approximately 2% of injected cells form larger macroscopic metastases, while 5% of cells remain as dormant cells in the brain. New therapies with permeability for the blood-brain barrier are needed to counteract both types of tumor cells.

Vaccinating healthcare workers: Level of implementation, barriers and proposal for evidence-based policies in Turkey

PubMed Central

Tanriover, Mine Durusu; Altınel, Serdar; Unal, Serhat

2017-01-01

ABSTRACT The role of healthcare workers in life-long vaccination is very important in the means of 2 sided infection, rising patient awareness and being a role model for the patients. Numerous organizations publish guidelines for vaccination of HCWs, while healthcare facilities develop vaccination policies according to the accreditation standards. Nevertheless, vaccination rates among HCWs are far below targets. The obstacles to getting vaccinated or recommending vaccination may include rather universal factors such as the vaccine paradox, however in the case of HCWs, probably a different set of factors are included. The aims of this article are to gain an overview of vaccination strategies for HCWs, to assess the coverage rates of HCWs and make in-depth analyses of the potential barriers to vaccination and potential factors to motivate HCWs for vaccination in Turkey and to compare them with the global picture to improve implementation of policies concerning vaccination of HCWs. PMID:28059668

Tailored delivery of analgesic ziconotide across a blood brain barrier model using viral nanocontainers

NASA Astrophysics Data System (ADS)

Anand, Prachi; O'Neil, Alison; Lin, Emily; Douglas, Trevor; Holford, Mandë

2015-08-01

The blood brain barrier (BBB) is often an insurmountable obstacle for a large number of candidate drugs, including peptides, antibiotics, and chemotherapeutic agents. Devising an adroit delivery method to cross the BBB is essential to unlocking widespread application of peptide therapeutics. Presented here is an engineered nanocontainer for delivering peptidic drugs across the BBB encapsulating the analgesic marine snail peptide ziconotide (Prialt®). We developed a bi-functional viral nanocontainer based on the Salmonella typhimurium bacteriophage P22 capsid, genetically incorporating ziconotide in the interior cavity, and chemically attaching cell penetrating HIV-Tat peptide on the exterior of the capsid. Virus like particles (VLPs) of P22 containing ziconotide were successfully transported in several BBB models of rat and human brain microvascular endothelial cells (BMVEC) using a recyclable noncytotoxic endocytic pathway. This work demonstrates proof in principle for developing a possible alternative to intrathecal injection of ziconotide using a tunable VLP drug delivery nanocontainer to cross the BBB.

Barriers, facilitators, and recommendations related to implementing the Baby-Friendly Initiative (BFI): an integrative review.

PubMed

Semenic, Sonia; Childerhose, Janet E; Lauzière, Julie; Groleau, Danielle

2012-08-01

Despite growing evidence for the positive impact of the Baby-Friendly Initiative (BFI) on breastfeeding outcomes, few studies have investigated the barriers and facilitators to the implementation of Baby-Friendly practices that can be used to improve uptake of the BFI at the local or country levels. This integrative review aimed to identify and synthesize information on the barriers, facilitators, and recommendations related to the BFI from the international, peer-reviewed literature. Thirteen databases were searched using the keywords Baby Friendly, Baby-Friendly Hospital Initiative, BFI, BFHI, Ten Steps, implementation, adoption, barriers, facilitators, and their combinations. A total of 45 English-language articles from 16 different countries met the inclusion criteria for the review. Data analysis was guided by Cooper's five stages of integrative research review. Using a multiple intervention program framework, findings were categorized into sociopolitical, organizational-level, and individual-level barriers and facilitators to implementing the BFI, as well as intra-, inter-, and extraorganizational recommendations for strengthening BFI implementation. A wide variety of obstacles and potential solutions to BFI implementation were identified. Findings suggest some priority issues to address when pursuing Baby-Friendly designation, including the endorsements of both local administrators and governmental policy makers, effective leadership of the practice change process, health care worker training, the marketing influence of formula companies, and integrating hospital and community health services. Framing the BFI as a complex, multilevel, evidence-based change process and using context-focused research implementation models to guide BFI implementation efforts may help identify effective strategies for promoting wider adoption of the BFI in health services.

“Bureaucracy & Beliefs”: Assessing the Barriers to Accessing Opioid Substitution Therapy by People Who Inject Drugs in Ukraine

PubMed Central

Bojko, Martha J.; Mazhnaya, Alyona; Makarenko, Iuliia; Marcus, Ruthanne; Dvoriak, Sergii; Islam, Zahedul; Altice, Frederick L.

2016-01-01

Aims Opioid substitution therapy (OST) is an evidence-based HIV prevention strategy for people who inject drugs (PWIDs). Yet, only 2.7% of Ukraine’s estimated 310,000 PWIDs receive it despite free treatment since 2004. The multi-level barriers to entering OST among opioid dependent PWIDs have not been examined in Ukraine. Methods A multi-year mixed methods implementation science project included focus group discussions with 199 PWIDs in 5 major Ukrainian cities in 2013 covering drug treatment attitudes and beliefs and knowledge of and experiences with OST. Data were transcribed, translated into English and coded. Coded segments related to OST access, entry, knowledge, beliefs and attitudes were analyzed among 41 PWIDs who were eligible for but had never received OST. Findings A number of programmatic and structural barriers were mentioned by participants as barriers to entry to OST, including compulsory drug user registration, waiting lists, and limited number of treatment slots. Participants also voiced strong negative attitudes and beliefs about OST, especially methadone. Their perceptions about methadone’s side effects as well as the stigma of being a methadone client were expressed as obstacles to treatment. Conclusions Despite expressed interest in treatment, Ukrainian OST-naïve PWIDs evade OST for reasons that can be addressed through changes in program-level and governmental policies and social-marketing campaigns. Voiced OST barriers can effectively inform public health and policy directives related to HIV prevention and treatment in Ukraine to improve evidence-based treatment access and availability. PMID:27087758

Radio-frequency current drive efficiency in the presence of ITBs and a dc electric field

NASA Astrophysics Data System (ADS)

Rosa, P. R. da S.; Mourão, R.; Ziebell, L. F.

2009-05-01

This paper discusses the current drive efficiency by the combined action of EC and LH waves in the presence of a dc electric field and transport, with an internal transport barrier. The transport is assumed to be produced by magnetic fluctuations. The study explores the different barrier parameters and their influence on the current drive efficiency. We study the subject by numerically solving the Fokker-Planck equation. Our main result is that the barrier depth and barrier width are important to determine the correct shape of the current density profile but not to determine the current drive efficiency, which is very little influenced by these parameters. We also found similar results for the influence of the level of magnetic fluctuations on the current density profile and on the current drive efficiency.

Waist-up protection for blind individuals using the EyeCane as a primary and secondary mobility aid.

PubMed

Buchs, Galit; Simon, Noa; Maidenbaum, Shachar; Amedi, Amir

2017-01-01

One of the most stirring statistics in relation to the mobility of blind individuals is the high rate of upper body injuries, even when using the white-cane. We here addressed a rehabilitation- oriented challenge of providing a reliable tool for blind people to avoid waist-up obstacles, namely one of the impediments to their successful mobility using currently available methods (e.g., white-cane). We used the EyeCane, a device we developed which translates distances from several angles to haptic and auditory cues in an intuitive and unobtrusive manner, serving both as a primary and secondary mobility aid. We investigated the rehabilitation potential of such a device in facilitating visionless waist-up body protection. After ∼5 minutes of training with the EyeCane blind participants were able to successfully detect and avoid obstacles waist-high and up. This was significantly higher than their success when using the white-cane alone. As avoidance of obstacles required participants to perform an additional cognitive process after their detection, the avoidance rate was significantly lower than the detection rate. Our work has demonstrated that the EyeCane has the potential to extend the sensory world of blind individuals by expanding their currently accessible inputs, and has offered them a new practical rehabilitation tool.

Photovoltaic and thermophotovoltaic devices with quantum barriers

DOEpatents

Wernsman, Bernard R [Jefferson Hills, PA

2007-04-10

A photovoltaic or thermophotovoltaic device includes a diode formed by p-type material and n-type material joined at a p-n junction and including a depletion region adjacent to said p-n junction, and a quantum barrier disposed near or in the depletion region of the p-n junction so as to decrease device reverse saturation current density while maintaining device short circuit current density. In one embodiment, the quantum barrier is disposed on the n-type material side of the p-n junction and decreases the reverse saturation current density due to electrons while in another, the barrier is disposed on the p-type material side of the p-n junction and decreases the reverse saturation current density due to holes. In another embodiment, both types of quantum barriers are used.

Knocking down disease: a progress report on siRNA therapeutics

PubMed Central

Wittrup, Anders; Lieberman, Judy

2016-01-01

Small interfering RNAs (siRNAs), which downregulate gene expression guided by sequence complementarity, can be used therapeutically to block the synthesis of disease-causing proteins. The main obstacle to siRNA drugs — their delivery into the target cell cytosol — has been overcome to allow suppression of liver gene expression. Here, we review the results of recent clinical trials of siRNA therapeutics, which show efficient and durable gene knockdown in the liver, with signs of promising clinical outcomes and little toxicity. We also discuss the barriers to more widespread applications that target tissues besides the liver and the most promising avenues to overcome them. PMID:26281785

TRAINING OLDER WORKERS FOR TECHNOLOGY-BASED EMPLOYMENT.

PubMed

Lee, Chin Chin; Czaja, Sara J; Sharit, Joseph

2009-01-01

An increasingly aging workforce and advances in technology are changing work environments and structures. The continued employability of older adults, particularly those of lower socioeconomic status (SES), requires them to participate in training programs to ensure their competence in today's workplace. Focus groups with 37 unemployed adults (51-76 years old) were conducted to gather information about barriers and obstacles for returning to work, training needs and formats, work experiences, and perceptions of the characteristics of an ideal job. Overall, results indicated that participants experienced age discrimination and lack of technology skills. They also expressed a desire to receive additional training on technology and a preference for classroom training.

Pediatric vaccines on the horizon.

PubMed

Chávez-Bueno, Susana; Stull, Terrence L

2010-09-01

Vaccines have saved the lives of millions of children and continue to be essential interventions to control infectious diseases among people of all ages. The list of recommended vaccines for children has expanded in recent years; however, many viral, bacterial and parasitic infections remain a major cause of morbidity and mortality in children. Improved vaccines to prevent Streptococcus pneumoniae and Neisseria meningitidis infections in children will soon be available. Recent scientific advances are being applied to design new childhood vaccines affording enhanced efficacy, safety and tolerability. Financial barriers and other obstacles to adequate vaccine access need to be eliminated to assure coverage for all children and adolescents.

[Bioavailability of antiglaucoma drugs].

PubMed

Demailly, P

2000-05-01

The biodisponibility of antiglaucoma drugs, generally delivered in an aqueous eye-drop solution depends on their capacity to cross the cornea. The structure of the cornea forms a barrier to strongly lipophilic substances and the continuous renewal of the lacrimal film creates a major obstacle, preventing active substances from penetrating the eye. Active substances must thus be delivered in highly concentrated solutions. The systemic bioavailability of antiglaucoma drugs taken orally, for example beta-blockers, is well known, their behavior after eye-drop administration remains poorly elucidated and highly dependent on individual susceptibility. We reviewed the literature on pilocarpine, beta-blockers, adrenergic drugs (dipivalyl-epinephrine, apraclonidine, brimonidine), carbon anhydrase inhibitors (acetazolamide, dorzolamide).

Current-induced changes of migration energy barriers in graphene and carbon nanotubes.

PubMed

Obodo, J T; Rungger, I; Sanvito, S; Schwingenschlögl, U

2016-05-21

An electron current can move atoms in a nanoscale device with important consequences for the device operation and breakdown. We perform first principles calculations aimed at evaluating the possibility of changing the energy barriers for atom migration in carbon-based systems. In particular, we consider the migration of adatoms and defects in graphene and carbon nanotubes. Although the current-induced forces are large for both the systems, in graphene the force component along the migration path is small and therefore the barrier height is little affected by the current flow. In contrast, the same barrier is significantly reduced in carbon nanotubes as the current increases. Our work also provides a real-system numerical demonstration that current-induced forces within density functional theory are non-conservative.

Transmittance and Tunneling Current through a Trapezoidal Barrier under Spin Polarization Consideration

NASA Astrophysics Data System (ADS)

Noor, F. A.; Nabila, E.; Mardianti, H.; Ariani, T. I.; Khairurrijal

2018-04-01

The transmittance and tunneling current in heterostructures under spin polarization consideration were studied by employing a zinc-blended structure for the heterostructures. An electron tunnels through a potential barrier by applying a bias voltage to the barrier, which is called the trapezoidal potential barrier. In order to study the transmittance, an Airy wave function approach was employed to find the transmittance. The obtained transmittance was then utilized to compute the tunneling current by using a Gauss quadrature method. It was shown that the transmittances were asymmetric with the incident angle of the electron. It was also shown that the tunneling currents increased as the bias voltage increased.

Practical lessons for bringing policy-makers on board in sexual and reproductive health research.

PubMed

Guieu, Aurore; Zhang, Wei-Hong; Lafort, Yves; Decat, Peter; De Meyer, Sara; Wang, Shuchen; Kerstens, Birgit; Duysburgh, Els

2016-11-11

The need to translate research into policy, i.e. making research findings a driving force in agenda-setting and policy change, is increasingly acknowledged. However, little is known about translation mechanisms in the field of sexual and reproductive health (SRH) outside North American or European contexts. This paper seeks to give an overview of the existing knowledge on this topic as well as to document practical challenges and remedies from the perspectives of researchers involved in four SRH research consortium projects in Latin America, sub-Saharan Africa, China and India. A literature review and relevant project documents were used to develop an interview guide through which researchers could reflect on their experiences in engaging with policy-makers, and particularly on the obstacles met and the strategies deployed by the four project consortia to circumvent them. Our findings confirm current recommendations on an early and steady involvement of policy-makers, however they also suggest that local barriers between researchers and policy-making spheres and individuals can represent major hindrances to the realization of translation objectives. Although many of the challenges might be common to different contexts, creating locally-adapted responses is deemed key to overcome them. Researchers' experiences also indicate that - although inevitable - recognizing and addressing these challenges is a difficult, time- and energy-consuming process for all partners involved. Despite a lack of existing knowledge on translation efforts in SRH research outside North American or European contexts, and more particularly in low and middle-income countries, it is clear that existing pressure on health and policy systems in these settings further complicates them. This article brings together literature findings and researchers' own experiences in translating research results into policy and highlights the major challenges research conducted on sexual and reproductive health outside North American or European contexts can meet. Future SRH projects should be particularly attentive to these potential obstacles in order to tailor appropriate and consistent strategies within their existing resources.

Why is it hard to make progress in assessing children's decision-making competence?

PubMed

Hein, Irma M; Troost, Pieter W; Broersma, Alice; de Vries, Martine C; Daams, Joost G; Lindauer, Ramón J L

2015-01-10

For decades, the discussion on children's competence to consent to medical issues has concentrated around normative concerns, with little progress in clinical practices. Decision-making competence is an important condition in the informed consent model. In pediatrics, clinicians need to strike a proper balance in order to both protect children's interests when they are not fully able to do so themselves and to respect their autonomy when they are. Children's competence to consent, however, is currently not assessed in a standardized way. Moreover, the correlation between competence to give informed consent and age in children has never been systematically investigated, nor do we know which factors exactly contribute to children's competence.This article aims at identifying these gaps in knowledge and suggests options for dealing with the obstacles in empirical research in order to advance policies and practices regarding children's medical decision-making competence. Understanding children's competency is hampered by the law. Legislative regulations concerning competency are established on a strong presumption that persons older than a certain age are competent, whereas younger persons are not. Furthermore, a number of contextual factors are believed to be of influence on a child's decision-making competence: the developmental stage of children, the influence of parents and peers, the quality of information provision, life experience, the type of medical decision, and so on. Ostensibly, these diverse and extensive barriers hinder any form of advancement in this conflicted area. Addressing these obstacles encourages the discussion on children's competency, in which the most prominent question concerns the lack of a clear operationalization of children's competence to consent. Empirical data are needed to substantiate the discussion. The empirical approach offers an opportunity to give direction to the debate. Recommendations for future research include: studying a standardized assessment instrument covering all four relevant dimensions of competence (understanding, reasoning, appreciation, expressing a choice), including a study population of children covering the full age range of 7 to 18 years, improving information provision, and assessing relevant contextual data.

Evaluation of real-time location systems in their hospital contexts.

PubMed

Fisher, Jill A; Monahan, Torin

2012-10-01

The purpose of the research was to assess real-time location systems (RTLS) that have been implemented in U.S. hospitals. We examined the type of uses to which RTLS have been put, the degree of functionality of the various technologies and software, and the organizational effects of implementing RTLS. The project was a 3-year qualitative study of 23 U.S. hospitals that had implemented RTLS for the purpose of tracking assets, personnel, and/or patients. We observed the systems in use and conducted 80 semi-structured interviews with hospital personnel and vendors. In order to protect the confidentiality of the hospitals and vendors in our sample, we conducted an aggregate analysis of our findings rather than providing evaluations of specific technologies or hospital case studies. The most important findings from our research were (1) substandard functionality of most real-time location systems in use and (2) serious obstacles to effective deployment of the systems due to the material and organizational constraints of the hospitals themselves. We found that the current best use of RTLS is for asset tracking, but importantly it requires whole-hospital deployment as well as centralized control of the system, preferably by materials management or biomedical engineering departments. There are serious technological, material, and organizational barriers to the implementation of RTLS, and these barriers need to be overcome if hospitals are to maximize the potential benefits of these systems. In addition to considering the available technological options, hospitals must assess their unique environments, including the myriad material and organizational constraints that will affect the success of RTLS implementation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Preliminary study of online machine translation use of nursing literature: quality evaluation and perceived usability

PubMed Central

2012-01-01

Background Japanese nurses are increasingly required to read published international research in clinical, educational, and research settings. Language barriers are a significant obstacle, and online machine translation (MT) is a tool that can be used to address this issue. We examined the quality of Google Translate® (English to Japanese and Korean to Japanese), which is a representative online MT, using a previously verified evaluation method. We also examined the perceived usability and current use of online MT among Japanese nurses. Findings Randomly selected nursing abstracts were translated and then evaluated for intelligibility and usability by 28 participants, including assistants and research associates from nursing universities throughout Japan. They answered a questionnaire about their online MT use. From simple comparison of mean scores between two language pairs, translation quality was significantly better, with respect to both intelligibility and usability, for Korean-Japanese than for English-Japanese. Most respondents perceived a language barrier. Online MT had been used by 61% of the respondents and was perceived as not useful enough. Conclusion Nursing articles translated from Korean into Japanese by an online MT system could be read at an acceptable level of comprehension, but the same could not be said for English-Japanese translations. Respondents with experience using online MT used it largely to grasp the overall meanings of the original text. Enrichment in technical terms appeared to be the key to better usability. Users will be better able to use MT outputs if they improve their foreign language proficiency as much as possible. Further research is being conducted with a larger sample size and detailed analysis. PMID:23151362

Implementation of mild therapeutic hypothermia for post-resuscitation care of sudden cardiac arrest survivors in cardiology units in Poland.

PubMed

Kołtowski, Łukasz; Malesa, Karolina; Tomaniak, Mariusz; Stępińska, Janina; Średniawa, Beata; Karolczyk, Paulina; Puchta, Dominika; Kowalik, Robert; Kremis, Elżbieta; Filipiak, Krzysztof J; Banaszewski, Marek; Opolski, Grzegorz; Bagińska, Marta

2017-11-01

The post-cardiac arrest (CA) period is often associated with secondary damage of the brain that leads to severe neurological deficits. The current practice guidelines recommend the use of therapeutic hypothermia (TH) to prevent neurological deficit and improve survival. The aim of the study was to investigate the implementation of medical guidelines in clinical practice and to evaluate the barriers for implementation of TH in cardiology units in Poland. A telephone survey, fax and online inquiry form were used to assess the implementation of TH in cardiology units in the management of unconscious patients after cardiac arrest (CA). The questions addressed the local practice, TH protocol, reasons for not using TH and outcomes of CA patients. We obtained information from 79 units out of 150 asked (53%). At the time of the survey, 24 units (30.8%) were using TH as part of their post-CA management. Of all CA patients, 45% underwent TH in cardiac intensive care units (CICU), 37.5% in the coronary care unit (CCU) and 12.5% in the intensive care unit (ICU). The major barrier for the implementation of TH declared by the non-cooling centers was lack of sufficient knowledge regarding the technique and protocol, as well as experience (37%); access to dedicated equipment was not perceived as an obstacle. The number of cardiology units that provide TH for comatose CA patients is low. The main limiting factor for wider use of TH is lack of knowledge and experience. There is a clear need for urgent educational activities for cardiology units. The benefits of TH still have not reached their potential in cardiology units.

Barred from better medicine? Reexamining regulatory barriers to the inclusion of prisoners in research

PubMed Central

Huang, Elaine; Cauley, Jacqueline

2017-01-01

Abstract In 2015, President Obama announced plans for the Precision Medicine Initiative® (PMI), an ambitious longitudinal project aimed at revolutionizing medicine. Integral to this Initiative is the recruitment of over one million Americans into a volunteer research cohort, the All of UsSM Research Program. The announcement has generated much excitement but absent is a discussion of how the All of Us Research Program—to be implemented within the context of social realities of mass incarcerations and racial disparities in criminal justice and healthcare—might excaberate health disparities. We examine how attainment of Initiative's stated goals of reflecting the diversity of the American population and including all who are interested in participating might be impeded by regulatory and administrative barriers to the involvement of participants who become incarcerated during longitudinal studies. Changes have been proposed to the federal policy for human subjects research protections, but current regulations and administrative policies—developed under a protectionist paradigm in response to scandalous research practices with confined populations—dramatically limit research involving prisoners. Our review provides rationale for the development of Initiative policies that anticipate recruitment and retention obstacles that might frustrate inclusivity and exacerbate health disparities. Furthermore, we question the effective ban on biomedical and behavioral research involving prisoners and advocate for regulatory reforms that restore participatory research rights of prisoners. Disparities in health and justice are intertwined, and without regulatory reforms to facilitate participatory research rights of prisoners and careful planning of viable and responsible recruitment, engagement, and retention strategies, Initiative could miss discovery opportunities, exacerbate health disparities, and increase levels of distrust in science. PMID:28852561

Females and STEM: Determining the K-12 Experiences that Influenced Women to Pursue STEM Fields

NASA Astrophysics Data System (ADS)

Petersen, Anne Marie

In the United States, careers in the fields of Science, Technology, Engineering, and Mathematics (STEM) are increasing yet there are not enough trained personnel to meet this demand. In addition, of those that seek to pursue STEM fields in the United States, only 26% are female. In order to increase the number of women seeking STEM based bachelor's degrees, K-12 education must provide a foundation that prepares students for entry into these fields. The purpose of this phenomenological study was to determine the perceived K-12 experiences that influenced females to pursue a STEM field. Twelve college juniors or seniors seeking a degree in Biology, Mathematics, or Physics were interviewed concerning their K-12 experiences. These interviews were analyzed and six themes emerged. Teacher passion and classroom characteristics such as incorporating challenging activities played a significant role in the females' decisions to enter STEM fields. Extra-curricular activities such as volunteer and mentor opportunities and the females' need to benefit others also influenced females in their career choice. Both the formal (within the school) and informal (outside of the traditional classroom) pipeline opportunities that these students encountered helped develop a sense of self-efficacy in science and mathematics; this self-efficacy enabled them to persist in pursuing these career fields. Several participants cited barriers that they encountered in K-12 education, but these barriers were primarily internal as they struggled with overcoming self-imposed obstacles in learning and being competitive in the mathematics and science classrooms. The experiences from these female students can be used by K-12 educators to prepare and encourage current female students to enter STEM occupations.

Private investment in AIDS vaccine development: obstacles and solutions.

PubMed

Batson, A; Ainsworth, M

2001-01-01

The development of vaccines for the prevention of AIDS, malaria, tuberculosis, and other diseases requires both public and private investment. Private investment, however, has been far lower than might have been hoped, given the massive human toll of these diseases, particularly in the poorest countries. With a view to understanding this situation and exploring potential solutions, the World Bank AIDS Vaccine Task Force commissioned a study on the perspectives of the biotechnology, vaccine, and pharmaceutical industries regarding investment in research and development work on an AIDS vaccine. It was found that different obstacles to the development of an AIDS vaccine arose during the product development cycle. During the earlier phases, before obtaining proof of product, the principal barriers were scientific. The lack of consensus on which approach was likely to be effective increased uncertainty and the risks associated with investing in expensive clinical trials. The later phases, which involved adapting, testing, and scaling up production for different populations, were most influenced by market considerations. In order to raise the levels of private research and development in an AIDS vaccine there will probably have to be a combination of push strategies, which reduce the cost and scientific risk of investment, and pull strategies, which guarantee a market.

Hybrid simulation of the shock wave trailing the Moon

NASA Astrophysics Data System (ADS)

Israelevich, P.; Ofman, L.

2012-04-01

Standing shock wave behind the Moon was predicted be Michel (1967) but never observed nor simulated. We use 1D hybrid code in order to simulate the collapse of the plasma-free cavity behind the Moon and for the first time to model the formation of this shock. Starting immediately downstream of the obstacle we consider the evolution of plasma expansion into the cavity in the frame of reference moving along with the solar wind. Well-known effects as electric charging of the cavity affecting the plasma flow and counter streaming ion beams in the wake are reproduced. Near the apex of the inner Mach cone where the plasma flows from the opposite sides of the obstacle meet, a shock wave arises. The shock is produced by the interaction of oppositely directed proton beams in the plane containing solar wind velocity and interplanetary magnetic field vectors. In the direction across the magnetic field and the solar wind velocity, the shock results from the interaction of the plasma flow with the region of the enhanced magnetic field inside the cavity that plays the role of magnetic barrier. The appearance of the standing shock wave is expected at the distance of ~ 7RM downstream of the Moon.

Establishing Medical Students' Cultural and Linguistic Competence for the Care of Spanish-Speaking Limited English Proficient Patients.

PubMed

Vela, Monica; Fritz, Cassandra; Jacobs, Elizabeth A

2016-09-01

Limited English proficient (LEP) patients are at risk of disparities in health and health care quality. These disparities can be mitigated by providing care in a language they understand. Undergraduate medical education provides an opportunity to stress that language barriers negatively impact the quality and safety of health care for LEP patients and to teach students how to overcome them. Because the preponderance of LEP patients in the USA is Spanish speaking, the majority of US medical schools have established medical Spanish coursework for interested students. However, 70 % of medical schools note significant obstacles to delivering this curriculum. The most commonly cited obstacles include a lack of time to deliver it, heterogeneous student skill levels, and insufficient faculty support. We also note that educators need to make sure not to propagate disparities and medical errors for LEP patients. We provide recommendations for establishing medical students' linguistic and cultural competence for the care Spanish-speaking limited English proficiency patients, with the caution that this instruction must be coupled with education as to when to call on an interpreter if participants are not fluent in Spanish at the end of the course.

The World Health Organization and the contested beginnings of psychiatric epidemiology as an international discipline: one rope, many strands.

PubMed

Lovell, Anne M

2014-08-01

This paper focuses on the relatively late emergence of psychiatric epidemiology as an international discipline, through local-global exchanges during the first 15 years of the World Health Organization (WHO). Building an epidemiological canon within WHO's Mental Health Programme faced numerous obstacles. First, an idealist notion of mental health inherent in WHO's own definition of health contributed to tensions around the object of psychiatric epidemiology. Second, the transfer of methods from medical epidemiology to research on mental disorders required mobilizing conceptual justifications, including a 'contagion argument'. Third, epidemiological research at WHO was stymied by other public health needs, resource scarcity and cultural barriers. This history partly recapitulates the development of psychiatric epidemiology in North America and Europe, but is also shaped by concerns in the developing world, translated through first-world 'experts'. Resolving the tensions arising from these obstacles allowed WHO to establish its international schizophrenia research, which in turn provided proof of concept for psychiatric epidemiology in the place of scepticism within and without psychiatry. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Pedestrian Pathfinding in Urban Environments: Preliminary Results

NASA Astrophysics Data System (ADS)

López-Pazos, G.; Balado, J.; Díaz-Vilariño, L.; Arias, P.; Scaioni, M.

2017-12-01

With the rise of urban population, many initiatives are focused upon the smart city concept, in which mobility of citizens arises as one of the main components. Updated and detailed spatial information of outdoor environments is needed to accurate path planning for pedestrians, especially for people with reduced mobility, in which physical barriers should be considered. This work presents a methodology to use point clouds to direct path planning. The starting point is a classified point cloud in which ground elements have been previously classified as roads, sidewalks, crosswalks, curbs and stairs. The remaining points compose the obstacle class. The methodology starts by individualizing ground elements and simplifying them into representative points, which are used as nodes in the graph creation. The region of influence of obstacles is used to refine the graph. Edges of the graph are weighted according to distance between nodes and according to their accessibility for wheelchairs. As a result, we obtain a very accurate graph representing the as-built environment. The methodology has been tested in a couple of real case studies and Dijkstra algorithm was used to pathfinding. The resulting paths represent the optimal according to motor skills and safety.

Nitride based quantum well light-emitting devices having improved current injection efficiency

DOEpatents

Tansu, Nelson; Zhao, Hongping; Liu, Guangyu; Arif, Ronald

2014-12-09

A III-nitride based device provides improved current injection efficiency by reducing thermionic carrier escape at high current density. The device includes a quantum well active layer and a pair of multi-layer barrier layers arranged symmetrically about the active layer. Each multi-layer barrier layer includes an inner layer abutting the active layer; and an outer layer abutting the inner layer. The inner barrier layer has a bandgap greater than that of the outer barrier layer. Both the inner and the outer barrier layer have bandgaps greater than that of the active layer. InGaN may be employed in the active layer, AlInN, AlInGaN or AlGaN may be employed in the inner barrier layer, and GaN may be employed in the outer barrier layer. Preferably, the inner layer is thin relative to the other layers. In one embodiment the inner barrier and active layers are 15 .ANG. and 24 .ANG. thick, respectively.

Threshold concepts as barriers to understanding climate science

NASA Astrophysics Data System (ADS)

Walton, P.

2013-12-01

Whilst the scientific case for current climate change is compelling, the consequences of climate change have largely failed to permeate through to individuals. This lack of public awareness of the science and the potential impacts could be considered a key obstacle to action. The possible reasons for such limited success centre on the issue that climate change is a complex subject, and that a wide ranging academic, political and social research literature on the science and wider implications of climate change has failed to communicate the key issues in an accessible way. These failures to adequately communicate both the science and the social science of climate change at a number of levels results in ';communication gaps' that act as fundamental barriers to both understanding and engagement with the issue. Meyer and Land (2003) suggest that learners can find certain ideas and concepts within a discipline difficult to understand and these act as a barrier to deeper understanding of a subject. To move beyond these threshold concepts, they suggest that the expert needs to support the learner through a range of learning experiences that allows the development of learning strategies particular to the individual. Meyer and Land's research into these threshold concepts has been situated within Economics, but has been suggested to be more widely applicable though there has been no attempt to either define or evaluate threshold concepts to climate change science. By identifying whether common threshold concepts exist specifically in climate science for cohorts of either formal or informal learners, scientists will be better able to support the public in understanding these concepts by changing how the knowledge is communicated to help overcome these barriers to learning. This paper reports on the findings of a study that examined the role of threshold concepts as barriers to understanding climate science in a UK University and considers its implications for wider scientific engagement with the public to develop climate literacy. The analysis of 3 successive cohorts of students' journals who followed the same degree module identified that threshold concepts do exist within the field, such as those related to: role of ocean circulation, use of proxy indicators, forcing factors and feedback mechanisms. Once identified, the study looked at possible strategies to overcome these barriers to support student climate literacy. It concluded that the use of threshold concepts could be problematic when trying to improve climate literacy, as each individual has their own concepts they find ';troublesome' that do not necessarily relate to others. For scientists this presents the difficulty of how to develop a strategy that supports the individual that is cost and time effective. However, the study identifies that eLearning can be used effectively to help people understand troublesome knowledge.

Assessing supply-side barriers to uptake of intermittent preventive treatment for malaria in pregnancy: a qualitative study and document and record review in two regions of Uganda.

PubMed

Rassi, Christian; Graham, Kirstie; Mufubenga, Patrobas; King, Rebecca; Meier, Joslyn; Gudoi, Sam Siduda

2016-07-04

Intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine (SP), provided as part of routine antenatal care (ANC), is one of three malaria-in-pregnancy prevention and control mechanisms recommended by the World Health Organization (WHO). However, despite high ANC attendance and increased efforts to address known obstacles, IPTp uptake figures have remained low. This study aimed to identify and assess barriers that continue to impede IPTp uptake in Uganda, in particular for women who attend ANC. The paper focuses on supply-side barriers, i.e., challenges relating to the health service provider. In-depth interviews were conducted in two regions of Uganda in November 2013 and April/May 2014 with four different target audiences: seven district health officials, 15 health workers, 19 women who had attended ANC, and five opinion leaders. In addition, a document and record review was carried out at four health facilities. Guidelines with regard to IPTp provision in Uganda have been shown to be inconsistent and, at the time of the research, did not reflect the most recent WHO policy recommendation. There is a lack of training and supervision opportunities for health workers, resulting in poor knowledge of IPTp guidelines and uncertainty about the safety and efficacy of SP. ANC is not consistently offered in health facilities, leading to some women being denied services. While strengthening of the supply chain appears to have reduced the occurrence of stock-outs of SP in public facilities, stock-outs reportedly continue to occur in the private sector. There are also sources of data inaccuracy along the data recording and reporting chain, limiting policy makers' ability to react adequately to trends and challenges. Given the high ANC attendance rates in Uganda, supply-side barriers are likely to account for many missed opportunities for the provision of IPTp in Uganda. Improvements will require consistent provision of ANC, implementation of current WHO IPTp policy recommendations, supply of SP to the private sector, availability of clear guidelines, as well as improved training and supervision for health workers. Improving facility and district-level recording and reporting will further strengthen the country's ability to address uptake of IPTp.

Water Reallocation - Increasing Opportunities for Cooperation, Administration and Market

NASA Astrophysics Data System (ADS)

Cai, X.; Marston, L.

2016-12-01

Nowadays utilizable water in many regions around the world has been allocated among the various users. Increasing demands and limited water supplies necessitates water reallocation given that the existing allocation is economically inefficient, socially unfair, and environmentally unsustainable. Water reallocation, a dynamic adaptation strategy to changing socioeconomic and environmental conditions, offers a flexible water management approach to mitigate water scarcity under changing socioeconomic, climatic, and environmental conditions. Water reallocation can be implemented via collective cooperation, administration, and/or market-based approaches. In spite of the numerous benefits of reallocating water between users, examples of successful water transfers are relatively sparse and the expected benefits are rarely met in full due to several complex impediments. This study discusses the key barriers to wider implementation of water reallocation based on overview of the current body of water reallocation literature. Many examples of water transfers from around the world illustrate both the benefits and challenges associated with reallocation. To overcome the obstacles for more effective reallocation, we propose an interdisciplinary approach to water reallocation that couples developments in the natural sciences and engineering disciplines with current water reallocation scholarship, which is predominately rooted in the social sciences. We conclude by calling for an integrated research platform that focuses on supporting both voluntary and nonvoluntary forms of water reallocation; however, a greater emphasis should be on nonmarket means of water transfer since it is more feasible for many regions where water rights are not well defined and institutional capacity is insufficient.

Conference report on tobacco taxes in Central America: current situation and opportunities to reduce prevalence and increase fiscal revenues.

PubMed

Garcés, Ana; Garcés, Miguel; Barnoya, Joaquin; Cabrera, Maynor; Sandoval, Rosa; Orozco, Juan Guillermo; Chaloupka, Frank J

2014-01-01

As stated in Article 6 of Framework Convention on Tobacco Control (FCTC), increasing tobacco prices through higher taxes is one of the most effective interventions to reduce tobacco use and to encourage smokers to quit. The potential for tax increases on tobacco products in Central America is ample. We aim to synthesize the current tobacco taxes situation and highlight research needs to strengthen taxation. In May 2012, a workshop was carried out with representatives from each Central American country to analyze the tobacco tax situation in each country and to identify key research gaps with experts in the field. Tobacco taxes in Central America fall far short of the levels recommended by FCTC. Moreover, the legal framework is complex and creates barriers for higher taxes that require further research and political will. Top research priorities are an in-depth analysis of tobacco tax legislation, impact of tax and price policies, analysis of costs associated to health care of tobacco-related diseases and lost productivity, and the feasibility of approaches to increasing tobacco taxes in certain contexts. An additional area of research is the interrelationship between human rights and tobacco control. Central American countries would benefit from increasing excise taxes on tobacco products. The lack of available data and research to counteract tobacco industry arguments are significant obstacles. Active leadership of civil society in support of the partnership of chronic disease interventions is vital in order to obtain tax increases on tobacco products.

Refining the aggregate exposure pathway

EPA Science Inventory

Advancements in measurement technologies and modeling capabilities continue to result in an abundance of exposure information, adding to that currently in existence. However, fragmentation within the exposure science community acts as an obstacle for realizing the vision set fort...

A μ analysis-based, controller-synthesis framework for robust bioinspired visual navigation in less-structured environments.

PubMed

Keshavan, J; Gremillion, G; Escobar-Alvarez, H; Humbert, J S

2014-06-01

Safe, autonomous navigation by aerial microsystems in less-structured environments is a difficult challenge to overcome with current technology. This paper presents a novel visual-navigation approach that combines bioinspired wide-field processing of optic flow information with control-theoretic tools for synthesis of closed loop systems, resulting in robustness and performance guarantees. Structured singular value analysis is used to synthesize a dynamic controller that provides good tracking performance in uncertain environments without resorting to explicit pose estimation or extraction of a detailed environmental depth map. Experimental results with a quadrotor demonstrate the vehicle's robust obstacle-avoidance behaviour in a straight line corridor, an S-shaped corridor and a corridor with obstacles distributed in the vehicle's path. The computational efficiency and simplicity of the current approach offers a promising alternative to satisfying the payload, power and bandwidth constraints imposed by aerial microsystems.

Ratchet Transport of Chiral Particles Caused by the Transversal Asymmetry: Current Reversals and Particle Separation

NASA Astrophysics Data System (ADS)

Liu, Jian-li; Lu, Shi-cai; Ai, Bao-quan

2018-06-01

Due to the chirality of active particles, the transversal asymmetry can induce the the longitudinal directed transport. The transport of chiral active particles in a periodic channel is investigated in the presence of two types of the transversal asymmetry, the transverse force and the transverse rigid half-circle obstacles. For all cases, the counterclockwise and clockwise particles move to the opposite directions. For the case of the only transverse force, the chiral active particles can reverse their directions when increasing the transverse force. When the transverse rigid half-circle obstacles are introduced, the transport behavior of particles becomes more complex and multiple current reversals occur. The direction of the transport is determined by the competition between two types of the transversal asymmetry. For a given chirality, by suitably tailoring parameters, particles with different self-propulsion speed can move in different directions and can be separated.

Education, outreach and the future of remote sensing in human health

NASA Technical Reports Server (NTRS)

Wood, B. L.; Beck, L. R.; Lobitz, B. M.; Bobo, M. R.

2000-01-01

The human health community has been slow to adopt remote sensing technology for research, surveillance, or control activities. This chapter presents a brief history of the National Aeronautics and Space Administration's experiences in the use of remotely sensed data for health applications, and explores some of the obstacles, both real and perceived, that have slowed the transfer of this technology to the health community. These obstacles include the lack of awareness, which must be overcome through outreach and proper training in remote sensing, and inadequate spatial, spectral and temporal data resolutions, which are being addressed as new sensor systems are launched and currently overlooked (and underutilized) sensors are newly discovered by the health community. A basic training outline is presented, along with general considerations for selecting training candidates. The chapter concludes with a brief discussion of some current and future sensors that show promise for health applications.

AST Combustion Workshop: Diagnostics Working Group Report

NASA Technical Reports Server (NTRS)

Locke, Randy J.; Hicks, Yolanda R.; Hanson, Ronald K.

1996-01-01

A workshop was convened under NASA's Advanced Subsonics Technologies (AST) Program. Many of the principal combustion diagnosticians from industry, academia, and government laboratories were assembled in the Diagnostics/Testing Subsection of this workshop to discuss the requirements and obstacles to the successful implementation of advanced diagnostic techniques to the test environment of the proposed AST combustor. The participants, who represented the major relevant areas of advanced diagnostic methods currently applied to combustion and related fields, first established the anticipated AST combustor flowfield conditions. Critical flow parameters were then examined and prioritized as to their importance to combustor/fuel injector design and manufacture, environmental concerns, and computational interests. Diagnostic techniques were then evaluated in terms of current status, merits and obstacles for each flow parameter. All evaluations are presented in tabular form and recommendations are made on the best-suited diagnostic method to implement for each flow parameter in order of applicability and intrinsic value.

Effect of skin barrier disruption on immune responses to topically applied cross-reacting material, CRM(197), of diphtheria toxin.

PubMed

Godefroy, S; Peyre, M; Garcia, N; Muller, S; Sesardic, D; Partidos, C D

2005-08-01

The high accessibility of the skin and the presence of immunocompetent cells in the epidermis makes this surface an attractive route for needle-free administration of vaccines. However, the lining of the skin by the stratum corneum is a major obstacle to vaccine delivery. In this study we examined the effect of skin barrier disruption on the immune responses to the cross-reacting material CRM(197), a nontoxic mutant of diphtheria toxin (DTx) that is considered as a vaccine candidate. Application of CRM(197), together with cholera toxin (CT), onto the tape-stripped skin of mice elicited antibody responses that had anti-DTx neutralizing activity. Vaccine delivery onto mildly ablated skin or intact skin did not elicit any detectable anti-CRM(197) antibodies. Mice immunized with CRM(197) alone onto the tape-stripped skin mounted a vigorous antigen-specific proliferative response. In contrast, the induction of cellular immunity after CRM(197) deposition onto mildly ablated or intact skin was adjuvant dependent. Furthermore, epidermal cells were activated and underwent apoptosis that was more pronounced when the stratum corneum was removed by tape stripping. Overall, these findings highlight the potential for transcutaneous delivery of CRM(197) and establish a correlation between the degree of barrier disruption and levels of antigen-specific immune responses. Moreover, these results provide the first evidence that the development of a transcutaneous immunization strategy for diphtheria, based on simple and practical methods to disrupt the skin barrier, is feasible.

Barriers to timely prenatal care among women with insurance: the importance of prepregnancy factors.

PubMed

Braveman, P; Marchi, K; Egerter, S; Pearl, M; Neuhaus, J

2000-06-01

This study, designed to avoid methodologic limitations of previous research, aimed to identify the important noninsurance barriers to timely prenatal care. We identified a subsample of a cross-sectional statewide representative postpartum survey conducted in California during 1994-1995, focusing on 3071 low-income women with Medi-Cal or private coverage throughout pregnancy. Twenty-eight percent of those women had untimely care, although only 6% were unaware of their pregnancies during the first trimester. Controlling for numerous sociodemographic factors; knowledge, attitudes, beliefs, and behaviors; stressful life circumstances; and logistic obstacles that might deter seeking or receiving care, the following risk factors for untimely care were significant and experienced by more than one fifth of women: unwanted or unplanned pregnancy (affecting 43% and 66% of women, respectively), no regular provider before pregnancy (affecting 22% of women), and no schooling beyond high school (affecting 76% of women). Transportation problems, affecting 8% of women, appeared to be the only significant logistic barrier to timely care. Improving timeliness of prenatal care among low-income women with third-party coverage is likely to require broad social and health policies that focus on factors affecting women before pregnancy. Assistance with transportation could contribute to more timely care for some low-income women, but programs focusing primarily on other noninsurance barriers during pregnancy might not substantially improve the timeliness of care, at least among low-income women with third-party coverage.

Skin Barrier Restoration and Moisturization Using Horse Oil-Loaded Dissolving Microneedle Patches.

PubMed

Lee, Chisong; Eom, Younghyon Andrew; Yang, Huisuk; Jang, Mingyu; Jung, Sang Uk; Park, Ye Oak; Lee, Si Eun; Jung, Hyungil

2018-01-01

Horse oil (HO) has skin barrier restoration and skin-moisturizing effects. Although cream formulations have been used widely and safely, their limited penetration through the stratum corneum is a major obstacle to maximizing the cosmetic efficacy of HO. Therefore, we aimed to encapsulate HO in a cosmetic dissolving microneedle (DMN) for efficient transdermal delivery. To overcome these limitations of skin permeation, HO-loaded DMN (HO-DMN) patches were developed and evaluated for their efficacy and safety using in vitro and clinical studies. Despite the lipophilic nature of HO, the HO-DMN patches had a sharp shape and uniform array, with an average length and tip diameter of 388.36 ± 16.73 and 38.54 ± 5.29 µm, respectively. The mechanical strength of the HO-DMN patches was sufficient (fracture force of 0.29 ± 0.01 N), and they could successfully penetrate pig skin. During the 4-week clinical evaluation, HO-DMN patches caused significant improvements in skin and dermal density, skin elasticity, and moisturization. Additionally, a brief safety assessment showed that the HO-DMN patches induced negligible adverse events. The HO-DMNs are efficient, safe, and convenient for wide use in cosmetic applications for skin barrier restoration and moisturization. © 2018 S. Karger AG, Basel.

Issues in access to safe drinking water and basic hygiene for persons with physical disabilities in rural Cambodia.

PubMed

MacLeod, Marin; Pann, Mala; Cantwell, Ray; Moore, Spencer

2014-12-01

An estimated 1.6 million people die from diarrheal diseases each year due to lack of access to safe water and sanitation, and persons with physical disabilities face additional barriers. In Cambodia, approximately 5% of the population is disabled, presenting substantial obstacles in accessing these basic services. The purpose of this study was twofold: first, to identify the challenges facing persons with physical disabilities in accessing safe household water and basic hygiene in rural Cambodia; and, second, to use these results to generate policy and practice recommendations for the water and sanitation hygiene sector implementing water treatment system interventions in rural settings. Fifteen field interviews were conducted with persons with physical disabilities. Thematic analysis was used to identify six main themes. The results indicated that environmental barriers to access were greater in the workplace than household settings and those persons with disabilities had greater awareness about safe drinking water compared to basic hygiene. Additionally, lack of physical strength, distance to water, and lack of financial means were noted as common access barriers. The findings support ongoing research and offer insight into the particular challenges facing persons with physical disabilities in rural areas in accessing safe drinking water and basic hygiene.

Barriers and Facilitators to HIV Testing Among Women

PubMed Central

McDougall, Graham J.; Dalmida, Safiya George; Foster, Pamela Payne; Burrage, Joe

2017-01-01

Aim The purpose of this secondary analysis was to analyze for barriers and facilitators to HIV testing in women attending community health clinics. Introduction The Centers for Disease Control and Prevention (CDC), reported that all women account for 20% or 1 in 5 of new HIV cases (CDC, 2012). Of those new cases in heterosexual women, 5,300 were Black, 1,300 were White, and 1,200 were Hispanic/Latina. The CDC estimated that in 2012 there were 9,268 individuals living with a diagnosis of HIV or AIDS, of which 19% were women. Results The existing de-identified data consisted of thirty individual interviews conducted using a semi-structured interview guide was collected as the initial phase of the parent study, “HIV Testing and Women’s Attitudes on HIV Vaccine Trials”. This secondary analysis addressed the identification of key obstacles to HIV testing and only those related portions of the transcripts were analyzed. The major themes identified were familiarity with testing, stigma, fear, perceived risks, and access to care. Conclusion The themes implicated the need to further assess women for barriers and facilitators to testing, tailor community based interventions that have the ability to decrease fear and stigma, increase trust in testing methods and offer counseling to positive results. PMID:29607406

[Facilitators and barriers to implementation of intercultural health policy in Chile].

PubMed

Pérez, Camila; Nazar, Gabriela; Cova, Félix

2016-02-01

Objective To identify elements that either facilitate or hinder implementation of Chile's intercultural health policy. Methods A descriptive study was conducted with the participation of health services users from the Mapuche ethnic group, biomedical health professionals, intercultural facilitators, and key informants in two health facilities serving towns with a high density of Mapuche population. The information was obtained through semi-structured interviews that were analyzed thematically. Results Factors identified as facilitating the implementation of this policy include laws and regulations pertaining to the rights of indigenous peoples, the empowerment of users around their rights, the formation of implementation teams, the presence of professionals of Mapuche origin in health facilities, and the existence of processes for systematization of the work carried out. The asymmetric relationship between the Mapuche people and the state, and between the Mapuche health system and the biomedical model, constitutes a fundamental barrier. Other obstacles include the lack of theoretical and practical clarity around the concept of intercultural health and a lack of resources. Conclusions Despite the facilitators identified and the achievements to date, meaningful progress in implementation of an intercultural health policy is limited by barriers that are hard to change. These include the usual forms of government planning and the hegemony of the biomedical model.