Complexities in barrier island response to sea level rise: Insights from numerical model experiments, North Carolina Outer Banks

USGS Publications Warehouse

Moore, Laura J.; List, Jeffrey H.; Williams, S. Jeffress; Stolper, David

2010-01-01

Using a morphological-behavior model to conduct sensitivity experiments, we investigate the sea level rise response of a complex coastal environment to changes in a variety of factors. Experiments reveal that substrate composition, followed in rank order by substrate slope, sea level rise rate, and sediment supply rate, are the most important factors in determining barrier island response to sea level rise. We find that geomorphic threshold crossing, defined as a change in state (e.g., from landward migrating to drowning) that is irreversible over decadal to millennial time scales, is most likely to occur in muddy coastal systems where the combination of substrate composition, depth-dependent limitations on shoreface response rates, and substrate erodibility may prevent sand from being liberated rapidly enough, or in sufficient quantity, to maintain a subaerial barrier. Analyses indicate that factors affecting sediment availability such as low substrate sand proportions and high sediment loss rates cause a barrier to migrate landward along a trajectory having a lower slope than average barrier island slope, thereby defining an “effective” barrier island slope. Other factors being equal, such barriers will tend to be smaller and associated with a more deeply incised shoreface, thereby requiring less migration per sea level rise increment to liberate sufficient sand to maintain subaerial exposure than larger, less incised barriers. As a result, the evolution of larger/less incised barriers is more likely to be limited by shoreface erosion rates or substrate erodibility making them more prone to disintegration related to increasing sea level rise rates than smaller/more incised barriers. Thus, the small/deeply incised North Carolina barriers are likely to persist in the near term (although their long-term fate is less certain because of the low substrate slopes that will soon be encountered). In aggregate, results point to the importance of system history (e.g., previous slopes, sediment budgets, etc.) in determining migration trajectories and therefore how a barrier island will respond to sea level rise. Although simple analytical calculations may predict barrier response in simplified coastal environments (e.g., constant slope, constant sea level rise rate, etc.), our model experiments demonstrate that morphological-behavior modeling is necessary to provide critical insights regarding changes that may occur in environments having complex geometries, especially when multiple parameters change simultaneously.

Barriers to accessing termination of pregnancy in a remote and rural setting: a qualitative study.

PubMed

Heller, R; Purcell, C; Mackay, L; Caird, L; Cameron, S T

2016-09-01

To explore the experiences of women from a remote and rural setting who had a termination of pregnancy (TOP), in relation to any barriers they may have experienced trying to access TOP. Qualitative interview study. Scottish Highlands and Western Isles. Women who had undergone TOP in the Scottish Highlands National Health Service between October 2014 and May 2015. Sixteen semi-structured, audio-recorded telephone interviews were conducted by a researcher with women who had consented to be interviewed at their initial assessment. Six stages of thematic analysis were followed to explore themes in and across participant accounts. Themes derived from interview transcripts. Four themes emerged relating to barriers to access and experience: (1) the impact of travel for TOP, (2) temporal factors unique to this population and how they affected women, (3) the attitude of health professionals, notably general practitioners, as a result of local culture, and (4) stigma surrounding TOP and the expectation that abortion will be traumatising. Women in remote and rural areas experience barriers to accessing TOP. Prompt referrals, more providers of TOP and tackling stigma associated with TOP could make delivery of this service more equitable and improve women's journey through TOP. Women in remote and rural areas of Scotland face multiple barriers to accessing termination of pregnancy. © 2016 Royal College of Obstetricians and Gynaecologists.

The enablers and barriers to continue breast milk feeding in women returning to work.

PubMed

Sulaiman, Zaharah; Liamputtong, Pranee; Amir, Lisa H

2016-04-01

To describe the enablers and barriers working women experience in continuing breast milk feeding after they return to work postpartum in urban Malaysia. In Malaysia, urban working women have low rates of breastfeeding and struggle to achieve the recommended 6 months exclusive breastfeeding. A qualitative enquiry based on a phenomenological framework and multiple methods were used to explore women's experiences in depth. Multiple qualitative methods using face-to-face interview and participant diary were used. Data collection took place in urban suburbs around Penang and Klang Valley, Malaysia from March-September 2011. Participants were 40 employed women with infants less than 24 months. Only 11 of the participants worked from home. Based on the women's experiences, we categorized them into three groups: 'Passionate' women with a strong determination and exclusively breastfed for 6 months, 'Ambivalent' women who initiated breastfeeding, but were unable to sustain exclusive breastfeeding after returning to work and 'Equivalent' women who introduced infant formula prior to returning to work. Passion and to a lesser extent intention, influenced women's choice. Women's characteristics played a greater role in their infant feeding outcomes than their work environment. © 2016 John Wiley & Sons Ltd.

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…

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.

Perceived benefits and barriers to exercise for recently treated patients with multiple myeloma: a qualitative study.

PubMed

Craike, Melinda J; Hose, Kaye; Courneya, Kerry S; Harrison, Simon J; Livingston, Patricia M

2013-07-01

Understanding the physical activity experiences of patients with multiple myeloma (MM) is essential to inform the development of evidence-based interventions and to quantify the benefits of physical activity. The aim of this study was to gain an in-depth understanding of the physical activity experiences and perceived benefits and barriers to physical activity for patients with MM. This was a qualitative study that used a grounded theory approach. Semi-structured interviews were conducted in Victoria, Australia by telephone from December 2011-February 2012 with patients who had been treated for MM within the preceding 2-12 months. Interviews were transcribed and analysed using the constant comparison coding method to reduce the data to themes. Gender differences and differences between treatment groups were explored. Twenty-four interviews were completed. The sample comprised 13 females (54%), with a mean age of 62 years (SD = 8.8). Sixteen (67%) participants had received an autologous stem cell transplant (ASCT). All participants currently engaged in a range of light to moderate intensity physical activity; walking and gardening were the most common activities. Recovery from the symptoms of MM and side effects of therapy, psychological benefits, social factors and enjoyment were important benefits of physical activity. Barriers to physical activity predominately related to the symptoms of MM and side effects of therapy, including pain, fatigue, and fear of infection. Low self- motivation was also a barrier. Women participated in a more diverse range of physical activities than men and there were gender differences in preferred type of physical activity. Women were more likely to report psychological and social benefits; whereas men reported physical activity as a way to keep busy and self-motivation was a barrier. Patients treated with an ASCT more often reported affective benefits of participation in physical activity and fatigue as a barrier. Patients treated with other therapies (e.g., chemotherapy, radiotherapy) were more likely to report pain as a barrier. Patients with MM experience debilitating effects of their condition and therapy, which influences their level and intensity of physical activity participation. Physical activity programs should be individualised; take into consideration gender differences and the impact of different types of therapy on physical activity; and focus on meeting the psychological, coping and recovery needs of patients.

Physical barriers formed from gelling liquids: 1. numerical design of laboratory and field experiments

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

Finsterle, S.; Moridis, G.J.; Pruess, K.

1994-01-01

The emplacement of liquids under controlled viscosity conditions is investigated by means of numerical simulations. Design calculations are performed for a laboratory experiment on a decimeter scale, and a field experiment on a meter scale. The purpose of the laboratory experiment is to study the behavior of multiple gout plumes when injected in a porous medium. The calculations for the field trial aim at designing a grout injection test from a vertical well in order to create a grout plume of a significant extent in the subsurface.

First-principles multiple-barrier diffusion theory. The case study of interstitial diffusion in CdTe

DOE PAGES

Yang, Ji -Hui; Park, Ji -Sang; Kang, Joongoo; ...

2015-02-17

The diffusion of particles in solid-state materials generally involves several sequential thermal-activation processes. However, presently, diffusion coefficient theory only deals with a single barrier, i.e., it lacks an accurate description to deal with multiple-barrier diffusion. Here, we develop a general diffusion coefficient theory for multiple-barrier diffusion. Using our diffusion theory and first-principles calculated hopping rates for each barrier, we calculate the diffusion coefficients of Cd, Cu, Te, and Cl interstitials in CdTe for their full multiple-barrier diffusion pathways. As a result, we found that the calculated diffusivity agrees well with the experimental measurement, thus justifying our theory, which is generalmore » for many other systems.« less

Multiple-Barrier Resonant Tunneling Structures for Application in a Microwave Generator Stabilized by Microstrip Resonator

DTIC Science & Technology

2000-06-23

conductivity ( NDC ) effects in double barrier resonant tunneling structures (DBRTS) prove the extremely fast frequency response of charge transport (less...UNCLASSIFIED Defense Technical Information Center Compilation Part Notice ADP013131 TITLE: Multiple-Barrier Resonant Tunneling Structures for...Institute Multiple-barrier resonant tunneling structures for application in a microwave generator stabilized by microstrip resonator S. V. Evstigneev, A. L

The intestinal barrier in multiple sclerosis: implications for pathophysiology and therapeutics.

PubMed

Camara-Lemarroy, Carlos R; Metz, Luanne; Meddings, Jonathan B; Sharkey, Keith A; Wee Yong, V

2018-05-30

Biological barriers are essential for the maintenance of homeostasis in health and disease. Breakdown of the intestinal barrier is an essential aspect of the pathophysiology of gastrointestinal inflammatory diseases, such as inflammatory bowel disease. A wealth of recent studies has shown that the intestinal microbiome, part of the brain-gut axis, could play a role in the pathophysiology of multiple sclerosis. However, an essential component of this axis, the intestinal barrier, has received much less attention. In this review, we describe the intestinal barrier as the physical and functional zone of interaction between the luminal microbiome and the host. Besides its essential role in the regulation of homeostatic processes, the intestinal barrier contains the gut mucosal immune system, a guardian of the integrity of the intestinal tract and the whole organism. Gastrointestinal disorders with intestinal barrier breakdown show evidence of CNS demyelination, and content of the intestinal microbiome entering into the circulation can impact the functions of CNS microglia. We highlight currently available studies suggesting that there is intestinal barrier dysfunction in multiple sclerosis. Finally, we address the mechanisms by which commonly used disease-modifying drugs in multiple sclerosis could alter the intestinal barrier and the microbiome, and we discuss the potential of barrier-stabilizing strategies, including probiotics and stabilization of tight junctions, as novel therapeutic avenues in multiple sclerosis.

Garden greenery and the health of older people in residential care facilities: a multi-level cross-sectional study.

PubMed

Dahlkvist, Eva; Hartig, Terry; Nilsson, Annika; Högberg, Hans; Skovdahl, Kirsti; Engström, Maria

2016-09-01

To test the relationship between greenery in gardens at residential facilities for older people and the self-perceived health of residents, mediated by experiences of being away and fascination when in the garden and the frequency of visitation there. To examine how these indirect effects vary with the number of physical barriers to visiting the garden. Many older people in residential facilities suffer from complex health problems. Access to a green outdoor environment may enable psychological distance, engage effortless attention, encourage more frequent visitation and promote resident health. A multi-level, cross-sectional, correlational design. Questionnaires were administered June-August, 2011 to convenience samples of residents at 72 facilities for older people with complex healthcare needs. One to 10 eligible residents were sampled during self-motivated garden visits at each facility (n = 290). They reported on their garden experiences and health. Facility staff reported on objective garden characteristics and barriers to access. A serial mediation model was tested with multiple linear regression analysis. The total indirect effect of greenery on self-perceived health was positive and significant. Garden greenery appears to affect health by enhancing a sense of being away, affording possibilities to experience the outdoor environment as interesting and encouraging visitation. Among residents in homes with multiple barriers, only fascination mediated the relationship between greenery and self-perceived health. Ample greenery in outdoor space at residential facilities for older people appears to promote experiences of being away and fascination, more frequent visitation and better health. © 2016 The Authors. Journal of Advanced Nursing Published by John Wiley & Sons Ltd.

Facilitating access to surgical care through a decentralised case-finding strategy: experience in Madagascar

PubMed Central

Hamer, Mirjam; Biddell, Jasmin; Claus, Nathan; Randall, Kirsten; Alcorn, Dennis; Parker, Gary; Shrime, Mark G

2017-01-01

Over two-thirds of the world’s population lack access to surgical care. Non-governmental organisation’s providing free surgeries may overcome financial barriers, but other barriers to care still exist. This analysis paper discusses two different case-finding strategies in Madagascar that aimed to increase the proportion of poor patients, women and those for whom multiple barriers to care exist. From October 2014 to June 2015, we used a centralised selection strategy, aiming to find 70% of patients from the port city, Toamasina, and 30% from the national capital and two remote cities. From August 2015 to June 2016, a decentralised strategy was used, aiming to find 30% of patients from Toamasina and 70% from 11 remote locations, including the capital. Demographic information and self-reported barriers to care were collected. Wealth quintile was calculated for each patient using a combination of participant responses to asset-related and demographic questions, and publicly available data. A total of 2971 patients were assessed. The change from centralised to decentralised selection resulted in significantly poorer patients undergoing surgery. All reported barriers to prior care, except for lack of transportation, were significantly more likely to be identified in the decentralised group. Patients who identified multiple barriers to prior surgical care were less likely to be from the richest quintile (p=0.037) and more likely to be in the decentralised group (p=0.046). Our country-specific analysis shows that decentralised patient selection strategies may be used to overcome barriers to care and allow patients in greatest need to access surgical care. PMID:29071129

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

PubMed

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

2015-05-02

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

Strategies for Disseminating Information on Biomedical Research on Autism to Hispanic Parents

ERIC Educational Resources Information Center

Lajonchere, Clara M.; Wheeler, Barbara Y.; Valente, Thomas W.; Kreutzer, Cary; Munson, Aron; Narayanan, Shrikanth; Kazemzadeh, Abe; Cruz, Roxana; Martinez, Irene; Schrager, Sheree M.; Schweitzer, Lisa; Chklovski, Tara; Hwang, Darryl

2016-01-01

Low income Hispanic families experience multiple barriers to accessing evidence-based information on Autism Spectrum Disorders (ASD). This study utilized a mixed-strategy intervention to create access to information in published bio-medical research articles on ASD by distilling the content into parent-friendly English- and Spanish-language ASD…

Anisotropic transport of normal metal-barrier-normal metal junctions in monolayer phosphorene.

PubMed

De Sarkar, Sangita; Agarwal, Amit; Sengupta, K

2017-07-19

We study transport properties of a phosphorene monolayer in the presence of single and multiple potential barriers of height U 0 and width d, using both continuum and microscopic lattice models, and show that the nature of electron transport along its armchair edge (x direction) is qualitatively different from its counterpart in both conventional two-dimensional electron gas with Schrödinger-like quasiparticles and graphene or surfaces of topological insulators hosting massless Dirac quasiparticles. We show that the transport, mediated by massive Dirac electrons, allows one to achieve collimated quasiparticle motion along x and thus makes monolayer phosphorene an ideal experimental platform for studying Klein paradox in the context of gapped Dirac materials. We study the dependence of the tunneling conductance [Formula: see text] as a function of d and U 0 , and demonstrate that for a given applied voltage V its behavior changes from oscillatory to decaying function of d for a range of U 0 with finite non-zero upper and lower bounds, and provide analytical expression for these bounds within which G decays with d. We contrast such behavior of G with that of massless Dirac electrons in graphene and also with that along the zigzag edge (y direction) in phosphorene where the quasiparticles obey an effective Schrödinger equation at low energy. We also study transport through multiple barriers along x and demonstrate that these properties hold for transport through multiple barriers as well. Finally, we suggest concrete experiments which may verify our theoretical predictions.

Hospitalist Perspective of Interactions with Medicine Subspecialty Consult Services.

PubMed

Adams, Traci N; Bonsall, Joanna; Hunt, Daniel; Puig, Alberto; Richards, Jeremy B; Yu, Liyang; McSparron, Jakob I; Shah, Nainesh; Weissler, Jonathan; Miloslavsky, Eli M

2018-05-01

Medicine subspecialty consultation is becoming increasingly important in inpatient medicine. We conducted a survey study in which we examined hospitalist practices and attitudes regarding medicine subspecialty consultation. The survey instrument was developed by the authors based on prior literature and administered online anonymously to hospitalists at 4 academic medical centers in the United States. The survey evaluated 4 domains: (1) current consultation practices, (2) preferences regarding consultation, (3) barriers to and facilitating factors of effective consultation, and (4) a comparison between hospitalist-fellow and hospitalist-subspecialty attending interactions. One hundred twenty-two of 261 hospitalists (46.7%) responded. The majority of hospitalists interacted with fellows during consultation. Of those, 90.9% reported that in-person communication occurred during less than half of consultations, and 64.4% perceived pushback at least "sometimes " in their consult interactions. Participants viewed consultation as an important learning experience, preferred direct communication with the consulting service, and were interested in more teaching during consultation. The survey identified a number of barriers to and facilitating factors of an effective hospitalist-consultant interaction, which impacted both hospitalist learning and patient care. Hospitalists reported more positive experiences when interacting with subspecialty attendings compared to fellows with regard to multiple aspects of the consultation. The hospitalist-consultant interaction is viewed as important for both hospitalist learning and patient care. Multiple barriers and facilitating factors impact the interaction, many of which are amenable to intervention.

Method of installing subsurface barrier

DOEpatents

Nickelson, Reva A.; Richardson, John G.; Kostelnik, Kevin M.; Sloan, Paul A.

2007-10-09

Systems, components, and methods relating to subterranean containment barriers. Laterally adjacent tubular casings having male interlock structures and multiple female interlock structures defining recesses for receiving a male interlock structure are used to create subterranean barriers for containing and treating buried waste and its effluents. The multiple female interlock structures enable the barriers to be varied around subsurface objects and to form barrier sidewalls. The barrier may be used for treating and monitoring a zone of interest.

Supporting Students with Invisible Disabilities: A Scoping Review of Postsecondary Education for Students with Mental Illness or an Acquired Brain Injury

ERIC Educational Resources Information Center

Venville, Annie; Mealings, Margaret; Ennals, Priscilla; Oates, Jennifer; Fossey, Ellie; Douglas, Jacinta; Bigby, Christine

2016-01-01

Students with invisible disabilities such as mental illness or acquired brain injury (ABI) experience multiple barriers that reduce their likelihood of postsecondary course completion. The present study conducted a systematic search of research reporting interventions for students experiencing mental illness or ABI to participate in postsecondary…

Academic Achievement and Aging out of Care: Foster Parents' Perceptions

ERIC Educational Resources Information Center

Mack, Robert D.

2012-01-01

Foster children experience multiple barriers and challenges that, amongst other issues, prevent them from achieving academically. At the age of 18, foster youth are forced out of the Department of Children and Families care, leading many of them to become homeless or to return to the homes from which they were displaced. Scholarly literature and…

Resonant activation in a colored multiplicative thermal noise driven closed system.

PubMed

Ray, Somrita; Mondal, Debasish; Bag, Bidhan Chandra

2014-05-28

In this paper, we have demonstrated that resonant activation (RA) is possible even in a thermodynamically closed system where the particle experiences a random force and a spatio-temporal frictional coefficient from the thermal bath. For this stochastic process, we have observed a hallmark of RA phenomena in terms of a turnover behavior of the barrier-crossing rate as a function of noise correlation time at a fixed noise variance. Variance can be fixed either by changing temperature or damping strength as a function of noise correlation time. Our another observation is that the barrier crossing rate passes through a maximum with increase in coupling strength of the multiplicative noise. If the damping strength is appreciably large, then the maximum may disappear. Finally, we compare simulation results with the analytical calculation. It shows that there is a good agreement between analytical and numerical results.

Perceived barriers to initiating and maintaining physical activity among South Asian and White British adults in their 60s living in the United Kingdom: a qualitative study.

PubMed

Horne, Maria; Skelton, Dawn A; Speed, Shaun; Todd, Chris

2013-01-01

To explore the barriers to initiating and maintaining regular physical activity (PA) among UK Indian, Pakistani and White British adults in their 60s. An exploratory qualitative approach was utilised using 15 focus groups and 40 in-depth interviews. Purposive sampling was used to recruit participants with different experiences of participation or non-participation in PA. Misunderstandings about the value of exercise in later life, particularly for those with ongoing healthcare problems, were identified in UK South Asian and White British older adults' accounts of their experience of the barriers to initiating and maintaining regular PA. Both groups and genders said that PA could exacerbate pre-existing health problems and result in physical harm. Although most beliefs were similar to those of the White British, ethnic-specific factors, such as language barriers, religious beliefs and cultural practices could act as additional barriers to undertaking and maintaining PA among UK South Asian older adults. Understanding the multiple levels of influence on older adults' PA behaviour can provide the basis for developing comprehensive approaches to health promotion initiatives aimed at increasing PA levels. Healthcare providers need to understand the characteristics and specific barriers faced by these groups of older adults; work with older people from these groups to develop culturally appropriate PA programmes and address the misunderstandings and misconceptions about the value of exercise in later-life, particularly in those with ongoing health problems.

Barriers to and Facilitators of Research Utilization: A Survey of Registered Nurses in China

PubMed Central

Wang, Li-Ping; Jiang, Xiao-Lian; Wang, Lei; Wang, Guo-Rong; Bai, Yang-Jing

2013-01-01

Aims This survey aims to describe the perception of barriers to and facilitators of research utilization by registered nurses in Sichuan province, China, and to explore the factors influencing the perceptions of the barriers to and facilitators of research utilization. Methods A cross sectional survey design and a double cluster sampling method were adopted. A total of 590 registered nurses from 3 tertiary level hospitals in Sichuan province, China, were recruited in a period from September 2006 to January 2007. A modified BARRUERS Scale and a Facilitators Scale were used. Data were analyzed with descriptive statistics, rank transformation test, and multiple linear regression. Results Barriers related to the setting subscale were more influential than barriers related to other subscales. The lack of authority was ranked as the top greatest barrier (15.7%), followed by the lack of time (13.4%) and language barrier (15.0%). Additional barriers identified were the reluctance of patients to research utilization, the lack of funding, and the lack of legal protection. The top three greatest facilitators were enhancing managerial support (36.9%), advancing education to increase knowledge base (21.1%), and increasing time for reviewing and implementing (17.5%), while cooperation of patients to research utilization, establishing a panel to evaluate researches, and funding were listed as additional facilitators. Hospital, educational background, research experience, and knowledge on evidence-based nursing were the factors influencing perceptions of the barriers and facilitators. Conclusions Nurses in China are facing a number of significant barriers in research utilization. Enhancing managerial support might be the most promising facilitator, given Chinese traditional culture and existing health care system. Hospital, educational background, research experience and knowledge on evidence-based nursing should be taken into account to promote research utilization. The BARRIERS Scale should consider funding and involvement of patients in research utilization. PMID:24312380

Why Wait Until Our Community Gets Cancer?: Exploring CRC Screening Barriers and Facilitators in the Spanish-Speaking Community in North Carolina.

PubMed

Martens, Christa E; Crutchfield, Trisha M; Laping, Jane L; Perreras, Lexie; Reuland, Daniel S; Cubillos, Laura; Pignone, Michael P; Wheeler, Stephanie B

2016-12-01

Colorectal cancer (CRC) is a leading cause of death among Hispanics in the United States. Despite the benefits of CRC screening, many Hispanics are not being screened. Using a combined methodology of focus groups and discrete choice experiment (DCE) surveys, the objectives for this research were as follows: (1) to improve understanding of preferences regarding potential CRC screening program characteristics, and (2) to improve understanding of the barriers and facilitators around CRC screening with the Hispanic, immigrant community in North Carolina. Four gender-stratified focus groups were conducted and DCE surveys were administered to 38 Spanish-speaking individuals across four counties in North Carolina. In-depth content analysis was used to examine the focus group data; descriptive analyses and mean attribute importance scores for cost of screening and follow-up care, travel time, and test options were calculated from DCE data. Data analyses showed that this population has a strong interest in CRC screening but experience barriers such as lack of access to resources, cost uncertainty, and stigma. Some of these barriers are unique to their cultural experiences in the United States, such as an expressed lack of tailored CRC information. Based on the DCE, cost variables were more important than testing options or travel time. This study suggests that Hispanics may have a general awareness of and interest in CRC screening, but multiple barriers prevent them from getting screened. Special attention should be given to designing culturally and linguistically appropriate programs to improve access to healthcare resources, insurance, and associated costs among Hispanics.

Anisotropic transport of normal metal-barrier-normal metal junctions in monolayer phosphorene

NASA Astrophysics Data System (ADS)

De Sarkar, Sangita; Agarwal, Amit; Sengupta, K.

2017-07-01

We study transport properties of a phosphorene monolayer in the presence of single and multiple potential barriers of height U 0 and width d, using both continuum and microscopic lattice models, and show that the nature of electron transport along its armchair edge (x direction) is qualitatively different from its counterpart in both conventional two-dimensional electron gas with Schrödinger-like quasiparticles and graphene or surfaces of topological insulators hosting massless Dirac quasiparticles. We show that the transport, mediated by massive Dirac electrons, allows one to achieve collimated quasiparticle motion along x and thus makes monolayer phosphorene an ideal experimental platform for studying Klein paradox in the context of gapped Dirac materials. We study the dependence of the tunneling conductance G\\equiv {{G}xx} as a function of d and U 0, and demonstrate that for a given applied voltage V its behavior changes from oscillatory to decaying function of d for a range of U 0 with finite non-zero upper and lower bounds, and provide analytical expression for these bounds within which G decays with d. We contrast such behavior of G with that of massless Dirac electrons in graphene and also with that along the zigzag edge (y direction) in phosphorene where the quasiparticles obey an effective Schrödinger equation at low energy. We also study transport through multiple barriers along x and demonstrate that these properties hold for transport through multiple barriers as well. Finally, we suggest concrete experiments which may verify our theoretical predictions.

Subsurface materials management and containment system

DOEpatents

Nickelson, Reva A.; Richardson, John G.; Kosteinik, Kevin M.; Sloan, Paul A.

2004-07-06

Systems, components, and methods relating to subterranean containment barriers. Laterally adjacent tubular casings having male interlock structures and multiple female interlock structures defining recesses for receiving a male interlock structure are used to create subterranean barriers for containing and treating buried waste and its effluents. The multiple female interlock structures enable the barriers to be varied around subsurface objects and to form barrier sidewalls. The barrier may be used for treating and monitoring a zone of interest.

Subsurface materials management and containment system

DOEpatents

Nickelson, Reva A.; Richardson, John G.; Kostelnik, Kevin M.; Sloan, Paul A.

2006-10-17

Systems, components, and methods relating to subterranean containment barriers. Laterally adjacent tubular casings having male interlock structures and multiple female interlock structures defining recesses for receiving a male interlock structure are used to create subterranean barriers for containing and treating buried waste and its effluents. The multiple female interlock structures enable the barriers to be varied around subsurface objects and to form barrier sidewalls. The barrier may be used for treating and monitoring a zone of interest.

Employment barriers, skills, and aspirations among unemployed job seekers with and without social anxiety disorder.

PubMed

Himle, Joseph A; Weaver, Addie; Bybee, Deborah; O'Donnell, Lisa; Vlnka, Sarah; Laviolette, Wayne; Steinberger, Edward; Golenberg, Zipora; Levine, Debra Siegel

2014-07-01

The literature has consistently demonstrated that social anxiety disorder has substantial negative impacts on occupational functioning. However, to date, no empirical work has focused on understanding the specific nature of vocational problems among persons with social anxiety disorder. This study examined the association between perceived barriers to employment, employment skills, and job aspirations and social anxiety among adults seeking vocational rehabilitation services. Data from intake assessments (June 2010-December 2011) of 265 low-income, unemployed adults who initiated vocational rehabilitation services in urban Michigan were examined to assess perceived barriers to employment, employment skills, job aspirations, and demographic characteristics among participants who did or did not screen positive for social anxiety disorder. Bivariate and multiple logistic regression analyses were performed. After adjustment for other factors, the multiple logistic regression analysis revealed that perceiving more employment barriers involving experience and skills, reporting fewer skills related to occupations requiring social skills, and having less education were significantly associated with social anxiety disorder. Participants who screened positive for social anxiety disorder were significantly less likely to aspire to social jobs. Employment-related characteristics that were likely to have an impact on occupational functioning were significantly different between persons with and without social anxiety problems. Identifying these differences in employment barriers, skills, and job aspirations revealed important information for designing psychosocial interventions for treatment of social anxiety disorder. The findings underscored the need for vocational services professionals to assess and address social anxiety among their clients.

Method of sealing casings of subsurface materials management system

DOEpatents

Nickelson, Reva A.; Richardson, John G.; Kostelnik, Kevin M.; Sloan, Paul A.

2007-02-06

Systems, components, and methods relating to subterranean containment barriers. Laterally adjacent tubular casings having male interlock structures and multiple female interlock structures defining recesses for receiving a male interlock structure are used to create subterranean barriers for containing and treating buried waste and its effluents. The multiple female interlock structures enable the barriers to be varied around subsurface objects and to form barrier sidewalls. The barrier may be used for treating and monitoring a zone of interest.

The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis.

PubMed

Johnson, Kurt L; Yorkston, Kathryn M; Klasner, Estelle R; Kuehn, Carrie M; Johnson, Erica; Amtmann, Dagmar

2004-02-01

To attain a better understanding of the benefits and barriers faced by persons with multiple sclerosis (MS) in the workplace. Qualitative research methodology comprising a series of semistructured interviews. Community-based setting. Fourteen women and 2 men with MS living in the community who were employed or recently employed at the time of interviews. Not applicable. Accounts of personal experiences related to employment. Four themes emerged: the cost-benefit economy of working; fatigue and cognitive changes; stress in the workplace; and accommodations made to address barriers. Although participants valued work highly, they were also aware of the cost of being employed. The consequences of unemployment or changing jobs were considered negative and appeared stressful. For persons with MS, employment had both costs and significant benefits. Accommodations in the workplace and modifications of roles and responsibilities at home made it possible for individuals to continue working. Health care providers must consider the complexity and timing of decisions by people with MS to continue or leave employment before recommending either action. Identifying critical periods of intervention to stabilize this cost-benefit balance is a critical next step for understanding issues of employment and MS.

Subsurface materials management and containment system, components thereof and methods relating thereto

DOEpatents

Nickelson, Reva A.; Richardson, John G.; Kostelnik, Kevin M.; Sloan, Paul A.

2006-04-18

Systems, components, and methods relating to subterranean containment barriers. Laterally adjacent tubular casings having male interlock structures and multiple female interlock structures defining recesses for receiving a male interlock structure are used to create subterranean barriers for containing and treating buried waste and its effluents. The multiple female interlock structures enable the barriers to be varied around subsurface objects and to form barrier sidewalls. The barrier may be used for treating and monitoring a zone of interest.

Improving continuing medical education by enhancing interactivity: lessons from Iran.

PubMed

Faghihi, Seyed Aliakbar; Khankeh, Hamid Reza; Hosseini, Seyed Jalil; Soltani Arabshahi, Seyed Kamran; Faghih, Zahra; Parikh, Sagar V; Shirazi, Mandana

2016-04-01

Continuing Medical Education (CME) has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners. Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general. The participants' experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers' use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME. Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME.

Prediction of safe driving Behaviours based on health belief model: the case of taxi drivers in Bandar Abbas, Iran.

PubMed

Razmara, Asghar; Aghamolaei, Teamur; Madani, Abdoulhossain; Hosseini, Zahra; Zare, Shahram

2018-03-20

Road accidents are among the main causes of mortality. As safe and secure driving is a key strategy to reduce car injuries and offenses, the present research aimed to explore safe driving behaviours among taxi drivers based on the Health Belief Model (HBM). This study was conducted on 184 taxi drivers in Bandar Abbas who were selected based on a multiple stratified sampling method. Data were collected by a questionnaire comprised of a demographic information section along with the constructs of the HBM. Data were analysed by SPSS ver19 via a Pearson's correlation coefficient and multiple regressions. The mean age of the participants was 45.1 years (SD = 11.1). They all had, on average, 10.3 (SD = 7/5) years of taxi driving experience. Among the HBM components, cues to action and perceived benefits were shown to be positively correlated with safe driving behaviours, while perceived barriers were negatively correlated. Cues to action, perceived barriers and perceived benefits were shown to be the strongest predictors of a safe drivers' behaviour. Based on the results of this study in designing health promotion programmes to improve safe driving behaviours among taxi drivers, cues to action, perceived benefits and perceived barriers are important. Therefore, advertising, the design of information campaigns, emphasis on the benefits of safe driving behaviours and modification barriers are recommended.

Expectations of barriers to psychosocial care: views of parents and adolescents in the community.

PubMed

Nanninga, Marieke; Reijneveld, Sijmen A; Knorth, Erik J; Jansen, Danielle E M C

2016-01-01

Parents with a child suffering from psychosocial problems frequently experience barriers to psychosocial care, which may hinder access. Expectations of barriers may have the same effect, but evidence is lacking. The aim of this study is to examine parents' and adolescents' expectations of barriers regarding psychosocial care for the child, along with associated child and family characteristics. We obtained data on an age-stratified random sample of school children/pupils aged 4-18 via questionnaires (N = 666; response rate 70.3 %). Expectations of barriers to psychosocial care were measured with the "Barriers to Treatment Participation Scale-Expectancies" questionnaire (BTPS-exp). Results showed that 64 % of the parents of children below age 12, 59 % of the parents of adolescents (age 12-18), and 84 % of the adolescents expected one or more barriers. Parents and adolescents expected barriers most frequently with respect to irrelevance of treatment. Mainly parents with low educational level and their adolescents expected barriers regarding treatment, and quite a few characteristics of parents of adolescents were associated with expecting multiple barriers regarding treatment demands and issues, for example, single parents, parents of lower educational level and of adolescent boys, and parents of adolescents with psychosocial problems. We conclude that adolescents especially, but also their parents and parents of younger children, expect major barriers to psychosocial care, which may greatly hinder appropriate care seeking. This evidence may support professionals and policymakers in their attempts to improve access to psychosocial care.

An interpretive description of chemotherapy-induced premature menopause among Latinas with breast cancer.

PubMed

Brisbois, Maryellen D

2014-09-01

To describe the experience of chemotherapy-induced premature menopause (CIPM) among Latinas, explore how CIPM was assimilated into the breast cancer experience, and relate measured acculturation levels to the CIPM experience. Interpretive descriptive method from a feminist inquiry lens. Telephone interviews with participants from 12 states in the United States. 20 Latinas who experienced CIPM after treatment for breast cancer. In-depth interviews and the Brief Acculturation Scale for Hispanics were used to elicit data, with interpreter assistance as needed. One overarching theme, Bigger Than Menopause, and three subthemes, Experiencing Menopause, Ever-Changing Landscape, and Working Through the Experience, were found. PARTICIPANTS' ability to assimilate CIPM into the breast cancer experience was affected by the magnitude of physiologic and psychosocial effects, access to health care, information and support, sense of control, and acculturation level. The CIPM experience for Latinas with breast cancer is multifaceted, with less acculturated Latinas facing multiple barriers in accessing health care, treatment, information, and support. PARTICIPANTS described CIPM as part of a larger context that included physiologic and psychosocial effects and affected participants' ability to assimilate CIPM into the breast cancer experience. The impact of low acculturation and barriers experienced were elucidated as factors associated with assimilating CIPM into the breast cancer experience.

An analysis of blood donation barriers experienced by North American and Caribbean university students in Grenada, West Indies.

PubMed

Dean, Benjamin W; Hewitt, Sarah N; Begos, Morgan C; Gomez, Angela; Messam, Locksley L McV

2018-02-01

To estimate the associations of nationality, university program, donation history and gender, with blood donation barriers experienced by non-donating students on the day of a campus blood drive. This project focused particularly on nationality and the effect of the different blood donation cultures in the students' countries of origin. A retrospective cohort study of 398 North American and Caribbean university students was conducted at St. George's University, Grenada, in 2010. Data were collected from non-donating students on campus while a blood drive was taking place. Log-binomial regression was used to estimate associations between the exposures of interest and donation barriers experienced by the students. North American (voluntary blood donation culture) students were more likely than Caribbean (replacement blood donation culture) students to experience "Lack of Time" (relative risk (RR) = 1.57; 95% confidence interval (CI): 1.19-2.07) and "Lack of Eligibility" (RR = 1.55; 95% CI: 1.08-2.22) as barriers to donation. Conversely, Caribbean students were a third as likely to state "Lack of Incentive" (RR = 0.32; 95% CI: 0.20-0.50), "Fear of Infection" (RR = 0.35; 95% CI: 0.21-0.58), and "Fear of Needles" (RR = 0.32; 95% CI: 0.21-0.48) were barriers than North American students. University students from voluntary blood donation cultures are likely to experience different barriers to donation than those from replacement cultures. Knowledge of barriers that students from contrasting blood donation systems face provides valuable information for blood drive promotion in university student populations that contain multiple nationalities. Copyright © 2017 Elsevier Ltd. All rights reserved.

Barriers to the Accessibility and Continuity of Health-Care Services in People with Multiple Sclerosis

PubMed Central

Bishop, Malachy; Pionke, J.J.; Strauser, David; Santens, Ryan L.

2017-01-01

Background: Individuals with multiple sclerosis (MS) face a range of barriers to accessing and using health-care services. The aim of this review was to identify specific barriers to accessing and using health-care services based on a continuum of the health-care delivery system. Methods: Literature searches were conducted in the PubMed, PsycINFO, CINAHL, and Web of Science databases. The following terms were searched as subject headings, key words, or abstracts: health care, access, barriers, physical disability, and multiple sclerosis. The literature search produced 361 potentially relevant citations. After screening titles, abstracts, and citations, eight citations were selected for full-text review. Results: Health-care barriers were divided into three continuous phases of receiving health care. In the before-visit phase, the most commonly identified barrier was transportation. In the during-visit phase, communication quality was the major concern. In the after-visit phase, discontinued referral was the major barrier encountered. Conclusions: There are multiple interrelated barriers to accessing and using health-care services along the health-care delivery continuum for people with MS and its associated physical disabilities, ranging from complex and long-recognized barriers that will likely require extended advocacy to create policy changes to issues that can and should be addressed through relatively minor changes in health-care delivery practices, improved care coordination, and increased provider awareness, education, and responsiveness to patients' needs. PMID:29270089

Attitudes, experiences, and beliefs affecting end-of-life decision-making among homeless individuals.

PubMed

Tarzian, Anita J; Neal, Maggie T; O'Neil, J Anne

2005-02-01

Individuals who are homeless may encounter various barriers to obtaining quality end-of-life (EOL) care, including access barriers, multiple sources of discrimination, and lack of knowledge among health care providers (HCPs) of their preferences and decision-making practices. Planning for death with individuals who have spent so much energy surviving requires an understanding of their experiences and preferences. This study sought to increase HCPs' awareness and understanding of homeless or similarly marginalized individuals' EOL experiences and treatment preferences. Focus groups were conducted with homeless individuals using a semi-structured interview guide to elicit participants' EOL experiences, decision-making practices, and personal treatment preferences. Five focus groups were conducted with 20 inner-city homeless individuals (4 per group) at a free urban health care clinic for homeless individuals in the United States. Sixteen of the 20 participants were African American; 4 were Caucasian. None were actively psychotic. All had experienced multiple losses and drug addiction. Five main themes emerged: valuing an individual's wishes; acknowledging emotions; the primacy of religious beliefs and spiritual experience; seeking relationship-centered care; and reframing advance care planning. The narrative process of this qualitative study uncovered an approach to EOL decision-making in which participants' reasoning was influenced by emotions, religious beliefs, and spiritual experience. Relationship-centered care, characterized by compassion and respectful, two-way communication, was obvious by its described absence--reasons for this are discussed. Recommendations for reframing advance care planning include ways for HCPs to transform advance care planning from that of a legal document to a process of goal-setting that is grounded in human connection, respect, and understanding.

Ecological School Counseling in High-Poverty Elementary Schools: Counselors' Backgrounds and Perceptions Regarding the Effects of Poverty, Importance of Advocacy and School-Based Mental Health Programs

ERIC Educational Resources Information Center

Brown, La Vera C.

2016-01-01

Elementary school counselors working in high-poverty schools experience several challenges due to the multiple barriers associated with serving children from low-SES families. Research shows that children from low-SES families are at risk of adverse consequences to their developmental and psychological progress due to negative environmental…

Innovative Approaches Address Aging and Mental Health Needs in LGBTQ Communities.

PubMed

Hoy-Ellis, Charles P; Ator, Michael; Kerr, Christopher; Milford, Jessica

2016-01-01

LGBTQ older adults have higher levels of psychological distress as compared to older adults in general. They also experience multiple barriers to accessing equitable, culturally competent mental health and aging services because of their distinct histories and particular social contexts. This article discusses this lack of access to services, and highlights an innovative way mental health services are being delivered in LGBTQ communities.

Transition model for ricin-aptamer interactions with multiple pathways and energy barriers

NASA Astrophysics Data System (ADS)

Wang, Bin; Xu, Bingqian

2014-02-01

We develop a transition model to interpret single-molecule ricin-aptamer interactions with multiple unbinding pathways and energy barriers measured by atomic force microscopy dynamic force spectroscopy. Molecular simulations establish the relationship between binding conformations and the corresponding unbinding pathways. Each unbinding pathway follows a Bell-Evans multiple-barrier model. Markov-type transition matrices are developed to analyze the redistribution of unbinding events among the pathways under different loading rates. Our study provides detailed information about complex behaviors in ricin-aptamer unbinding events.

Barriers and Facilitators to Scientific Writing Among Applied Epidemiologists.

PubMed

Pittman, Jessica; Stahre, Mandy; Tomedi, Laura; Wurster, Jessica

Communication in the form of written and oral reports and presentations is a core competency for epidemiologists at governmental public health agencies. Many applied epidemiologists do not publish peer-reviewed articles, limiting the scientific literature of best practices in evidence-based public health. To describe the writing and publishing experiences of applied epidemiologists and identify barriers and facilitators to publishing. Telephone focus groups and an 18-question multiple-choice and short-answer Web-based assessment were fielded in 2014. Six focus groups composed of 26 applied epidemiologists and an online assessment answered by 396 applied epidemiologists. Sample selection was stratified by years of experience. Past publishing experience, current job duties as related to publishing, barriers and facilitators to writing and publishing, and desired training in writing and publishing were assessed through focus groups and the online assessment. Focus groups identified 4 themes: job expectations, barriers to publishing, organizational culture, and the understanding of public health practice among reviewers as issues related to writing and publishing. Most respondents (80%) expressed a desire to publish; however, only 59% had published in a peer-reviewed journal. An academic appointment (among doctoral educated respondents) was identified as a facilitator to publishing as was access to peer-reviewed literature. Time (68%) was identified as the greatest barrier to writing and publishing. Other major barriers included lack of encouragement or support (33%) within the public health agency and agency clearance processes (32%). Assistance with journal selection (62%), technical writing skills (60%), and manuscript formatting (57%) were listed as the most needed trainings. Public health agencies can be facilitators for epidemiologists to contribute to the scientific literature through increasing access to the peer-reviewed literature, creating a supportive environment for writing and publishing, and investing in desired and needed training. The results have implications for modifying workplace policies surrounding writing and publishing.

Communication barriers to patient education in cardiac inpatient care: a qualitative study of multiple perspectives.

PubMed

Farahani, Mansoureh A; Sahragard, Roghiyeh; Carroll, Jennifer K; Mohammadi, Eesa

2011-06-01

Growing evidence in a variety of health-care settings supports the need to strengthen nurse-physician communication and interprofessional collaboration to optimize patient-health outcomes. The objective of this study is to explore communication barriers from the perspective of nurses themselves, as well as physicians, patients and families in a hospital-based cardiac care setting. Qualitative analysis of individual interviews with 35 participants was taken in two hospitals in Tehran, Iran. Interview questions asked about experiences with patient education and communication barriers among physicians, nurses and patients. The three major themes identified were: (i) lack of collegiality and communication between nurses and physicians; (ii) problematic communication between the health-care team, patients and their families; and (iii) cultural challenges. Findings from this study support the need for health-care organizations to be more collaborative and inclusive of nursing professionals. © 2011 Blackwell Publishing Asia Pty Ltd.

Pharmacologic studies in vulnerable populations: Using the pediatric experience.

PubMed

Zimmerman, Kanecia; Gonzalez, Daniel; Swamy, Geeta K; Cohen-Wolkowiez, Michael

2015-11-01

Historically, few data exist to guide dosing in children and pregnant women. Multiple barriers to inclusion of these vulnerable populations in clinical trials have led to this paucity of data. However, federal legislation targeted at pediatric therapeutics, innovative clinical trial design, use of quantitative clinical pharmacology methods, pediatric thought leadership, and collaboration have successfully overcome many existing barriers. This success has resulted in improved knowledge on pharmacokinetics, safety, and efficacy of therapeutics in children. To date, research in pregnant women has not been characterized by similar success. Wide gaps in knowledge remain despite the common use of therapeutics in pregnancy. Given the similar barriers to drug research and development in pediatric and pregnant populations, the route toward success in children may serve as a model for the advancement of drug development and appropriate drug administration in pregnant women. Copyright © 2015 Elsevier Inc. All rights reserved.

Manipulation of nanoscale V-pits to optimize internal quantum efficiency of InGaN multiple quantum wells

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

Chang, Chiao-Yun; Li, Heng; Shih, Yang-Ta

2015-03-02

We systematically investigated the influence of nanoscale V-pits on the internal quantum efficiency (IQE) of InGaN multiple quantum wells (MQWs) by adjusting the underlying superlattices (SLS). The analysis indicated that high barrier energy of sidewall MQWs on V-pits and long diffusion distance between the threading dislocation (TD) center and V-pit boundary were crucial to effectively passivate the non-radiative centers of TDs. For a larger V-pit, the thicker sidewall MQW on V-pit would decrease the barrier energy. On the contrary, a shorter distance between the TD center and V-pit boundary would be observed in a smaller V-pit, which could increase themore » carrier capturing capability of TDs. An optimized V-pit size of approximately 200–250 nm in our experiment could be concluded for MQWs with 15 pairs SLS, which exhibited an IQE value of 70%.« less

Mutagenic consequences of a single G-quadruplex demonstrate mitotic inheritance of DNA replication fork barriers

PubMed Central

Lemmens, Bennie; van Schendel, Robin; Tijsterman, Marcel

2015-01-01

Faithful DNA replication is vital to prevent disease-causing mutations, chromosomal aberrations and malignant transformation. However, accuracy conflicts with pace and flexibility and cells rely on specialized polymerases and helicases to ensure effective and timely replication of genomes that contain DNA lesions or secondary structures. If and how cells can tolerate a permanent barrier to replication is, however, unknown. Here we show that a single unresolved G-quadruplexed DNA structure can persist through multiple mitotic divisions without changing conformation. Failed replication across a G-quadruplex causes single-strand DNA gaps that give rise to DNA double-strand breaks in subsequent cell divisions, which are processed by polymerase theta (POLQ)-mediated alternative end joining. Lineage tracing experiments further reveal that persistent G-quadruplexes cause genetic heterogeneity during organ development. Our data demonstrate that a single lesion can cause multiple unique genomic rearrangements, and that alternative end joining enables cells to proliferate in the presence of mitotically inherited replication blocks. PMID:26563448

Mutagenic consequences of a single G-quadruplex demonstrate mitotic inheritance of DNA replication fork barriers.

PubMed

Lemmens, Bennie; van Schendel, Robin; Tijsterman, Marcel

2015-11-13

Faithful DNA replication is vital to prevent disease-causing mutations, chromosomal aberrations and malignant transformation. However, accuracy conflicts with pace and flexibility and cells rely on specialized polymerases and helicases to ensure effective and timely replication of genomes that contain DNA lesions or secondary structures. If and how cells can tolerate a permanent barrier to replication is, however, unknown. Here we show that a single unresolved G-quadruplexed DNA structure can persist through multiple mitotic divisions without changing conformation. Failed replication across a G-quadruplex causes single-strand DNA gaps that give rise to DNA double-strand breaks in subsequent cell divisions, which are processed by polymerase theta (POLQ)-mediated alternative end joining. Lineage tracing experiments further reveal that persistent G-quadruplexes cause genetic heterogeneity during organ development. Our data demonstrate that a single lesion can cause multiple unique genomic rearrangements, and that alternative end joining enables cells to proliferate in the presence of mitotically inherited replication blocks.

Innovative Approaches Address Aging and Mental Health Needs in LGBTQ Communities

PubMed Central

Hoy-Ellis, Charles P.; Ator, Michael; Kerr, Christopher; Milford, Jessica

2016-01-01

LGBTQ older adults have higher levels of psychological distress as compared to older adults in general. They also experience multiple barriers to accessing equitable, culturally competent mental health and aging services because of their distinct histories and particular social contexts. This article discusses this lack of access to services, and highlights an innovative way mental health services are being delivered in LGBTQ communities. PMID:28366982

Improving continuing medical education by enhancing interactivity: lessons from Iran

PubMed Central

FAGHIHI, SEYED ALIAKBAR; KHANKEH, HAMID REZA; HOSSEINI, SEYED JALIL; SOLTANI ARABSHAHI, SEYED KAMRAN; FAGHIH, ZAHRA; PARIKH, SAGAR V.; SHIRAZI, MANDANA

2016-01-01

Introduction Continuing Medical Education (CME) has been considered as a lifelong commitment for doctors to provide the optimal care for patients. Despite a long history of creating CME programs, outcomes are far from ideal. The present qualitative study aims to clarify the barriers affecting effectiveness of the CME programs in Iran based on the experiences of general practitioners. Methods Sixteen general practitioners were recruited to participate in in-depth interviews and field observations concerning experiences with CME. The study was performed using a qualitative content analysis method. The codes, categories and themes were explored through an inductive process in which the researchers moved from specific to general. Results The participants’ experiences identified a number of barriers, particularly insufficient interaction with the instructors; additional problems included the teachers’ use of an undifferentiated approach; unreal and abstract CME; and ignorance of the diverse reasons to participate in CME. Conclusion Based on the study results, there are multiple barriers to effective implementation of CME in Iran. The key barriers include insufficient interaction between the trainees and providers, which must be considered by other stakeholders and program designers. Such interactions would facilitate improved program design, invite more specific tailoring of the education to the participants, allow for more effective educational methods and set the stage for outcome evaluation from the learners actually applying their new knowledge in practice. Replication of these findings with another sample would improve confidence in these recommendations, but these findings are broadly consistent with findings in the educational literature on improving the efficacy of CME. PMID:27104199

Neighborhood, Socioeconomic, and Racial Influence on Chronic Pain.

PubMed

Maly, Angelika; Vallerand, April Hazard

2018-02-01

The purpose of this review is to highlight the neighborhood, socioeconomic, and racial influences on chronic pain. Negative influences on the experience of chronic pain are explored and defined as any adverse stressor common in low socioeconomic, urban neighborhoods that potentially contributes to health disparity in African Americans experiencing chronic pain. The multifactorial influences on chronic pain disparity in African Americans are explored and expounded upon in this review of existing evidence. Databases used for the search included CINAHL, PubMed, and PsycArticles. The experience of chronic pain is multifaceted, existing with multiple comorbidities and lasting consequences. To improve the burden of chronic pain requires a multifactorial assessment that considers neighborhood risk factors, emphasis on environmental stressors, limitations to support networks, barriers to physical activity, and access to primary care providers with whom communication is open and without bias. A comprehensive assessment of barriers will aid in the development of interventions that reach beyond the physical factors of chronic pain, also considering the psychosocial barriers to improving the burden of chronic pain in African Americans living in impoverished urban neighborhoods. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Barriers to participation in clinical trials: a physician survey.

PubMed

Mahmud, A; Zalay, O; Springer, A; Arts, K; Eisenhauer, E

2018-04-01

Clinical trials are vital for evidence-based cancer care. Oncologist engagement in clinical trials has an effect on patient recruitment, which in turn can affect trial success. Identifying barriers to clinical trial participation might enable interventions that could help to increase physician participation. To assess factors affecting physician engagement in oncology trials, a national survey was conducted using the online SurveyMonkey tool (SurveyMonkey, San Mateo, CA, U.S.A.; http://www.surveymonkey.com). Physicians associated with the Canadian Cancer Clinical Trials Network and the Canadian Cancer Trials Group were asked about their specialty, years of experience, barriers to participation, and motivating interventions, which included an open-ended question inviting survey takers to suggest interventions. The survey collected 207 anonymous responses. Respondents were predominantly medical oncologists (46.4%), followed by radiation oncologists (24.6%). Almost 70% of the respondents had more than 10 years of experience. Significant time constraints included extra paperwork (77%), patient education (54%), and extended follow-up or clinic visits (53%). Timing of events within trials was also a barrier to participation (55%). Most respondents favoured clinical work credits (72%), academic credits (67%), a clinical trial alert system (75%), a regular meeting to review trial protocols (65%), and a screening log to aid in patient accrual (67%) as motivational strategies. Suggested interventions included increased support staff, streamlined regulatory burden, and provision of greater funding for trials and easier access to ancillary services. The present study confirms that Canadian oncologists are willing to participate in clinical research, but face multiple barriers to trial participation. Those barriers could be mitigated by the implementation of several interventions identified in the study.

On the performance of capillary barriers as landfill cover

NASA Astrophysics Data System (ADS)

Kämpf, M.; Montenegro, H.

Landfills and waste heaps require an engineered surface cover upon closure. The capping system can vary from a simple soil cover to multiple layers of earth and geosynthetic materials. Conventional design features a compacted soil layer, which suffers from drying out and cracking, as well as root and animal intrusion. Capillary barriers consisting of inclined fine-over-coarse soil layers are investigated as an alternative cover system. Under unsaturated conditions, the textural contrast delays vertical drainage by capillary forces. The moisture that builds up above the contact will flow downdip along the interface of the layers. Theoretical studies of capillary barriers have identified the hydraulic properties of the layers, the inclination angle, the length of the field and the infiltration rate as the fundamental characteristics of the system. However, it is unclear how these findings can lead to design criteria for capillary barriers. To assess the uncertainty involved in such approaches, experiments have been carried out in a 8 m long flume and on large scale test sites (40 m x 15 m). In addition, the ability of a numerical model to represent the relevant flow processes in capillary barriers has been examined.

Females discriminate against heterospecific sperm in a natural hybrid zone.

PubMed

Cramer, Emily R A; Ålund, Murielle; McFarlane, S Eryn; Johnsen, Arild; Qvarnström, Anna

2016-08-01

When hybridization is maladaptive, species-specific mate preferences are selectively favored, but low mate availability may constrain species-assortative pairing. Females paired to heterospecifics may then benefit by copulating with multiple males and subsequently favoring sperm of conspecifics. Whether such mechanisms for biasing paternity toward conspecifics act as important reproductive barriers in socially monogamous vertebrate species remains to be determined. We use a combination of long-term breeding records from a natural hybrid zone between collared and pied flycatchers (Ficedula albicollis and F. hypoleuca), and an in vitro experiment comparing conspecific and heterospecific sperm performance in female reproductive tract fluid, to evaluate the potential significance of female cryptic choice. We show that the females most at risk of hybridizing (pied flycatchers) frequently copulate with multiple males and are able to inhibit heterospecific sperm performance. The negative effect on heterospecific sperm performance was strongest in pied flycatcher females that were most likely to have been previously exposed to collared flycatcher sperm. We thus demonstrate that a reproductive barrier acts after copulation but before fertilization in a socially monogamous vertebrate. While the evolutionary history of this barrier is unknown, our results imply that there is opportunity for it to be accentuated via a reinforcement-like process. © 2016 The Author(s). Evolution © 2016 The Society for the Study of Evolution.

Multiple barriers delay care among women with abnormal cancer screening despite patient navigation.

PubMed

Ramachandran, Ambili; Freund, Karen M; Bak, Sharon M; Heeren, Timothy C; Chen, Clara A; Battaglia, Tracy A

2015-01-01

While there is widespread dissemination of patient navigation programs in an effort to reduce delays in cancer care, little is known about the impact of barriers to care on timely outcomes. We conducted a secondary analysis of the Boston Patient Navigation Research Program (PNRP) to examine the effect that the presence of barriers had on time to diagnostic resolution of abnormal breast or cervical cancer screening tests. We used multivariable Cox proportional hazards regression with time to diagnostic resolution as the outcome to examine the effect of the number of barriers, controlling for demographic covariates and clustered by patients' primary navigator. There were 1481 women who received navigation; mean age was 39 years; 32% were White, 27% Black, and 31% Hispanic; 28% had private health insurance; and 38% did not speak English. Overall, half (n=745, 50%) had documentation of one or more barriers to care. Women with barriers were more likely to be older, non-White, non-English language speakers, and on public or no health insurance compared with women without barriers. In multivariable analyses, we found less timely diagnostic resolution as the number of barriers increased (one barrier, adjusted hazard ratio [aHR] 0.81 [95% CI 0.56-1.17], p=0.26; two barriers, aHR 0.55 [95% CI 0.37-0.81], p=0.0025; three or more barriers, aHR 0.31 [95% CI 0.21-0.46], p<0.0001)]. Within a patient navigation program proven to reduce delays in care, we found that navigated patients with documented barriers to care experience less timely resolution of abnormal cancer screening tests.

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.

Current trends of balloon laryngoplasty in Thailand.

PubMed

Moungthong, Greetha; Bunbanjerdsuk, Sacarin; Wright, Nida; Sathavornmanee, Thanakrit; Setabutr, Dhave

2017-06-01

To describe the current trend in balloon laryngoplasty usage and experience by practicing otolaryngologists in Thailand. Anonymous 11 question online and paper survey of otolaryngologists on their current balloon laryngoplasty practices. Current practices and experience in balloon laryngoplasty were queried with multiple choice and open-ended questions. Laser use is the most commonly utilized instrument to treat airway stenosis in Thailand. 86% of respondents do not have experience with balloon dilatation; yet, almost half (47.6%) report they perform a minimum of five airway surgeries per year. Most respondents had been in practice for less than 6 years (41%) and reported that they did not have exposure to balloon use during residency training. The largest barrier reported for the use of balloon instrumentation in the airway is inexperience (44.4%) followed by cost (38.3%), yet most feel that treatment in airway stenosis could benefit by usage of balloons (95.5%). Most otolaryngologists in Thailand do not have experience with the use of balloon dilatation and lack of exposure remains the largest barrier to its use. Otolaryngologists in Thailand feel that increased usage of balloons in the airway could improve airway stenosis treatment in the country.

Epstein Barr Virus and Blood Brain Barrier in Multiple Sclerosis

DTIC Science & Technology

2013-07-01

Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Multiple sclerosis (MS) is a chronic, autoimmune neurodegenerative disease . Epstein - Barr ...of EBV in MS disease . 15. SUBJECT TERMS Blood-brain-barrier, Epstein - Barr virus ; EBV; BBB; MS, Multiple sclerosis 16. SECURITY CLASSIFICATION OF...AD_________________ Award Number: W81XWH-12-1-0225 TITLE: Epstein Barr virus and blood brain

Barriers to help-seeking for a gambling problem: the experiences of gamblers who have sought specialist assistance and the perceptions of those who have not.

PubMed

Pulford, Justin; Bellringer, Maria; Abbott, Max; Clarke, Dave; Hodgins, David; Williams, Jeremy

2009-03-01

This paper presents barriers to help-seeking data as reported by users of a national gambling helpline (help-seekers, HS, N = 125) as well as data pertaining to perceived barriers to seeking help as reported by gamblers recruited from the general population (non-help-seekers, NHS, N = 104). All data were collected via a structured, multi-modal survey. When asked to identify actual or perceived barriers to seeking help, responses indicative of pride (78% of HS participants, 84% of NHS participants), shame (73% of HS participants, 84% of NHS participants) or denial (87% of NHS participants) were most frequently reported. These three factors were also most often identified as the real or perceived primary barrier to help-seeking (collectively accounting for 55% of HS, and 60% of NHS, responses to this question) and were the only barriers to be identified by more than 10% of either HS and NHS participants without prompting. It was of note, however, that participants in both groups identified multiple barriers to help-seeking (mean of 6.7 and 12.2, respectively) and that, when presented with a list of 21 possible barrier items, NHS participants endorsed 19 of the listed items significantly more often than their HS counterparts. The implications of these findings, with respect to promoting greater or earlier help-seeking activity amongst problem gamblers, are discussed.

WATER QUALITY IN SOURCE WATER, TREATMENT, AND DISTRIBUTION SYSTEMS

EPA Science Inventory

Most drinking water utilities practice the multiple-barrier concept as the guiding principle for providing safe water. This chapter discusses multiple barriers as they relate to the basic criteria for selecting and protecting source waters, including known and potential sources ...

Removal of bacteria, protozoa and viruses through a multiple-barrier household water disinfection system.

PubMed

Espinosa-García, A C; Díaz-Ávalos, C; Solano-Ortiz, R; Tapia-Palacios, M A; Vázquez-Salvador, N; Espinosa-García, S; Sarmiento-Silva, R E; Mazari-Hiriart, M

2014-03-01

Municipal water disinfection systems in some areas are not always able to meet water consumer needs, such as ensuring distributed water quality, because household water management can be a contributing factor in water re-contamination. This fact is related to the storage options that are common in places where water is scarce or is distributed over limited time periods. The aim of this study is to assess the removal capacity of a multiple-barrier water disinfection device for protozoa, bacteria, and viruses. Water samples were taken from households in Mexico City and spiked with a known amount of protozoa (Giardia cyst, Cryptosporidium oocyst), bacteria (Escherichia coli), and viruses (rotavirus, adenovirus, F-specific ribonucleic acid (FRNA) coliphage). Each inoculated sample was processed through a multiple-barrier device. The efficiency of the multiple-barrier device to remove E. coli was close to 100%, and more than 87% of Cryptosporidium oocysts and more than 98% of Giardia cysts were removed. Close to 100% of coliphages were removed, 99.6% of the adenovirus was removed, and the rotavirus was almost totally removed. An effect of site by zone was detected; this observation is important because the water characteristics could indicate the efficiency of the multiple-barrier disinfection device.

Transition to adult mental health services for young people with attention deficit hyperactivity disorder in Italy: Parents' and clinicians' experiences.

PubMed

Reale, Laura; Frassica, Simona; Gollner, Astrid; Bonati, Maurizio

2015-01-01

The aim of this study was to describe the experiences of parents and clinicians in relation to the transition from child and adolescent neuropsychiatric services (CANPS) to adult services for people with attention deficit hyperactivity disorder (ADHD) in Italy. Parents of people with ADHD who reached the transition boundary for CANPS were sampled from the A.I.F.A. association (Italian Association of ADHD Families). We thematically analyzed informative and qualitative questionnaires completed by parents and clinicians. Parents' (n = 24) and clinicians' (n = 27) experiences differed slightly on challenges and unmet needs, whereas clinicians agreed on the variables required for an optimal transition process. Poor transition and multiple barriers to such care were identified. Specifically, far fewer people received services, especially public health services, after reaching the age of 18, and perceived barriers included problems with user access, limited transition protocols, poor service coordination, and possible lack of ADHD-related knowledge on the part of adult practitioners. Care continuity in mental healthcare remains a need to be prioritized and better defined also for ADHD patients (and their parents). Parents' and clinicians' experiences are more likely to be positive if transition management is characterized by a gradual preparation, a period of parallel care, and commonly acknowledged, clear information on available services and how to access them. Identifying the needs and barriers of the people representing the different roles (clinicians, parents, and users) involved in the transition to adult mental health services is of particular importance in designing effective, shared transfer planning procedures.

Single-molecule chemo-mechanical unfolding reveals multiple transition state barriers in a small single-domain protein

NASA Astrophysics Data System (ADS)

Guinn, Emily J.; Jagannathan, Bharat; Marqusee, Susan

2015-04-01

A fundamental question in protein folding is whether proteins fold through one or multiple trajectories. While most experiments indicate a single pathway, simulations suggest proteins can fold through many parallel pathways. Here, we use a combination of chemical denaturant, mechanical force and site-directed mutations to demonstrate the presence of multiple unfolding pathways in a simple, two-state folding protein. We show that these multiple pathways have structurally different transition states, and that seemingly small changes in protein sequence and environment can strongly modulate the flux between the pathways. These results suggest that in vivo, the crowded cellular environment could strongly influence the mechanisms of protein folding and unfolding. Our study resolves the apparent dichotomy between experimental and theoretical studies, and highlights the advantage of using a multipronged approach to reveal the complexities of a protein's free-energy landscape.

Intrinsic incompatibilities evolving as a by-product of divergent ecological selection: Considering them in empirical studies on divergence with gene flow.

PubMed

Kulmuni, J; Westram, A M

2017-06-01

The possibility of intrinsic barriers to gene flow is often neglected in empirical research on local adaptation and speciation with gene flow, for example when interpreting patterns observed in genome scans. However, we draw attention to the fact that, even with gene flow, divergent ecological selection may generate intrinsic barriers involving both ecologically selected and other interacting loci. Mechanistically, the link between the two types of barriers may be generated by genes that have multiple functions (i.e., pleiotropy), and/or by gene interaction networks. Because most genes function in complex networks, and their evolution is not independent of other genes, changes evolving in response to ecological selection can generate intrinsic barriers as a by-product. A crucial question is to what extent such by-product barriers contribute to divergence and speciation-that is whether they stably reduce gene flow. We discuss under which conditions by-product barriers may increase isolation. However, we also highlight that, depending on the conditions (e.g., the amount of gene flow and the strength of selection acting on the intrinsic vs. the ecological barrier component), the intrinsic incompatibility may actually destabilize barriers to gene flow. In practice, intrinsic barriers generated as a by-product of divergent ecological selection may generate peaks in genome scans that cannot easily be interpreted. We argue that empirical studies on divergence with gene flow should consider the possibility of both ecological and intrinsic barriers. Future progress will likely come from work combining population genomic studies, experiments quantifying fitness and molecular studies on protein function and interactions. © 2017 The Authors. Molecular Ecology Published by John Wiley & Sons Ltd.

Using normalisation process theory to understand barriers and facilitators to implementing mindfulness-based stress reduction for people with multiple sclerosis.

PubMed

Simpson, Robert; Simpson, Sharon; Wood, Karen; Mercer, Stewart W; Mair, Frances S

2018-01-01

Objectives To study barriers and facilitators to implementation of mindfulness-based stress reduction for people with multiple sclerosis. Methods Qualitative interviews were used to explore barriers and facilitators to implementation of mindfulness-based stress reduction, including 33 people with multiple sclerosis, 6 multiple sclerosis clinicians and 2 course instructors. Normalisation process theory provided the underpinning conceptual framework. Data were analysed deductively using normalisation process theory constructs (coherence, cognitive participation, collective action and reflexive monitoring). Results Key barriers included mismatched stakeholder expectations, lack of knowledge about mindfulness-based stress reduction, high levels of comorbidity and disability and skepticism about embedding mindfulness-based stress reduction in routine multiple sclerosis care. Facilitators to implementation included introducing a pre-course orientation session; adaptations to mindfulness-based stress reduction to accommodate comorbidity and disability and participants suggested smaller, shorter classes, shortened practices, exclusion of mindful-walking and more time with peers. Post-mindfulness-based stress reduction booster sessions may be required, and objective and subjective reports of benefit would increase clinician confidence in mindfulness-based stress reduction. Discussion Multiple sclerosis patients and clinicians know little about mindfulness-based stress reduction. Mismatched expectations are a barrier to participation, as is rigid application of mindfulness-based stress reduction in the context of disability. Course adaptations in response to patient needs would facilitate uptake and utilisation. Rendering access to mindfulness-based stress reduction rapid and flexible could facilitate implementation. Embedded outcome assessment is desirable.

A comparison of unemployed job-seekers with and without social anxiety

PubMed Central

Himle, Joseph A; Weaver, Addie; Bybee, Deborah; O'Donnell, Lisa; Vlnka, Sarah; Laviolette, Wayne; Steinberger, Edward; Zipora, Golenberg; Levine, Debra Siegel

2014-01-01

Objective Literature consistently demonstrates that social anxiety disorder has substantial negative impacts on occupational functioning. However, to date, no identified empirical work has focused on understanding the specific nature of vocational problems among persons with social anxiety disorder. This study examines the association between employment-related factors (i.e., barriers to employment; skills related to employment; and job aspirations) and social anxiety among a sample of adults seeking vocational rehabilitation services. Methods Data from intake assessments, including a screen for social anxiety disorder, of 265 low-income, unemployed adults who initiated vocational rehabilitation services in urban Michigan was examined to assess differences in barriers to employment, employment skills, job aspirations, and demographic characteristics among participants who screened positive for social anxiety disorder compared to those who did not. Bivariate and multiple logistic regression analyses were performed. Results Multiple logistic regression analysis revealed that greater perceived experience and skill barriers to employment, fewer skills related to social-type occupations, and less education were significantly associated with social anxiety, after adjusting for other factors. Bivariate analysis also suggested that participants who screened positive for social anxiety disorder were significantly less likely to aspire to social jobs. Conclusions Employment-related factors likely impacting occupational functioning were significantly different between persons with and without social anxiety problems. Identifying these differences in employment barriers, skills, and job aspirations offer potentially important functional targets for psychosocial interventions aimed at social anxiety disorder and suggest the need for vocational service professionals to assess and address social anxiety among their clients. PMID:24733524

Characteristics and Treatment Preferences of People with Symptoms of Posttraumatic Stress Disorder: An Internet Survey

PubMed Central

Spence, Jay; Titov, Nickolai; Solley, Karen; Dear, Blake F.; Johnston, Luke; Wootton, Bethany; Kemp, Alice; Andrews, Gavin; Zou, Judy; Lorian, Carolyn; Choi, Isabella

2011-01-01

Background Although Posttraumatic Stress Disorder (PTSD) is a severe and disabling anxiety disorder, relatively few people with this condition access evidence-based care. Barriers to treatment are multiple and complex, but the emerging field of Internet therapy for PTSD may improve access to evidence-based treatment. However, little is known about the characteristics of people with PTSD who seek online treatment, or whether they perceive internet treatment as an acceptable treatment option. Methodology An online survey was used to collect information about the demographic and symptom characteristics of individuals with elevated levels of PTSD symptoms, and this was compared to data from corresponding sample from a national survey. Previous treatment experiences, perceived barriers to treatment and treatment preferences for Internet therapy and face-to-face treatment were also compared. Principal Findings High levels of PTSD symptoms were reported by survey respondents. Psychological distress and disability was greater than reported by individuals with PTSD from a national survey. Half of the sample reported not having received treatment for PTSD; however, 88% of those who reported receiving treatment stated they received an evidence-based treatment. Primary barriers to treatment included cost, poor awareness of service availability, lack of prior treatment response and not perceiving personal distress as severe enough to warrant treatment. Most survey respondents indicated they were willing to try Internet treatment for PTSD. Conclusions The Internet sample was symptomatically severe and multiple barriers existed to treatment. Internet therapy is an acceptable option for the treatment of PTSD in an internet sample. PMID:21818274

Farmer Participation in U.S. Farm Bill Conservation Programs

NASA Astrophysics Data System (ADS)

Reimer, Adam P.; Prokopy, Linda S.

2014-02-01

Conservation policy in agricultural systems in the United States relies primarily on voluntary action by farmers. Federal conservation programs, including the Environmental Quality Incentives Program, offer incentives, both financial and technical, to farmers in exchange for adoption of conservation practices. Understanding motivations for (as well as barriers to) participation in voluntary programs is important for the design of future policy and effective outreach. While a significant literature has explored motivations and barriers to conservation practice adoption and participation in single programs, few studies in the U.S. context have explored general participation by farmers in one place and time. A mixed-methods research approach was utilized to explore farmer participation in all U.S. Farm Bill programs in Indiana. Current and past program engagement was high, with nearly half of survey respondents reporting participation in at least one program. Most participants had experience with the Conservation Reserve Program, with much lower participation rates in other programs. Most interview participants who had experience in programs were motivated by the environmental benefits of practices, with incentives primarily serving to reduce the financial and technical barriers to practice adoption. The current policy arrangement, which offers multiple policy approaches to conservation, offers farmers with different needs and motivations a menu of options. However, evidence suggests that the complexity of the system may be a barrier that prevents participation by farmers with scarce time or resources. Outreach efforts should focus on increasing awareness of program options, while future policy must balance flexibility of programs with complexity.

Is anybody listening? A phenomenological study of pain in hospitalized persons with AIDS.

PubMed

Newshan, G

1998-01-01

Pain is a common problem among hospitalized persons with AIDS (PWAs), yet it has not been well studied. The purpose of this study was to understand, using the phenomenological method, the experience of pain in hospitalized PWAs. Multiple sources of data, including interviews with 11 hospitalized PWAs, literature, poetry, and film, were used to investigate the phenomenon. Five broad themes emerged: knowing pain, battling pain, having AIDS, pain's influence, and being a drug user. Multiple barriers to effective pain management were identified. Although there were commonalities in the experience of pain in chemically dependent and nonchemically dependent PWAs, unique challenges for the chemically dependent PWAs were identified. The findings indicate the importance of listening to and believing reports of pain. In addition, the findings underscore the delicate balance that exists between pain relief and relapse in PWAs with a history of chemical dependency.

Physical Activity Promotion, Beliefs, and Barriers Among Australasian Oncology Nurses.

PubMed

Keogh, Justin W L; Pühringer, Petra; Olsen, Alicia; Sargeant, Sally; Jones, Lynnette M; Climstein, Mike

2017-03-01

To describe the physical activity (PA) promotion practices, beliefs, and barriers of Australasian oncology nurses and gain preliminary insight into how PA promotion practices may be affected by the demographics of the nurses.
. Cross-sectional survey.
. Australia and New Zealand.
. 119 registered oncology nurses.
. Self-reported online survey completed once per participant.
. Questions assessed the PA promotion beliefs (e.g., primary healthcare professionals responsible for PA promotion, treatment stage), PA benefits (e.g., primary benefits, evidence base), and PA promotion barriers of oncology nurses.
. Oncology nurses believed they were the major providers of PA advice to their patients. They promoted PA prior to, during, and post-treatment. The three most commonly cited benefits of PA for their patients were improved quality of life, mental health, and activities of daily living. Lack of time, lack of adequate support structures, and risk to patient were the most common barriers to PA promotion. Relatively few significant differences in the oncology nurses' PA promotion practices, beliefs, and barriers were observed based on hospital location or years of experience.
. Despite numerous barriers, Australasian oncology nurses wish to promote PA to their patients with cancer across multiple treatment stages because they believe PA is beneficial for their patients.
. Hospitals may need to better support oncology nurses in promoting PA to their patients and provide better referral pathways to exercise physiologists and physiotherapists.

Women, infants, and children cash value voucher (CVV) use in Arizona: a qualitative exploration of barriers and strategies related to fruit and vegetable purchases.

PubMed

Bertmann, Farryl M W; Barroso, Cristina; Ohri-Vachaspati, Punam; Hampl, Jeffrey S; Sell, Karen; Wharton, Christopher M

2014-01-01

Women, Infants, and Children (WIC) cash value vouchers (CVV) have been inconsistently redeemed in Arizona. The objective of this study was to explore perceived barriers to use of CVV as well as strategies participants use to overcome them. Eight focus groups were conducted to explore attitudes and behaviors related to CVV use. Focus groups were conducted at 2 WIC clinics in metro-Phoenix, AZ. Participants in WIC who were at least 18 years of age and primarily responsible for buying and preparing food for their households. Perceived barriers to CVV use and strategies used to maximize their purchasing value. Transcripts were analyzed using a general inductive approach to identify emergent themes. Among 41 participants, multiple perceived barriers emerged, such as negative interactions in stores or confusion over WIC rules. Among experienced shoppers, WIC strategies also emerged to deal with barriers and maximize CVV value, including strategic choice of times and locations at which to shop and use of price-matching, rewards points, and other ways to increase purchasing power. Arizona WIC participants perceived barriers that limit easy redemption of CVV. Useful strategies were also identified that could be important to explore further to improve WIC CVV purchasing experiences. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Self-fulfillment despite barriers: volunteer work of people living with HIV.

PubMed

Samson, André; Lavigne, René M; MacPherson, Paul

2009-11-01

With the decline in the morbidity and mortality associated with HIV infection, the majority of people living with HIV (PWHIV) experience a higher quality of life and longer life expectancy. Since this diagnosis no longer prevents an active lifestyle, many PWHIV are re-integrating into the workplace or are contemplating this possibility. Despite the multiple advantages associated with a return to work, research has identified barriers related to work and HIV infection. These barriers could prevent an important minority of PWHIV who wish to return to work from re-integrating into this environment. In this context, volunteering could be an alternate way to regain an active lifestyle. This research found that volunteer work allowed participants to enrich their social lives, to regain a sense of psychological well-being, and to apply their abilities to the benefit of others. However, participants are restricted by their preference to volunteer for HIV-related organizations in order to avoid social stigma and rejection.

Student-perceived barriers and facilitators to e-learning in continuing professional development in primary care.

PubMed

Docherty, Andrea; Sandhu, Harbinder

2006-01-01

WHAT IS ALREADY KNOWN IN THIS AREA • E-learning is being increasingly used within learning and teaching including its application within healthcare education and service provision. Multiple advantages have been identified including enhanced accessibility and increased flexibility of learning. Guidance on the generic-design and development of e-learning courses has been generated. WHAT THIS WORK ADDS • This paper provides a detailed understanding of the barriers and facilitators to e-learning as perceived by students on a continuing professional development (CPD); course arid highlights its multifaceted values. In addition, the paper ṕrovides evidence-based guidance for the development of courses within CPD utilising e-learning. SUGGESTIONS FOR FUTURE RESEARCH • Future research would benefit from, focusing upon the perceptions of staff including barriers and facilitators to the implementation of e-learning and awareness of student experience to generate a balanced and informed understanding of e-learning within the context-of CPD.

[The effect of self-foot reflexology on the relief of premenstrual syndrome and dysmenorrhea in high school girls].

PubMed

Kim, Yi-Soon; Kim, Min-Za; Jeong, Ihn-Sook

2004-08-01

This study was aimed to identify the effect of self-foot reflexology on the relief of premenstrual syndrome and dysmenorrhea in high school girls. Study subjects was 236 women residing in the community, teachers and nurses who were older than 45 were recruited. Data was collected with self administered questionnaires from July 1st to August 31st, 2003 and analysed using SPSS/WIN 10.0 with Xtest, t-test, and stepwise multiple logistic regression at a significant level of =.05. The breast cancer screening rate was 57.2%, and repeat screening rate was 15.3%. With the multiple logistic regression analysis, factors associated with mammography screening were age and perceived barriers of action, and factors related to the repeat mammography screening were education level and other cancer screening experience. Based on the results, we recommend the development of an intervention program to decrease the perceived barrier of action, to regard mammography as an essential test in regular check-up, and to give active advertisement and education to the public to improve the rates of breast cancer screening and repeat screening.

Understanding barriers to implementing the Norwegian national guidelines for healthy school meals: a case study involving three secondary schools.

PubMed

Holthe, Asle; Larsen, Torill; Samdal, Oddrun

2011-07-01

The main goal of the present study was to investigate the barriers to implementing the Norwegian national guidelines for healthy school meals as perceived by principals, project leaders, teachers and students. This study employed a multiple-case design using an explorative approach. Data were collected at three secondary schools in Norway participating in the intervention project Physical activity and healthy school meals. Individual interviews were conducted with school principals and project leaders, and focus group interviews were conducted separately with teachers and students. Four categories of barriers were identified: (1) lack of adaptation of the guidelines to the target group; (2) lack of resources and funding; (3) conflicting values and goals; and (4) access to unhealthy food outside school. The research identified differences in perceived barriers between the staff responsible for implementation and the students as the target group of the measures. All staff groups perceived barriers relating to both resources, and conflicting values and goals. The teachers were more concerned about issues of relevance for adaptation to the target groups than were the principals and project leaders. The students were concerned mostly with issues directly affecting their experience with items offered in the canteen. © 2010 Blackwell Publishing Ltd.

Integrating pharmacists into primary care teams: barriers and facilitators.

PubMed

Jorgenson, Derek; Laubscher, Tessa; Lyons, Barry; Palmer, Rebecca

2014-08-01

This study evaluated the barriers and facilitators that were experienced as pharmacists were integrated into 23 existing primary care teams located in urban and rural communities in Saskatchewan, Canada. Qualitative design using data from one-on-one telephone interviews with pharmacists, physicians and nurse practitioners from the 23 teams that integrated a new pharmacist role. Four researchers from varied backgrounds used thematic analysis of the interview transcripts to determine key themes. The research team met on multiple occasions to agree on the key themes and received written feedback from an external auditor and two of the original interviewees. Seven key themes emerged describing the barriers and facilitators that the teams experienced during the pharmacist integration: (1) relationships, trust and respect; (2) pharmacist role definition; (3) orientation and support; (4) pharmacist personality and professional experience; (5) pharmacist presence and visibility; (6) resources and funding; and (7) value of the pharmacist role. Teams from urban and rural communities experienced some of these challenges in unique ways. Primary care teams that integrated a pharmacist experienced several common barriers and facilitators. The negative impact of these barriers can be mitigated with effective planning and support that is individualized for the type of community where the team is located. © 2013 Royal Pharmaceutical Society.

Characterising the research profile of the critical care physiotherapy workforce and engagement with critical care research: a UK national survey

PubMed Central

Allum, Laura; Shaw, Michelle; Pattison, Natalie; Dark, Paul

2018-01-01

Objective To characterise the research profile of UK critical care physiotherapists including experience, training needs, and barriers and enablers to engagement in critical care research. ‘Research’ was defined broadly to encompass activities related to quantitative and qualitative studies, service evaluations, clinical audit and quality improvements. Design Closed-question online survey, with optional free-text responses. Setting UK critical care community. Participants UK critical care physiotherapists, regardless of clinical grade or existing research experience. Results 268 eligible survey responses were received during the 12-week study period (21 incomplete, 7.8%). Respondents were based in university-affiliated (n=133, 49.6%) and district general (n=111, 41.4%) hospitals, and generally of senior clinical grade. Nearly two-thirds had postgraduate qualifications at master’s level or above (n=163, 60.8%). Seven had a doctoral-level qualification. Respondents reported a range of research experience, predominantly data acquisition (n=144, 53.7%) and protocol development (n=119, 44.4%). Perceived research training needs were prevalent, including topics of research methods, critical literature appraisal, protocol development and statistical analysis (each reported by ≥50% respondents). Multiple formats for delivery of future research training were identified. Major barriers to research engagement included lack of protected time (n=220, 82.1%), funding (n=177, 66.0%) and perceived experience (n=151, 56.3%). Barriers were conceptually categorised into capability, opportunity and motivation themes. Key enabling strategies centred on greater information provision about clinical research opportunities, access to research training, secondment roles and professional networks. Conclusions UK critical care physiotherapists are skilled, experienced and motivated to participate in research, including pursuing defined academic research pathways. Nonetheless wide-ranging training needs and notable barriers preclude further involvement. Strategies to harness the unique skills of this profession to enhance the quality, quantity and scope of critical care research, benefiting from a multiprofessional National Clinical Research Network, are required. PMID:29866725

Barriers to glaucoma case finding as perceived by optometrists in Ireland.

PubMed

Barrett, Catriona; O'Brien, Colm; Butler, John S; Loughman, James

2018-01-01

This research was designed to provide an in-depth exploration of the perceptions of optometrists relating to the challenges of glaucoma case finding in the Irish health-care system. A survey was developed, piloted and distributed for anonymous completion by optometrists registered to practise in Ireland. The survey included 10 five-level Likert items exploring potential barriers to glaucoma detection and a free-text box for participants to comment more broadly. One hundred and ninety-nine optometrists (27 per cent of registrants) responded to the survey. Among the barriers identified, there was notable agreement (71 per cent) with the need for extra training on glaucoma detection. Logistic regression showed that optometrists without postgraduate qualifications were more likely to agree with the need for extra training (OR 3.2, 95 per cent CI 1.3-8.1). Respondents largely agreed (61 per cent) that patient unwillingness to pay additional fees for supplementary glaucoma-specific tests was also a barrier. Appointment times of less than 30 minutes were significantly associated with six of the 10 proposed barriers to glaucoma detection. A logistic regression analysis (n = 179) confirmed that the time allotted per appointment was a significant predictor of the agreement time of optometrists as a barrier (χ 2 [1] = 13.52, p < 0.001). Multiple linear regression showed that optometrists with less experience, charging lower fees, and working in large multiples or franchised practices have the shortest appointment times. The strong link found between postgraduate education and the confidence of optometrists in detecting glaucoma indicates that optometrists wishing to increase their scope of practice in the new legislative environment in Ireland may more actively seek training in areas of interest. The responses also indicate a lack of funding for the level of diagnostic testing required for accurate glaucoma diagnosis. Recent increases in the state's eye examination fees look likely to address the identified time and financial barriers to glaucoma detection in Ireland. Future work should look to analyse the effects of increased funding on optometric case finding for glaucoma. © 2017 Optometry Australia.

Agent based modeling of the effects of potential treatments over the blood-brain barrier in multiple sclerosis.

PubMed

Pennisi, Marzio; Russo, Giulia; Motta, Santo; Pappalardo, Francesco

2015-12-01

Multiple sclerosis is a disease of the central nervous system that involves the destruction of the insulating sheath of axons, causing severe disabilities. Since the etiology of the disease is not yet fully understood, the use of novel techniques that may help to understand the disease, to suggest potential therapies and to test the effects of candidate treatments is highly advisable. To this end we developed an agent based model that demonstrated its ability to reproduce the typical oscillatory behavior observed in the most common form of multiple sclerosis, relapsing-remitting multiple sclerosis. The model has then been used to test the potential beneficial effects of vitamin D over the disease. Many scientific studies underlined the importance of the blood-brain barrier and of the mechanisms that influence its permeability on the development of the disease. In the present paper we further extend our previously developed model with a mechanism that mimics the blood-brain barrier behavior. The goal of our work is to suggest the best strategies to follow for developing new potential treatments that intervene in the blood-brain barrier. Results suggest that the best treatments should potentially prevent the opening of the blood-brain barrier, as treatments that help in recovering the blood-brain barrier functionality could be less effective. Copyright © 2015 Elsevier B.V. All rights reserved.

Age-Associated Perceptions of Physical Activity Facilitators and Barriers Among Women in Rural Southernmost Illinois

PubMed Central

Carnahan, Leslie R.; Peacock, Nadine R.

2016-01-01

Introduction Women living in rural areas in the United States experience disproportionately high rates of diseases such as obesity and heart disease and are less likely than women living in urban areas to meet daily physical activity (PA) recommendations. The purpose of our research was to understand age-specific perceptions of barriers and facilitators to rural women engaging in PA and to identify strategies to promote PA among these women. Methods As part of a community health assessment to learn about women’s health issues, 110 adult women participated in 14 focus groups. The women were divided into 4 age groups, and focus groups were held in various community settings. We used qualitative analysis methods to explore themes in the women’s narratives, including themes related to PA knowledge, PA behavior, and access to PA facilities. Results Participants described multiple and often conflicting individual, social, and environmental barriers and facilitators to PA. Several barriers and facilitators were shared across age groups (eg, competing priorities and inadequate knowledge about PA’s role in disease prevention and disease management). Other barriers (eg, illness and injury) and facilitators (eg, PA as a social opportunity) differed by age group. Conclusion Rural women in southernmost Illinois have often contradictory barriers and facilitators to PA, and those barriers and facilitators are different at different points in a woman’s life. Our findings suggest the need for multilevel, multisector approaches to promote PA. Additionally, this research supports the need for tailored PA promotion programs for rural women to address the barriers these women face across their lifespan. PMID:27685431

Conditions affecting boundary response to messages out of awareness.

PubMed

Fisher, S

1976-05-01

Multiple studies evaluated the role of the following parameters in mediating the effects of auditory subliminal inputs upon the body boundary: being made aware that exposure to subliminal stimuli is occurring, nature of the priming preliminary to the input, length of exposure, competing sensory input, use of specialized content messages, tolerance for unrealistic experience, and masculinity-feminity. A test-retest design was typically employed that involved measuring the baseline Barrier score with the Holtzman bolts and then ascertaining the Barrier change when responding to a second series of Holtzman blots at the same time that subliminal input was occurring. Complex results emerged that defined in considerably new detail what facilitates and blocks the boundary-disrupting effects of subliminal messages in men and to a lesser degree in women.

Barriers to Care-Seeking for Children’s Oral Health Among Low-Income Caregivers

PubMed Central

Kelly, Susan E.; Binkley, Catherine J.; Neace, William P.; Gale, Bruce S.

2005-01-01

Objectives. We identified psychosocial, structural, and cultural barriers to seeking dental care among nonutilizing caregivers of Medicaid-enrolled children. Methods. We used Medicaid utilization records to identify utilizing and nonutilizing African American and White caregivers of Medicaid-enrolled children in Jefferson County, Kentucky. We conducted 8 focus groups (N=76) with a stratified random sample of responding caregivers; transcripts were qualitatively analyzed. Results. Psychosocial factors associated with utilization included oral health beliefs, norms of caregiver responsibility, and positive caregiver dental experiences. Utilizing groups reported higher education; health beliefs included identifying oral health with overall health and professional preventive dental care with caregiver responsibility for children’s overall health. These beliefs may mediate shared structural barriers, including transportation, school absence policies, discriminatory treatment, and difficulty locating providers who accept Medicaid. Expectation of poor oral health among some low-income caregivers was among factors identified with nonutilization. Conclusions. Disadvantaged caregivers reported multiple barriers to accessing dental care for their children. Providers, Medicaid administrators, and schools must coordinate steps to encourage caregiver-controlled dental care, build trust, and link professional preventive dental care with caregiver responsibility for children’s overall health. PMID:16043666

Permeability of the blood-brain barrier predicts conversion from optic neuritis to multiple sclerosis.

PubMed

Cramer, Stig P; Modvig, Signe; Simonsen, Helle J; Frederiksen, Jette L; Larsson, Henrik B W

2015-09-01

Optic neuritis is an acute inflammatory condition that is highly associated with multiple sclerosis. Currently, the best predictor of future development of multiple sclerosis is the number of T2 lesions visualized by magnetic resonance imaging. Previous research has found abnormalities in the permeability of the blood-brain barrier in normal-appearing white matter of patients with multiple sclerosis and here, for the first time, we present a study on the capability of blood-brain barrier permeability in predicting conversion from optic neuritis to multiple sclerosis and a direct comparison with cerebrospinal fluid markers of inflammation, cellular trafficking and blood-brain barrier breakdown. To this end, we applied dynamic contrast-enhanced magnetic resonance imaging at 3 T to measure blood-brain barrier permeability in 39 patients with monosymptomatic optic neuritis, all referred for imaging as part of the diagnostic work-up at time of diagnosis. Eighteen healthy controls were included for comparison. Patients had magnetic resonance imaging and lumbar puncture performed within 4 weeks of onset of optic neuritis. Information on multiple sclerosis conversion was acquired from hospital records 2 years after optic neuritis onset. Logistic regression analysis showed that baseline permeability in normal-appearing white matter significantly improved prediction of multiple sclerosis conversion (according to the 2010 revised McDonald diagnostic criteria) within 2 years compared to T2 lesion count alone. There was no correlation between permeability and T2 lesion count. An increase in permeability in normal-appearing white matter of 0.1 ml/100 g/min increased the risk of multiple sclerosis 8.5 times whereas having more than nine T2 lesions increased the risk 52.6 times. Receiver operating characteristic curve analysis of permeability in normal-appearing white matter gave a cut-off of 0.13 ml/100 g/min, which predicted conversion to multiple sclerosis with a sensitivity of 88% and specificity of 72%. We found a significant correlation between permeability and the leucocyte count in cerebrospinal fluid as well as levels of CXCL10 and MMP9 in the cerebrospinal fluid. These findings suggest that blood-brain barrier permeability, as measured by magnetic resonance imaging, may provide novel pathological information as a marker of neuroinflammation related to multiple sclerosis, to some extent reflecting cellular permeability of the blood-brain barrier, whereas T2 lesion count may more reflect the length of the subclinical pre-relapse phase.See Naismith and Cross (doi:10.1093/brain/awv196) for a scientific commentary on this article. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain.

The Doctor of Philosophy Experience of Athletic Trainers: Facilitators and Barriers to Anticipatory Faculty Socialization.

PubMed

Bowman, Thomas G; Klossner, Joanne C; Mazerolle, Stephanie M

2017-10-01

  It is important to understand the process whereby athletic trainers learn about their future roles, particularly when the roles can be complex and demanding. Little is known about the experiences of athletic training doctoral students, including facilitators and barriers to socialization as aspiring faculty members.   To investigate factors influencing the anticipatory socialization of athletic training doctoral students into future faculty roles.   Qualitative study.   Universities with athletic training doctoral students.   We recruited 28 students (19 women, 9 men, age = 28 ± 3 years) with a minimum of 1 year of doctoral coursework completed and participating in an assistantship at the time of the study to reach data saturation. Participants were certified for 6 ± 3 years and represented 5 National Athletic Trainers' Association districts and 9 institutions.   We completed semistructured, 1-on-1 telephone interviews with participants. We transcribed each interview verbatim and analyzed the data using an inductive approach. Peer review, multiple-analyst triangulation, and member checks ensured trustworthiness.   We uncovered 4 themes from our analysis related to facilitators and barriers to professional socialization. Participants described comprehensive autonomous experiences in research that allowed them to feel confident they could sustain a scholarly agenda. Independent experiences and lack of pedagogy training yielded mixed preparedness relative to teaching responsibilities. Limited formal experience led to incomplete role understanding related to the service component of the professoriate. Finally, with regard to the administrative duties associated with athletic training faculty positions, participants noted a lack of direct exposure to common responsibilities.   Role occupation in various aspects of the professoriate helped doctoral students prepare as future faculty members, although full role understanding was limited. Intentional exposure to research, teaching, service, and administrative expectations during doctoral experiences may facilitate the socialization of future athletic training faculty into academic roles.

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

Organizational Infrastructure in the Collegiate Athletic Training Setting, Part III: Benefits of and Barriers in the Medical and Academic Models

PubMed Central

Eason, Christianne M.; Mazerolle, Stephanie M.; Goodman, Ashley

2017-01-01

Context: Academic and medical models are emerging as alternatives to the athletics model, which is the more predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of these models. Objective: To investigate the perceived benefits of and barriers in the medical and academic models. Design: Qualitative study. Setting: National Collegiate Athletic Association Divisions I, II, and III. Patients or Other Participants: A total of 16 full-time ATs (10 men, 6 women; age = 32 ± 6 years, experience = 10 ± 6 years) working in the medical (n = 8) or academic (n = 8) models. Data Collection and Analysis: We conducted semistructured telephone interviews and evaluated the qualitative data using a general inductive approach. Multiple-analyst triangulation and peer review were completed to satisfy data credibility. Results: In the medical model, role congruency and work-life balance emerged as benefits, whereas role conflict, specifically intersender conflict with coaches, was a barrier. In the academic model, role congruency emerged as a benefit, and barriers were role strain and work-life conflict. Subscales of role strain included role conflict and role ambiguity for new employees. Role conflict stemmed from intersender conflict with coaches and athletics administrative personnel and interrole conflict with fulfilling multiple overlapping roles (academic, clinical, administrative). Conclusions: The infrastructure in which ATs provide medical care needs to be evaluated. We found that the medical model can support better alignment for both patient care and the wellbeing of ATs. Whereas the academic model has perceived benefits, role incongruence exists, mostly because of the role complexity associated with balancing teaching, patient-care, and administrative duties. PMID:27977302

Organizational Infrastructure in the Collegiate Athletic Training Setting, Part III: Benefits of and Barriers in the Medical and Academic Models.

PubMed

Eason, Christianne M; Mazerolle, Stephanie M; Goodman, Ashley

2017-01-01

 Academic and medical models are emerging as alternatives to the athletics model, which is the more predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of these models.  To investigate the perceived benefits of and barriers in the medical and academic models.  Qualitative study.  National Collegiate Athletic Association Divisions I, II, and III.  A total of 16 full-time ATs (10 men, 6 women; age = 32 ± 6 years, experience = 10 ± 6 years) working in the medical (n = 8) or academic (n = 8) models.  We conducted semistructured telephone interviews and evaluated the qualitative data using a general inductive approach. Multiple-analyst triangulation and peer review were completed to satisfy data credibility.  In the medical model, role congruency and work-life balance emerged as benefits, whereas role conflict, specifically intersender conflict with coaches, was a barrier. In the academic model, role congruency emerged as a benefit, and barriers were role strain and work-life conflict. Subscales of role strain included role conflict and role ambiguity for new employees. Role conflict stemmed from intersender conflict with coaches and athletics administrative personnel and interrole conflict with fulfilling multiple overlapping roles (academic, clinical, administrative).  The infrastructure in which ATs provide medical care needs to be evaluated. We found that the medical model can support better alignment for both patient care and the wellbeing of ATs. Whereas the academic model has perceived benefits, role incongruence exists, mostly because of the role complexity associated with balancing teaching, patient-care, and administrative duties.

Implementation of integrated dual disorders treatment: a qualitative analysis of facilitators and barriers.

PubMed

Brunette, Mary F; Asher, Dianne; Whitley, Rob; Lutz, Wilma J; Wieder, Barbara L; Jones, Amanda M; McHugo, Gregory J

2008-09-01

Approximately half of the people who have serious mental illnesses experience a co-occurring substance use disorder at some point in their lifetime. Integrated dual disorders treatment, a program to treat persons with co-occurring disorders, improves outcomes but is not widely available in public mental health settings. This report describes the extent to which this intervention was implemented by 11 community mental health centers participating in a large study of practice implementation. Facilitators and barriers to implementation are described. Trained implementation monitors conducted regular site visits over two years. During visits, monitors interviewed key informants, conducted ethnographic observations of implementation efforts, and assessed fidelity to the practice model. These data were coded and used as a basis for detailed site reports summarizing implementation processes. The authors reviewed the reports and distilled the three top facilitators and barriers for each site. The most prominent cross-site facilitators and barriers were identified. Two sites reached high fidelity, six sites reached moderate fidelity, and three sites remained at low fidelity over the two years. Prominent facilitators and barriers to implementation with moderate to high fidelity were administrative leadership, consultation and training, supervisor mastery and supervision, chronic staff turnover, and finances. Common facilitators and barriers to implementation of integrated dual disorders treatment emerged across sites. The results confirmed the importance of the use of the consultant-trainer in the model of implementation, as well as the need for intensive activities at multiple levels to facilitate implementation. Further research on service implementation is needed, including but not limited to clarifying strategies to overcome barriers.

Improved Delivery of Cardiovascular Care (IDOCC): Findings from Narrative Reports by Practice Facilitators.

PubMed

Liddy, Clare; Rowan, Margo; Valiquette-Tessier, Sophie-Claire; Drosinis, Paul; Crowe, Lois; Hogg, William

2017-03-01

Practice facilitation can help family physicians adopt evidence-based guidelines. However, many practices struggle to effectively implement practice changes that result in meaningful improvement. Building on our previous research, we examined the barriers to and enablers of implementation perceived by practice facilitators (PF) in helping practices to adopt the Improved Delivery of Cardiovascular Care (IDOCC) program, which took place at 84 primary care practices in Ottawa, Canada between April 2008 and March 2012. We conducted a qualitative analysis of PFs' narrative reports using a multiple case study design. We used a combined purposeful sampling approach to identify cases that 1) reflected experiences typical of the broader sample and 2) presented sufficient breadth of experience from each project step and family practice model. Sampling continued until data saturation was reached. Team members conducted a qualitative analysis of reports using an open and axial coding style and a constant comparative approach. Barriers and enablers were divided into five constructs: structural, organizational, provider, patient, and innovation. Narratives from 13 practice sites were reviewed. A total of 8 barriers and 11 enablers were consistently identified across practices. Barriers were most commonly reported at the organizational (n = 3) and structural level, (n = 2) while enablers were most common at the innovation level (n = 6). While physicians responded positively to PFs' presence and largely supported their recommendations for practice change, organizational and structural aspects such as lack of time, minimal staff engagement, and provider reimbursement remained too great for practices to successfully implement practice-level changes. Trial Registration: ClinicalTrials.gov, NCT00574808.

Despite Increased Insurance Coverage, Nonwhite Sexual Minorities Still Experience Disparities In Access To Care.

PubMed

Hsieh, Ning; Ruther, Matt

2017-10-01

Previous studies suggest that members of sexual minority groups have poorer access to health services than heterosexuals. However, few studies have examined how sexual orientation interacts with gender and race to affect health care experience. Moreover, little is known about the role in health care disparities played by economic strains such as unemployment and poverty, which may result from prejudice and discrimination based on sexual orientation. Using data for 2013-15 from the National Health Interview Survey, we found that most members of sexual minority groups no longer have higher uninsurance rates than heterosexuals, but many continue to experience poorer access to high-quality care. Gay nonwhite men, bisexual white women, and bisexual and lesbian nonwhite women are disadvantaged in multiple aspects of access, compared to straight white men. Only some of these disparities are attributable to economic factors, which implies that noneconomic barriers to care are substantial. Our results suggest that the intersection of multiple social identities can reveal important gaps in health care experience. Making culturally sensitive services available may be key to closing the gaps. Project HOPE—The People-to-People Health Foundation, Inc.

Links between patterns of racial socialization and discrimination experiences and psychological adjustment: a cluster analysis.

PubMed

Ajayi, Alex A; Syed, Moin

2014-10-01

This study used a person-oriented analytic approach to identify meaningful patterns of barriers-focused racial socialization and perceived racial discrimination experiences in a sample of 295 late adolescents. Using cluster analysis, three distinct groups were identified: Low Barrier Socialization-Low Discrimination, High Barrier Socialization-Low Discrimination, and High Barrier Socialization-High Discrimination clusters. These groups were substantively unique in terms of the frequency of racial socialization messages about bias preparation and out-group mistrust its members received and their actual perceived discrimination experiences. Further, individuals in the High Barrier Socialization-High Discrimination cluster reported significantly higher depressive symptoms than those in the Low Barrier Socialization-Low Discrimination and High Barrier Socialization-Low Discrimination clusters. However, no differences in adjustment were observed between the Low Barrier Socialization-Low Discrimination and High Barrier Socialization-Low Discrimination clusters. Overall, the findings highlight important individual differences in how young people of color experience their race and how these differences have significant implications on psychological adjustment. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Removing barriers to educating children in foster care through interagency collaboration: a seven county multiple-case study.

PubMed

Weinberg, Lois A; Zetlin, Andrea; Shea, Nancy M

2009-01-01

This multiple-case study examines interagency collaboration between child protective services (CPS), local education agencies (LEAs), and other public agencies in seven California counties. These agencies were provided technical assistance to remove barriers impeding the education of children in foster care and improve their educational outcomes. Results of this study suggest that making changes to remove educational barriers for foster children and improve their educational outcomes requires successful collaboration between CPS and LEAs and strong leadership within at least one of the agencies.

Towards Inter- and Intra- Cellular Protein Interaction Analysis: Applying the Betweenness Centrality Graph Measure for Node Importance

NASA Astrophysics Data System (ADS)

Barton, Alan J.; Haqqani, Arsalan S.

2011-11-01

Three public biological network data sets (KEGG, GeneRIF and Reactome) are collected and described. Two problems are investigated (inter- and intra- cellular interactions) via augmentation of the collected networks to the problem specific data. Results include an estimate of the importance of proteins for the interaction of inflammatory cells with the blood-brain barrier via the computation of Betweenness Centrality. Subsequently, the interactions may be validated from a number of differing perspectives; including comparison with (i) existing biological results, (ii) the literature, and (iii) new hypothesis driven biological experiments. Novel therapeutic and diagnostic targets for inhibiting inflammation at the blood-brain barrier in a number of brain diseases including Alzheimer's disease, stroke and multiple sclerosis are possible. In addition, this methodology may also be applicable towards investigating the breast cancer tumour microenvironment.

Workplace Participatory Occupational Health/Health Promotion Program

PubMed Central

Zhang, Yuan; Flum, Marian; Kotejoshyer, Rajashree; Fleishman, Jane; Henning, Robert; Punnett, Laura

2018-01-01

Nursing home employees experience high physical and psychosocial workloads, resulting in poor health outcomes. An occupational health/health promotion program, designed to facilitate employee participation, was initiated in three nursing homes. The aim of the current study was to evaluate facilitators and barriers of the program after 3-year implementation. Focus groups with employees and in-depth interviews with top and middle managers were conducted. The Social Ecological Model was used to organize the evaluation. Facilitators and barriers were reported from both managers’ and employees’ perspectives, and were categorized as intrapersonal, interpersonal, institutional, and corporate level. Management support, financial resources, and release time for participation were identified as the three most important factors. Supports from multiple levels including both human and environment, and managers and employees, are important for a successful participatory occupational health/health promotion program. PMID:26977705

The health visitor's role in the identification of domestic abuse.

PubMed

Litherland, Rachel

2012-08-01

Internationally, domestic abuse is a significant public health issue in terms of imposing physical and psychological distress upon victims, having a detrimental impact upon parenting and causing psychological problems for victim's children. Figures identify that one in four UK women experience domestic abuse. However, it is acknowledged that reported rates are gross underestimates of true figures and that multiple barriers exist that inhibit domestic abuse identification. This paper reviews the literature to explore these barriers and ascertain evidence-based strategies that will help practitioners to identify domestic abuse more effectively. Particular attention is paid to domestic abuse screening tools, as research suggests their use increases disclosure rates. The paper concludes that routine and recurrent enquiry using a screening tool, information giving to all women, knowledgeable staff and supportive environments, are all potential facilitators to identification.

Focus on Success: An Explanatory Embedded Multiple-Case Study on How Youth Successfully Navigate Workforce Development Programs in Southern Nevada

ERIC Educational Resources Information Center

Villalobos, Ricardo

2017-01-01

This explanatory qualitative study investigated the perspectives of participant's and practitioner's perceived barriers to success and the necessary navigational expertise for overcoming the identified barriers. This multiple-case study research design examined three WIA out-of-school youth workforce development programs in Southern Nevada, with…

Parasol: An Architecture for Cross-Cloud Federated Graph Querying

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

Lieberman, Michael; Choudhury, Sutanay; Hughes, Marisa

2014-06-22

Large scale data fusion of multiple datasets can often provide in- sights that examining datasets individually cannot. However, when these datasets reside in different data centers and cannot be collocated due to technical, administrative, or policy barriers, a unique set of problems arise that hamper querying and data fusion. To ad- dress these problems, a system and architecture named Parasol is presented that enables federated queries over graph databases residing in multiple clouds. Parasol’s design is flexible and requires only minimal assumptions for participant clouds. Query optimization techniques are also described that are compatible with Parasol’s lightweight architecture. Experiments onmore » a prototype implementation of Parasol indicate its suitability for cross-cloud federated graph queries.« less

Structural barriers to HIV prevention among men who have sex with men (MSM) in Vietnam: Diversity, stigma, and healthcare access.

PubMed

Philbin, Morgan M; Hirsch, Jennifer S; Wilson, Patrick A; Ly, An Thanh; Giang, Le Minh; Parker, Richard G

2018-01-01

Men who have sex with men (MSM) in Vietnam experience disproportionate rates of HIV infection. To advance understanding of how structural barriers may shape their engagement with HIV prevention services, we draw on 32 in-depth interviews and four focus groups (n = 31) conducted with MSM in Hanoi between October 2015- March 2016. Three primary factors emerged: (1) Diversity, both in relation to identity and income; Vietnamese MSM described themselves as segregated into Bóng kín (hidden, often heterosexually-identified MSM) and Bóng lộ ('out,' transgender, or effeminate MSM). Lower-income, 'hidden' MSM from rural areas were reluctant to access MSM-targeted services; (2) Stigma: MSM reported being stigmatized by the healthcare system, family, and other MSM; and (3) Healthcare access: this was limited due to economic barriers and lack of MSM-friendly services. Our research suggests the need for multiple strategies to reach diverse types of MSM as well as to address barriers in access to health services such as stigma and costs. While a great deal has been written about the diversity of MSM in relation to gender performance and sexual identities, our research points to the substantial structural-level barriers that must be addressed in order to achieve meaningful and effective HIV prevention for MSM worldwide.

Opportunities and barriers to on-farm composting and compost application: A case study from northwestern Europe.

PubMed

Viaene, J; Van Lancker, J; Vandecasteele, B; Willekens, K; Bijttebier, J; Ruysschaert, G; De Neve, S; Reubens, B

2016-02-01

Maintaining and increasing soil quality and fertility in a sustainable way is an important challenge for modern agriculture. The burgeoning bioeconomy is likely to put further pressure on soil resources unless they are managed carefully. Compost has the potential to be an effective soil improver because of its multiple beneficial effects on soil quality. Additionally, it fits within the bioeconomy vision because it can valorize biomass from prior biomass processing or valorize biomass unsuitable for other processes. However, compost is rarely used in intensive agriculture, especially in regions with high manure surpluses. The aim of this research is to identify the barriers to on-farm composting and the application of compost in agriculture, using a mixed method approach for the case of Flanders. The significance of the 28 identified barriers is analyzed and they are categorized as market and financial, policy and institutional, scientific and technological and informational and behavioral barriers. More specifically, the shortage of woody biomass, strict regulation, considerable financial and time investment, and lack of experience and knowledge are hindering on-farm composting. The complex regulation, manure surplus, variable availability and transport of compost, and variable compost quality and composition are barriers to apply compost. In conclusion, five recommendations are suggested that could alleviate certain hindering factors and thus increase attractiveness of compost use in agriculture. Copyright © 2015 Elsevier Ltd. All rights reserved.

Understanding and meeting injection device needs in multiple sclerosis: a survey of patient attitudes and practices

PubMed Central

Verdun di Cantogno, Elisabetta; Russell, Susan; Snow, Tom

2011-01-01

Background: All established disease-modifying drugs for multiple sclerosis require parenteral administration, which can cause difficulties for some patients, sometimes leading to suboptimal adherence. A new electronic autoinjection device has been designed to address these issues. Methods: Patients with relapsing multiple sclerosis currently receiving subcutaneous or intramuscular interferon beta-1a, interferon beta-1b, or glatiramer acetate completed an online questionnaire (July 4–25, 2008) that surveyed current injection practices, experiences with current injection methods, and impressions and appeal of the new device. Results: In total, 422 patients completed the survey, of whom 44% used autoinjectors, 43% prefilled syringes, and 13% syringes and vials; overall, 66% currently self-injected. Physical and psychological barriers to self-injection included difficulty with injections, needle phobia, and concerns over correct injection technique. Only 40% of respondents were “very satisfied” with their current injection method. The new electronic autoinjector was rated as “very appealing” by 65% of patients. The benefits of the new device included the ability to customize injection settings and to review dosing history. Conclusion: New technologies may help patients overcome physical and psychological barriers to self-injection. The combination of a reliable and flexible autoinjection device with dose-monitoring technology may improve communication between health care professionals and patients, and improve treatment adherence. PMID:21573048

A phenomenology of informal caregiving for HIV/AIDS in India: Exploring women's search for authoritative knowledge, self-efficacy and resilience.

PubMed

Shukla, Shrivridhi; McCoyd, Judith L M

2018-04-12

Women provide informal caregiving across the world and are often expected to provide care even when ailing themselves. We explore the lived experience of 33 impoverished married Indian women living with HIV and caring for their husbands and/or children living with HIV. Drawing on concepts of authoritative knowledge (AK), self-efficacy and resilience, we found a trajectory that reveals barriers to accessing care, yet we also found that women developed strengths and resiliency. Women gather information, develop "environ-info," and deliberatively weigh AK from health workers, family/friends' advice, and their own experiences. Over multiple iterations of this process, they build self-reliance and resilience.

Climate for women in climate science: Women scientists and the Intergovernmental Panel on Climate Change.

PubMed

Gay-Antaki, Miriam; Liverman, Diana

2018-02-27

The Intergovernmental Panel on Climate Change (IPCC) is an authoritative and influential source of reports on climate change. The lead authors of IPCC reports include scientists from around the world, but questions have been raised about the dominance of specific disciplines in the report and the disproportionate number of scholars from the Global North. In this paper, we analyze the as-yet-unexamined issue of gender and IPCC authorship, looking at changes in gender balance over time and analyzing women's views about their experience and barriers to full participation, not only as women but also at the intersection of nationality, race, command of English, and discipline. Over time, we show that the proportion of female IPCC authors has seen a modest increase from less than 5% in 1990 to more than 20% in the most recent assessment reports. Based on responses from over 100 women IPCC authors, we find that many women report a positive experience in the way in which they are treated and in their ability to influence the report, although others report that some women were poorly represented and heard. We suggest that an intersectional lens is important: not all women experience the same obstacles: they face multiple and diverse barriers associated with social identifiers such as race, nationality, command of English, and disciplinary affiliation. The scientific community benefits from including all scientists, including women and those from the Global South. This paper documents barriers to participation and identifies opportunities to diversify climate science. Copyright © 2018 the Author(s). Published by PNAS.

Climate for women in climate science: Women scientists and the Intergovernmental Panel on Climate Change

PubMed Central

Gay-Antaki, Miriam; Liverman, Diana

2018-01-01

The Intergovernmental Panel on Climate Change (IPCC) is an authoritative and influential source of reports on climate change. The lead authors of IPCC reports include scientists from around the world, but questions have been raised about the dominance of specific disciplines in the report and the disproportionate number of scholars from the Global North. In this paper, we analyze the as-yet-unexamined issue of gender and IPCC authorship, looking at changes in gender balance over time and analyzing women’s views about their experience and barriers to full participation, not only as women but also at the intersection of nationality, race, command of English, and discipline. Over time, we show that the proportion of female IPCC authors has seen a modest increase from less than 5% in 1990 to more than 20% in the most recent assessment reports. Based on responses from over 100 women IPCC authors, we find that many women report a positive experience in the way in which they are treated and in their ability to influence the report, although others report that some women were poorly represented and heard. We suggest that an intersectional lens is important: not all women experience the same obstacles: they face multiple and diverse barriers associated with social identifiers such as race, nationality, command of English, and disciplinary affiliation. The scientific community benefits from including all scientists, including women and those from the Global South. This paper documents barriers to participation and identifies opportunities to diversify climate science. PMID:29440422

Exploring Linguistic Barriers to Help-Seeking Behaviors: The Lived Experiences of Chinese Undergraduate Students

ERIC Educational Resources Information Center

Hillis, Erin Rene

2017-01-01

First time college undergraduate students from China face linguistic and cultural barriers when seeking academic help from their faculty members, but there is little research addressing these students' experiences of encountering these barriers, nor how the barriers are overcome. This qualitative transcendental phenomenological study sought…

Astrocytic TYMP and VEGFA drive blood–brain barrier opening in inflammatory central nervous system lesions

PubMed Central

Chapouly, Candice; Tadesse Argaw, Azeb; Horng, Sam; Castro, Kamilah; Zhang, Jingya; Asp, Linnea; Loo, Hannah; Laitman, Benjamin M.; Mariani, John N.; Straus Farber, Rebecca; Zaslavsky, Elena; Nudelman, German; Raine, Cedric S.

2015-01-01

In inflammatory central nervous system conditions such as multiple sclerosis, breakdown of the blood–brain barrier is a key event in lesion pathogenesis, predisposing to oedema, excitotoxicity, and ingress of plasma proteins and inflammatory cells. Recently, we showed that reactive astrocytes drive blood–brain barrier opening, via production of vascular endothelial growth factor A (VEGFA). Here, we now identify thymidine phosphorylase (TYMP; previously known as endothelial cell growth factor 1, ECGF1) as a second key astrocyte-derived permeability factor, which interacts with VEGFA to induce blood–brain barrier disruption. The two are co-induced NFκB1-dependently in human astrocytes by the cytokine interleukin 1 beta (IL1B), and inactivation of Vegfa in vivo potentiates TYMP induction. In human central nervous system microvascular endothelial cells, VEGFA and the TYMP product 2-deoxy-d-ribose cooperatively repress tight junction proteins, driving permeability. Notably, this response represents part of a wider pattern of endothelial plasticity: 2-deoxy-d-ribose and VEGFA produce transcriptional programs encompassing angiogenic and permeability genes, and together regulate a third unique cohort. Functionally, each promotes proliferation and viability, and they cooperatively drive motility and angiogenesis. Importantly, introduction of either into mouse cortex promotes blood–brain barrier breakdown, and together they induce severe barrier disruption. In the multiple sclerosis model experimental autoimmune encephalitis, TYMP and VEGFA co-localize to reactive astrocytes, and correlate with blood–brain barrier permeability. Critically, blockade of either reduces neurologic deficit, blood–brain barrier disruption and pathology, and inhibiting both in combination enhances tissue preservation. Suggesting importance in human disease, TYMP and VEGFA both localize to reactive astrocytes in multiple sclerosis lesion samples. Collectively, these data identify TYMP as an astrocyte-derived permeability factor, and suggest TYMP and VEGFA together promote blood–brain barrier breakdown. PMID:25805644

The Stakeholder Model of voice research: Acknowledging barriers to human rights of all stakeholders in a communicative exchange.

PubMed

Madill, Catherine; Warhurst, Samantha; McCabe, Patricia

2018-02-01

The act of communication is a complex, transient and often abstract phenomenon that involves many stakeholders, each of whom has their own perspective: the speaker, the listener, the observer and the researcher. Current research practices in voice disorder are frequently framed through a single lens - that of the researcher/clinician or their participant/patient. This single lens approach risks overlooking significant barriers to the basic human right of freedom of expression for those with a voice disorder as it omits consideration of the impact of voice disorder on the listener, and consideration of the wider impact of the voice in the occupational context. Recent research in the area of voice has developed a multiple lens and subsequent Stakeholder Model that acknowledges the experience and reality of multiple stakeholders viewing the same phenomenon, the voice. This research paradigm is built on Article 19 of the Universal Declaration of Human Rights as it considers the realities of all stakeholders in forming a deeper understanding of the causality, impact and aspects of communication disorder. The Stakeholder Model will be presented as a suggestion for future investigations of communication disorders more widely.

The Use of Apps for Health in Persons with Multiple Sclerosis, Parkinson's Disease and Stroke - Barriers and Facilitators.

PubMed

Winberg, C; Kylberg, M; Pettersson, C; Harnett, T; Hedvall, P-O; Mattsson, T; Månsson Lexell, E

2017-01-01

The importance of mobile health has increased during recent years but few studies have described the use of apps among persons with neurological disabilities. The aim of this paper was to describe how persons ageing with a neurological disability experience barriers and facilitators in relation to using apps in everyday life. A qualitative approach was used. 16 persons with neurological disorders participated in two group discussions. Data were analyzed by content analysis. The analysis formed four categories; Impairments make apps harder to use, Use of apps is increased by learnability and sharing, Valuating the information in an app, and Apps act supportive and motivating. The participants used apps in the same way as persons without disabilities. Impairments and trustworthiness were perceived as barriers, which need to be acknowledged when developing apps for this population. Use of apps was facilitated by the possibility to share data and to connect with others. Apps may have the potential to improve self-management for persons ageing with disabilities but further research is needed.

Improving Cancer Outcomes Through International Collaboration in Academic Cancer Treatment Trials

PubMed Central

Trimble, Edward L.; Abrams, Jeffrey S.; Meyer, Ralph M.; Calvo, Fabien; Cazap, Eduardo; Deye, James; Eisenhauer, Elizabeth; Fitzgerald, Thomas J.; Lacombe, Denis; Parmar, Max; Seibel, Nita; Shankar, Lalitha; Swart, Ann Marie; Therasse, Patrick; Vikram, Bhadrasain; von Frenckell, Remy; Friedlander, Michael; Fujiwara, Keiichi; Kaplan, Richard S.; Meunier, Francoise

2009-01-01

Purpose The need for international collaboration in cancer clinical trials has grown stronger as we have made progress both in cancer treatment and screening. We sought to identify those efforts already underway which facilitate such collaboration, as well as barriers to greater collaboration. Methods We reviewed the collective experiences of many cooperative groups, governmental organizations, nongovernmental organizations, and academic investigators in their work to build international collaboration in cancer clinical trials across multiple disease sites. Results More than a decade of work has led to effective global harmonization for many of the elements critical to cancer clinical trials. Many barriers remain, but effective international collaboration in academic cancer treatment trials should become the norm, rather than the exception. Conclusion Our ability to strengthen international collaborations will result in maximization of our resources and patients, permitting us to change practice by establishing more effective therapeutic strategies. Regulatory, logistical, and financial hurdles, however, often hamper the conduct of joint trials. We must work together as a global community to overcome these barriers so that we may continue to improve cancer treatment for patients around the world. PMID:19720905

Compound Event Barrier Coverage in Wireless Sensor Networks under Multi-Constraint Conditions.

PubMed

Zhuang, Yaoming; Wu, Chengdong; Zhang, Yunzhou; Jia, Zixi

2016-12-24

It is important to monitor compound event by barrier coverage issues in wireless sensor networks (WSNs). Compound event barrier coverage (CEBC) is a novel coverage problem. Unlike traditional ones, the data of compound event barrier coverage comes from different types of sensors. It will be subject to multiple constraints under complex conditions in real-world applications. The main objective of this paper is to design an efficient algorithm for complex conditions that can combine the compound event confidence. Moreover, a multiplier method based on an active-set strategy (ASMP) is proposed to optimize the multiple constraints in compound event barrier coverage. The algorithm can calculate the coverage ratio efficiently and allocate the sensor resources reasonably in compound event barrier coverage. The proposed algorithm can simplify complex problems to reduce the computational load of the network and improve the network efficiency. The simulation results demonstrate that the proposed algorithm is more effective and efficient than existing methods, especially in the allocation of sensor resources.

Compound Event Barrier Coverage in Wireless Sensor Networks under Multi-Constraint Conditions

PubMed Central

Zhuang, Yaoming; Wu, Chengdong; Zhang, Yunzhou; Jia, Zixi

2016-01-01

It is important to monitor compound event by barrier coverage issues in wireless sensor networks (WSNs). Compound event barrier coverage (CEBC) is a novel coverage problem. Unlike traditional ones, the data of compound event barrier coverage comes from different types of sensors. It will be subject to multiple constraints under complex conditions in real-world applications. The main objective of this paper is to design an efficient algorithm for complex conditions that can combine the compound event confidence. Moreover, a multiplier method based on an active-set strategy (ASMP) is proposed to optimize the multiple constraints in compound event barrier coverage. The algorithm can calculate the coverage ratio efficiently and allocate the sensor resources reasonably in compound event barrier coverage. The proposed algorithm can simplify complex problems to reduce the computational load of the network and improve the network efficiency. The simulation results demonstrate that the proposed algorithm is more effective and efficient than existing methods, especially in the allocation of sensor resources. PMID:28029118

Finding Medical Care for Colorectal Cancer Symptoms: Experiences among Those Facing Financial Barriers

ERIC Educational Resources Information Center

Thomson, Maria D.; Siminoff, Laura A.

2015-01-01

Financial barriers can substantially delay medical care seeking. Using patient narratives provided by 252 colorectal cancer patients, we explored the experience of financial barriers to care seeking. Of the 252 patients interviewed, 84 identified financial barriers as a significant hurdle to obtaining health care for their colorectal cancer…

The perceived benefits and barriers to exercise participation in persons with multiple sclerosis.

PubMed

Stroud, Nicole; Minahan, Clare; Sabapathy, Surendran

2009-01-01

The purpose of this study was to examine the perceived benefits and barriers to exercise participation in persons with multiple sclerosis (MS). A cross-sectional postal survey comprised of 93 adults with MS was conducted. Participants completed the Exercise Benefits and Barriers Scale (EBBS), Spinal Cord Injury Exercise Self-Efficacy Scale (EXSE), Multiple Sclerosis Impact Scale, Disease Steps Scale and International Physical Activity Questionnaire. Forty-three percent of the participants were classified as exercising individuals (EX group) as compared with non-exercising individuals (non-EX group). Participants in the EX group reported significantly higher scores on the EBBS and EXSE. Items related to physical performance and personal accomplishment were cited as the greatest perceived benefits to exercise participation and those items related to physical exertion as the greatest perceived barriers to both the EX and non-EX groups. When compared with previous studies conducted in the general population, the participants in the present study reported different perceived barriers to exercise participation. Furthermore, awareness of the benefits of physical activity is not sufficient to promote exercise participation in persons with MS. Perceived exercise self-efficacy is shown to play an important role in promoting exercise participation in persons with MS.

District nurses' experiences of preventive home visits to 75-year-olds in Stockholm: a qualitative study.

PubMed

Lagerin, Annica; Törnkvist, Lena; Hylander, Ingrid

2016-09-01

Aims This study had two aims: to describe the dialogue between district nurses (DNs) and older people in preventive home visits (PHVs) from the perspective of the DNs, and to identify barriers to and facilitators of this dialogue as perceived by the DNs. The number of older people is rapidly increasing in all western countries, and as people's age increases, the probability that they will have multiple diseases also increases. Planned actions are therefore needed to promote health and prevent diseases among older people so they can remain in good health and live in their homes for as long as possible. In Sweden, PHVs to 75-year-olds by DNs are one such action. This qualitative study included five group interviews with 20 DNs. Data were analysed with qualitative content analysis. Findings DNs' experiences of barriers to and facilitators of a successful health dialogue were sorted into five domains. Together, these domains provided a systematic description of the interaction between the DN and the older person in the PHV. The domains included: establishing trustful contact, conducting a structured interview, making an overall assessment, proposing health-promoting activities and offering follow-up. The barriers and facilitators could be related to the older person, the DN or the home environment. The latent content of the interviews was evident in three themes that were related to the DNs' experiences of barriers and facilitators. These themes illustrated professional dilemmas that the DNs had to resolve to achieve the purpose of the PHV. The study demonstrates that the interaction between a DN and an older person in a PHV can be described as a complex social process in which the DN balances a personal and professional approach, combines a person-oriented and a task-oriented approach and employs both a salutogenic and pathogenic perspective.

Therapist, Parent, and Youth Perspectives of Treatment Barriers to Family-Focused Community Outpatient Mental Health Services

PubMed Central

Jenkins, Melissa M.; Haine-Schlagel, Rachel

2012-01-01

This exploratory qualitative study describes treatment barriers to receiving family-focused child mental health services for youths with disruptive behavior problems from multiple perspectives. Data were collected during a series of focus groups and interviews, including: 4 therapist focus groups, 3 parent focus groups, and 10 youth semi-structured interviews. Therapist, parent, and youth stakeholder participants discussed perceived barriers to effective treatment, the problems with current child outpatient therapy, and desired changes (i.e., policy, intervention, etc.) to improve mental health services. Results indicate similar themes around treatment barriers and dissatisfaction with services within and across multiple stakeholder groups, including inadequate support and lack of family involvement; however, parents and therapists, in particular, identified different contributing factors to these barriers. Overall, stakeholders reported much frustration and dissatisfaction with current community-based outpatient child therapy services. Study findings can inform service provision, intervention development, and future research. PMID:24019737

Moving beyond the language barrier: the communication strategies used by international medical graduates in intercultural medical encounters.

PubMed

Jain, Parul; Krieger, Janice L

2011-07-01

To understand the communication strategies international medical graduates use in medical interactions to overcome language and cultural barriers. In-depth interviews were conducted with 12 international physicians completing their residency training in internal medicine in a large hospital in Midwestern Ohio. The interview explored (a) barriers participants encountered while communicating with their patients regarding language, affect, and culture, and (b) communication convergence strategies used to make the interaction meaningful. International physicians use multiple convergence strategies when interacting with their patients to account for the intercultural and intergroup differences, including repeating information, changing speaking styles, and using non-verbal communication. Understanding barriers to communication faced by international physicians and recognizing accommodation strategies they employ in the interaction could help in training of future international doctors who come to the U.S. to practice medicine. Early intervention could reduce the time international physicians spend navigating through the system and trying to learn by experimenting with different strategies which will allow these physicians to devote more time to patient care. We recommend developing a training manual that is instructive of the socio-cultural practices of the region where international physician will start practicing medicine. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Behavioral Determinants of Brushing Young Children's Teeth: Implications for Anticipatory Guidance

PubMed Central

Huebner, Colleen E.; Riedy, Christine A.

2010-01-01

Purpose The purposes of this study were to identify parents' motivation, support, and barriers to twice daily tooth-brushing of infants and preschool-age children and to discover new approaches to encourage this important health behavior. Methods Qualitative interviews were conducted with 44 rural parents about tooth-brushing habits and experiences. Results Forty of 44 parents reported that they had begun to brush their child's teeth; 24 (55%) reported brushing twice a day or more. Parents who brushed twice a day, vs less often, were more likely to describe specific skills to overcome barriers; they expressed high self-efficacy and held high self-standards for brushing. Parents who brushed their children's teeth less than twice daily were more likely to: hold false beliefs about the benefits of twice daily tooth-brushing; report little normative pressure or social support for the behavior; have lower self-standards; describe more external constraints; and offer fewer ideas to overcome barriers. Conclusions The findings support an integrative framework in which barriers and support for parents' twice daily brushing of their young children's teeth are multiple and vary among individuals. Knowledge of behavioral determinants specific to individual parents could strengthen anticipatory guidance and recommendations about at-home oral hygiene of young children. PMID:20298653

Implementing Cardiopulmonary Resuscitation Training Programs in High Schools: Iowa's Experience.

PubMed

Hoyme, Derek B; Atkins, Dianne L

2017-02-01

To understand perceived barriers to providing cardiopulmonary resuscitation (CPR) education, implementation processes, and practices in high schools. Iowa has required CPR as a graduation requirement since 2011 as an unfunded mandate. A cross-sectional study was performed through multiple choice surveys sent to Iowa high schools to collect data about school demographics, details of CPR programs, cost, logistics, and barriers to implementation, as well as automated external defibrillator training and availability. Eighty-four schools responded (26%), with the most frequently reported school size of 100-500 students and faculty size of 25-50. When the law took effect, 51% of schools had training programs already in place; at the time of the study, 96% had successfully implemented CPR training. Perceived barriers to implementation were staffing, time commitment, equipment availability, and cost. The average estimated startup cost was <$1000 US, and the yearly maintenance cost was <$500 with funds typically allocated from existing school resources. The facilitator was a school official or volunteer for 81% of schools. Average estimated training time commitment per student was <2 hours. Automated external defibrillators are available in 98% of schools, and 61% include automated external defibrillator training in their curriculum. Despite perceived barriers, school CPR training programs can be implemented with reasonable resource and time allocations. Copyright © 2016 Elsevier Inc. All rights reserved.

Implementing Cardiopulmonary Resuscitation Training Programs in High Schools: Iowa's Experience

PubMed Central

Hoyme, Derek B.; Atkins, Dianne L.

2017-01-01

Objective To understand perceived barriers to providing cardiopulmonary resuscitation (CPR) education, implementation processes, and practices in high schools. Study design Iowa has required CPR as a graduation requirement since 2011 as an unfunded mandate. A cross-sectional study was performed through multiple choice surveys sent to Iowa high schools to collect data about school demographics, details of CPR programs, cost, logistics, and barriers to implementation, as well as automated external defibrillator training and availability. Results Eighty-four schools responded (26%), with the most frequently reported school size of 100-500 students and faculty size of 25-50. When the law took effect, 51% of schools had training programs already in place; at the time of the study, 96% had successfully implemented CPR training. Perceived barriers to implementation were staffing, time commitment, equipment availability, and cost. The average estimated startup cost was <$1000 US, and the yearly maintenance cost was <$500 with funds typically allocated from existing school resources. The facilitator was a school official or volunteer for 81% of schools. Average estimated training time commitment per student was <2 hours. Automated external defibrillators are available in 98% of schools, and 61% include automated external defibrillator training in their curriculum. Conclusions Despite perceived barriers, school CPR training programs can be implemented with reasonable resource and time allocations. PMID:27852456

A qualitative study on African immigrant and refugee families' experiences of accessing primary health care services in Manitoba, Canada: it's not easy!

PubMed

Woodgate, Roberta Lynn; Busolo, David Shiyokha; Crockett, Maryanne; Dean, Ruth Anne; Amaladas, Miriam R; Plourde, Pierre J

2017-01-09

Immigrant and refugee families form a growing proportion of the Canadian population and experience barriers in accessing primary health care services. The aim of this study was to examine the experiences of access to primary health care by African immigrant and refugee families. Eighty-three families originating from 15 African countries took part in multiple open ended interviews in western Canada. Qualitative data was collected in six different languages between 2013 and 2015. Data analysis involved delineating units of meaning from the data, clustering units of meaning to form thematic statements, and extracting themes. African immigrant and refugee families experienced challenges in their quest to access primary health care that were represented by three themes: Expectations not quite met, facing a new life, and let's buddy up to improve access. On the theme of expectations not quite met, families struggled to understand and become familiar with a new health system that presented with a number of barriers including lengthy wait times, a shortage of health care providers, high cost of medication and non-basic health care, and less than ideal care. On the theme of facing a new life, immigrant and refugee families talked of the difficulties of getting used to their new and unfamiliar environments and the barriers that impact their access to health care services. They talked of challenges related to transportation, weather, employment, language and cultural differences, and lack of social support in their quest to access health care services. Additionally, families expressed their lack of social support in accessing care. Privately sponsored families and families with children experienced even less social support. Importantly, in the theme of let's buddy up to improve access, families recommended utilizing networking approaches to engage and improve their access to primary health care services. African immigrant and refugee families experience barriers to accessing primary health care. To improve access, culturally relevant programs, collaborative networking approaches, and policies that focus on addressing social determinants of health are needed.

Redefining Authentic Research Experiences in Introductory Biology Laboratories and Barriers to Their Implementation

PubMed Central

Spell, Rachelle M.; Guinan, Judith A.; Miller, Kristen R.; Beck, Christopher W.

2014-01-01

Incorporating authentic research experiences in introductory biology laboratory classes would greatly expand the number of students exposed to the excitement of discovery and the rigor of the scientific process. However, the essential components of an authentic research experience and the barriers to their implementation in laboratory classes are poorly defined. To guide future reform efforts in this area, we conducted a national survey of biology faculty members to determine 1) their definitions of authentic research experiences in laboratory classes, 2) the extent of authentic research experiences currently experienced in their laboratory classes, and 3) the barriers that prevent incorporation of authentic research experiences into these classes. Strikingly, the definitions of authentic research experiences differ among faculty members and tend to emphasize either the scientific process or the discovery of previously unknown data. The low level of authentic research experiences in introductory biology labs suggests that more development and support is needed to increase undergraduate exposure to research experiences. Faculty members did not cite several barriers commonly assumed to impair pedagogical reform; however, their responses suggest that expanded support for development of research experiences in laboratory classes could address the most common barrier. PMID:24591509

Redefining authentic research experiences in introductory biology laboratories and barriers to their implementation.

PubMed

Spell, Rachelle M; Guinan, Judith A; Miller, Kristen R; Beck, Christopher W

2014-01-01

Incorporating authentic research experiences in introductory biology laboratory classes would greatly expand the number of students exposed to the excitement of discovery and the rigor of the scientific process. However, the essential components of an authentic research experience and the barriers to their implementation in laboratory classes are poorly defined. To guide future reform efforts in this area, we conducted a national survey of biology faculty members to determine 1) their definitions of authentic research experiences in laboratory classes, 2) the extent of authentic research experiences currently experienced in their laboratory classes, and 3) the barriers that prevent incorporation of authentic research experiences into these classes. Strikingly, the definitions of authentic research experiences differ among faculty members and tend to emphasize either the scientific process or the discovery of previously unknown data. The low level of authentic research experiences in introductory biology labs suggests that more development and support is needed to increase undergraduate exposure to research experiences. Faculty members did not cite several barriers commonly assumed to impair pedagogical reform; however, their responses suggest that expanded support for development of research experiences in laboratory classes could address the most common barrier.

Teaching during consultation: factors affecting the resident-fellow teaching interaction.

PubMed

Miloslavsky, Eli M; McSparron, Jakob I; Richards, Jeremy B; Puig, Alberto; Sullivan, Amy M

2015-07-01

The subspecialty consultation represents a potentially powerful opportunity for resident learning, but barriers may limit the educational exchanges between fellows (subspecialty registrars) and residents (house officers). We conducted a focus group study of internal medicine (IM) residents and subspecialty fellows to determine barriers against and factors facilitating resident-fellow teaching interactions on the wards, and to identify opportunities for maximising teaching and learning. We conducted four focus groups of IM residents (n = 18) and IM subspecialty fellows (n = 16) at two academic medical centres in the USA during February and March 2013. Participants represented trainees in all 3 years of residency training and seven IM subspecialties. Four investigators analysed the transcripts using a structured qualitative framework approach, which was informed by literature on consultation and the theoretical framework of activity theory. We identified two domains of barriers and facilitating factors: personal and systems-based. Sub-themes in the personal domain included fellows' perceived resistance to consultations, residents' willingness to engage in teaching interactions, and perceptions and expectations. Sub-themes in the systems-based domain included the process of requesting the consult, the quality of the consult request, primary team structure, familiarity between residents and fellows, workload, work experience, culture of subspecialty divisions, and fellows' teaching skills. These barriers differentially affected the two stages of the consult identified in the focus groups (initial interaction and follow-up interaction). Residents and fellows want to engage in positive teaching interactions in the context of the clinical consult; however, multiple barriers influence both parties in the hospital environment. Many of these barriers are amenable to change. Interventions aimed at reducing barriers to teaching in the setting of consultation hold promise for improving teaching and learning on the wards. © 2015 John Wiley & Sons Ltd.

Atopic dermatitis in the domestic dog.

PubMed

Pucheu-Haston, Cherie M

2016-01-01

Dogs may develop a syndrome of spontaneous, inflammatory, pruritic dermatitis that shares many features with human atopic dermatitis, including a young age of onset, characteristic lesion distribution, immunoglobulin E sensitization to common environmental allergen sources, and evidence of epidermal barrier dysfunction. There are also several important differences between canine and human atopic dermatitis. Although dogs may suffer from multiple-organ hypersensitivity syndromes, there is no evidence that this species experiences the progressive evolution from cutaneous to respiratory allergy characteristic of the human atopic march. Despite the presence of epidermal barrier derangement, there is no significant association between canine atopic dermatitis and mutations in filaggrin. Finally, treatment of canine disease relies much less heavily on topical therapy than does its human counterpart, while allergy testing and allergen-specific immunotherapy provide an often essential component of effective clinical management of affected dogs. Copyright © 2016 Elsevier Inc. All rights reserved.

A comparative study of wood highway sound barriers

Treesearch

Stefan Grgurevich; Thomas Boothby; Harvey Manbeck; Courtney Burroughs; Stephen Cegelka; Craig Bernecker; Michael A. Ritter

2002-01-01

Prototype designs for wood highway sound barriers meeting the multiple criteria of structural integrity, acoustic effectiveness, durability, and potential for public acceptance have been developed. Existing installations of wood sound barriers were reviewed and measurements conducted in the field to estimate acoustic insertion losses. A complete matrix of design...

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

Livelihood Experiences and Adherence to HIV Antiretroviral Therapy among Participants in a Food Assistance Pilot in Bolivia: A Qualitative Study

PubMed Central

Palar, Kartika; Martin, Alexis; Oropeza Camacho, Martha Lidia; Derose, Kathryn Pitkin

2013-01-01

Introduction Health and development organizations increasingly promote livelihood interventions to improve health and economic outcomes for people living with HIV (PLHIV) receiving treatment with antiretroviral therapy (ART). In-depth understanding about how PLHIV make labor decisions in the context of treatment for HIV – and treatment decisions in the context of their livelihoods – is essential to guiding intervention design and developing hypotheses for future research on livelihoods and ART. However, few studies have explored the perspectives of PLHIV regarding integration of livelihoods and ART in urban, resource-limited settings. Methods Qualitative interviews explored the livelihood experiences of food insecure ART patients in four Bolivian cities (n = 211). Topics included work-related barriers to ART adherence, HIV-related barriers to work, and economic coping mechanisms. Themes were identified using content coding procedures, with two coders to maximize reliability. Results Participants reported complex economic lives often characterized by multiple economic activities, including both formal and informal labor. They struggled to manage ART treatment and livelihoods simultaneously, and faced a range of interpersonal and structural barriers. In particular, lack of HIV status disclosure, stigma, and discrimination were highly salient issues for study participants and likely to be unique to people with HIV, leading to conflict around requesting time off for clinic visits, resentment from co-workers about time off, and difficulties adhering to medication schedules. In addition, health system issues such as limited clinic hours or drug shortages exacerbated the struggle to balance economic activities with HIV treatment adherence. Conclusions Improved policy-level efforts to enforce existing anti-discrimination laws, reduce HIV-related stigma, and expand health services accessibility could mitigate many of the barriers discussed by our participants, improve adherence, and reduce the need for livelihoods interventions. PMID:23613976

Factors Influencing Amount of Weekly Exercise Time in Colorectal Cancer Survivors.

PubMed

Chou, Yun-Jen; Lai, Yeur-Hur; Lin, Been-Ren; Liang, Jin-Tung; Shun, Shiow-Ching

Performing regular exercise of at least 150 minutes weekly has benefits for colorectal cancer survivors. However, barriers inhibit these survivors from performing regular exercise. The aim of this study was to explore exercise behaviors and significant factors influencing weekly exercise time of more than 150 minutes in colorectal cancer survivors. A cross-sectional study design was used to recruit participants in Taiwan. Guided by the ecological model of health behavior, exercise barriers were assessed including intrapersonal, interpersonal, and environment-related barriers. A multiple logistic regression was used to explore the factors associated with the amount of weekly exercise. Among 321 survivors, 57.0% of them had weekly exercise times of more than 150 minutes. The results identified multiple levels of significant factors related to weekly exercise times including intrapersonal factors (occupational status, functional status, pain, interest in exercise, and beliefs about the importance of exercise) and exercise barriers related to environmental factors (lack of time and bad weather). No interpersonal factors were found to be significant. Colorectal cancer survivors experienced low levels of physical and psychological distress. Multiple levels of significant factors related to exercise time including intrapersonal factors as well as exercise barriers related to environmental factors should be considered. Healthcare providers should discuss with their patients how to perform exercise programs; the discussion should address multiple levels of the ecological model such as any pain problems, functional status, employment status, and time limitations, as well as community environment.

Organizational Infrastructure in the Collegiate Athletic Training Setting, Part II: Benefits of and Barriers in the Athletics Model

PubMed Central

Goodman, Ashley; Mazerolle, Stephanie M.; Eason, Christianne M.

2017-01-01

Context: The athletics model, in which athletic training clinical programs are part of the athletics department, is the predominant model in the collegiate athletic training setting. Little is known about athletic trainers' (ATs') perceptions of this model, particularly as it relates to organizational hierarchy. Objective: To explore the perceived benefits of and barriers in the athletics model. Design: Qualitative study. Setting: National Collegiate Athletic Association Divisions I and III. Patients or Other Participants: Eight full-time ATs (5 men, 3 women; age = 41 ± 13 years, time employed at the current institution = 14 ± 14 years, experience as a certified AT = 18 ± 13 years) working in the collegiate setting using the athletics model. Data Collection and Analysis: We conducted semistructured interviews via telephone or in person and used a general inductive approach to analyze the qualitative data. Multiple-analyst triangulation and peer review established trustworthiness. Results: Two benefits and 3 barriers emerged from the data. Role identity emerged as a benefit that occurred with role clarity, validation, and acceptance of the collegiate AT personality. Role congruence emerged as a benefit of the athletics model that occurred with 2 lower-order themes: relationship building and physician alignment and support. Role strain, staffing concerns, and work-life conflict emerged as barriers in the athletics model. Role strain occurred with 2 primary lower-order themes: role incongruity and role conflict. Conclusions: The athletics model is the most common infrastructure for employing ATs in collegiate athletics. Participants expressed positive experiences via character identity, support, trust relationships, and longevity. However, common barriers remain. To reduce role strain, misaligning values, and work-life conflict, ATs working in the athletics model are encouraged to evaluate their relationships with coaches and their supervisor and consider team physician alignment. Moreover, measures to increase quality athletic training staff from a care rather than a coverage standpoint should be considered. PMID:27977301

Evidence for multiple interspecific hybridization in Saccharomyces sensu stricto species.

PubMed

de Barros Lopes, Miguel; Bellon, Jennifer R; Shirley, Neil J; Ganter, Philip F

2002-01-01

Fluorescent amplified fragment length polymorphism analysis demonstrates a high level of gene exchange between Saccharomyces sensu stricto species, with some strains having undergone multiple interspecific hybridization events with subsequent changes in genome complexity. Two lager strains were shown to be hybrids between Saccharomyces cerevisiae and the alloploid species Saccharomyces pastorianus. The genome structure of CBS 380(T), the type strain of Saccharomyces bayanus, is also consistent with S. pastorianus gene transfer. The results indicate that the cider yeast, CID1, possesses nuclear DNA from three separate species. Mating experiments show that there are no barriers to interspecific conjugation of haploid cells. Furthermore, the allopolyploid strains were able to undergo further hybridizations with other Saccharomyces sensu stricto yeasts. These results demonstrate that introgression between the Saccharomyces sensu stricto species is likely.

Forecasting the Relative and Cumulative Effects of Multiple Stressors on At-risk Populations

DTIC Science & Technology

2011-08-01

Vitals (observed vital rates), Movement, Ranges, Barriers (barrier interactions), Stochasticity (a time series of stochasticity indices...Simulation Viewer are themselves stochastic . They can change each time it is run. B. 196 Analysis If multiple Census events are present in the life...30-year period. A monthly time series was generated for the 20th-century using monthly anomalies for temperature, precipitation, and percent

Enablers and barriers for women with gestational diabetes mellitus to achieve optimal glycaemic control - a qualitative study using the theoretical domains framework.

PubMed

Martis, Ruth; Brown, Julie; McAra-Couper, Judith; Crowther, Caroline A

2018-04-11

Glycaemic target recommendations vary widely between international professional organisations for women with gestational diabetes mellitus (GDM). Some studies have reported women's experiences of having GDM, but little is known how this relates to their glycaemic targets. The aim of this study was to identify enablers and barriers for women with GDM to achieve optimal glycaemic control. Women with GDM were recruited from two large, geographically different, hospitals in New Zealand to participate in a semi-structured interview to explore their views and experiences focusing on enablers and barriers to achieving optimal glycaemic control. Final thematic analysis was performed using the Theoretical Domains Framework. Sixty women participated in the study. Women reported a shift from their initial negative response to accepting their diagnosis but disliked the constant focus on numbers. Enablers and barriers were categorised into ten domains across the three study questions. Enablers included: the ability to attend group teaching sessions with family and hear from women who have had GDM; easy access to a diabetes dietitian with diet recommendations tailored to a woman's context including ethnic food and financial considerations; free capillary blood glucose (CBG) monitoring equipment, health shuttles to take women to appointments; child care when attending clinic appointments; and being taught CBG testing by a community pharmacist. Barriers included: lack of health information, teaching sessions, consultations, and food diaries in a woman's first language; long waiting times at clinic appointments; seeing a different health professional every clinic visit; inconsistent advice; no tailored physical activities assessments; not knowing where to access appropriate information on the internet; unsupportive partners, families, and workplaces; and unavailability of social media or support groups for women with GDM. Perceived judgement by others led some women only to share their GDM diagnosis with their partners. This created social isolation. Women with GDM report multiple enablers and barriers to achieving optimal glycaemic control. The findings of this study may assist health professionals and diabetes in pregnancy services to improve their care for women with GDM and support them to achieve optimal glycaemic control.

Global interrupt and barrier networks

DOEpatents

Blumrich, Matthias A.; Chen, Dong; Coteus, Paul W.; Gara, Alan G.; Giampapa, Mark E; Heidelberger, Philip; Kopcsay, Gerard V.; Steinmacher-Burow, Burkhard D.; Takken, Todd E.

2008-10-28

A system and method for generating global asynchronous signals in a computing structure. Particularly, a global interrupt and barrier network is implemented that implements logic for generating global interrupt and barrier signals for controlling global asynchronous operations performed by processing elements at selected processing nodes of a computing structure in accordance with a processing algorithm; and includes the physical interconnecting of the processing nodes for communicating the global interrupt and barrier signals to the elements via low-latency paths. The global asynchronous signals respectively initiate interrupt and barrier operations at the processing nodes at times selected for optimizing performance of the processing algorithms. In one embodiment, the global interrupt and barrier network is implemented in a scalable, massively parallel supercomputing device structure comprising a plurality of processing nodes interconnected by multiple independent networks, with each node including one or more processing elements for performing computation or communication activity as required when performing parallel algorithm operations. One multiple independent network includes a global tree network for enabling high-speed global tree communications among global tree network nodes or sub-trees thereof. The global interrupt and barrier network may operate in parallel with the global tree network for providing global asynchronous sideband signals.

Adolescents' Views of Food and Eating: Identifying Barriers to Healthy Eating

ERIC Educational Resources Information Center

Stevenson, Clifford; Doherty, Glenda; Barnett, Julie; Muldoon, Orla T.; Trew, Karen

2007-01-01

Contemporary Western society has encouraged an obesogenic culture of eating amongst youth. Multiple factors may influence an adolescent's susceptibility to this eating culture, and thus act as a barrier to healthy eating. Given the increasing prevalence of obesity amongst adolescents, the need to reduce these barriers has become a necessity.…

The component content of active particles in a plasma-chemical reactor based on volume barrier discharge

NASA Astrophysics Data System (ADS)

Soloshenko, I. A.; Tsiolko, V. V.; Pogulay, S. S.; Terent'yeva, A. G.; Bazhenov, V. Yu; Shchedrin, A. I.; Ryabtsev, A. V.; Kuzmichev, A. I.

2007-02-01

In this paper the results of theoretical and experimental studies of the component content of active particles formed in a plasma-chemical reactor composed of a multiple-cell generator of active particles, based on volume barrier discharge, and a working chamber are presented. For calculation of the content of uncharged plasma components an approach is proposed which is based on averaging of the power introduced over the entire volume. Advantages of such an approach lie in an absence of fitting parameters, such as the dimensions of microdischarges, their surface density and rate of breakdown. The calculation and the experiment were accomplished with the use of dry air (20% relative humidity) as the plasma generating medium. Concentrations of O3, HNO3, HNO2, N2 O5 and NO3 were measured experimentally in the discharge volume and working chamber for the residence time of particles on a discharge of 0.3 s and more and discharge specific power of 1.5 W cm-3. It has been determined that the best agreement between the calculation and the experiment occurs at calculated gas medium temperatures in the discharge plasma of about 400-425 K, which correspond to the experimentally measured rotational temperature of nitrogen. In most cases the calculated concentrations of O3, HNO3, HNO2, N2O5 and NO3 for the barrier discharge and the working chamber are in fairly good agreement with the respective measured values.

Musculoskeletal education in physical medicine and rehabilitation residency programs.

PubMed

Smith, Jay; Krabak, Brian J; Malanga, Gerard A; Moutvic, Margaret A

2004-10-01

To characterize current musculoskeletal (MSK) education experiences in physical medicine and rehabilitation residency programs and to identify perceived barriers to providing more extensive MSK education experiences. In addition, to establish utilization patterns for the PASSOR Physical Examination Core Competencies List. Between March and November 2003, all 81 physical medicine and rehabilitation residency program directors were asked to complete an MSK education survey developed by the authors. A total of 69 of 81 program directors (86%) responded after multiple contacts. The most frequently utilized MSK education formats were MSK lecture series, MSK departmental conferences, and physical examination workshops. Potential barriers to expanded MSK education included money, time, and staff number. Given unlimited resources, most residency programs would greatly increase utilization of visiting lecturers, CD-ROMs/DVDs, objective structured clinical examinations, and physical examination videos. Of the 30 program directors who recalled receiving the Core Competencies List, only 40% (12 of 30) have formally integrated the list into their residency training. Barriers to implementation included logistical challenges and lack of direction regarding implementation. Residency program directors indicate a strong interest in expanding resident MSK education through the use of CD-ROMs/DVDs, physical examination videos, objective structured clinical examinations, and visiting lecturer programs. CD-ROMs/DVDs and videos represent particularly attractive educational formats for supplementing resident MSK education due to the advantages of central production, nominal costs, widespread distribution, multimedia capabilities, and accessibility. These educational formats should be considered for targeted educational initiatives to enhance resident MSK education, regardless of residency program size or resources.

Multiple current peaks in room-temperature atmospheric pressure homogenous dielectric barrier discharge plasma excited by high-voltage tunable nanosecond pulse in air

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

Yang, De-Zheng; Wang, Wen-Chun; Zhang, Shuai

2013-05-13

Room temperature homogenous dielectric barrier discharge plasma with high instantaneous energy efficiency is acquired by using nanosecond pulse voltage with 20-200 ns tunable pulse width. Increasing the voltage pulse width can lead to the generation of regular and stable multiple current peaks in each discharge sequence. When the voltage pulse width is 200 ns, more than 5 organized current peaks can be observed under 26 kV peak voltage. Investigation also shows that the organized multiple current peaks only appear in homogenous discharge mode. When the discharge is filament mode, organized multiple current peaks are replaced by chaotic filament current peaks.

The impact of an online Facebook support group for people with multiple sclerosis on non-active users.

PubMed

Steadman, Jacqui; Pretorius, Chrisma

2014-01-01

Multiple sclerosis (MS) is a debilitating disease and there is little research on support networks for people with MS (PwMS). More specifically, most studies on online support groups focus on those who actively participate in the group, whereas the majority of those who utilise online support groups do so in a passive way. This study therefore aimed to explore the experiences of non-active users of an online Facebook support group for PwMS. Emphasis was placed on the facilitators and the barriers that were associated with membership to this group. An exploratory qualitative research design was implemented, whereby thematic analysis was utilised to examine the ten semi-structured interviews that were conducted. Several facilitators were acquired through the online support group; namely emotional support (constant source of support, exposure to negative aspects of the disease), informational support (group as a source of knowledge, quality of information) and social companionship (place of belonging). Some barriers were also identified; namely emotional support (emotions lost online, response to messages, exposure to negative aspects of the disease), informational support (information posted on the group, misuse of group) and social companionship (non-active status). These findings demonstrate that the non-active members of the online support group for PwMS have valid reasons for their non-active membership status. More important, the findings suggest that the online Facebook support group provided the group members with an important support network in the form of emotional support, informational support and social companionship, despite their non-active membership status or the barriers that have been identified.

Barriers and enablers to implementing multiple stroke guideline recommendations: a qualitative study.

PubMed

McCluskey, Annie; Vratsistas-Curto, Angela; Schurr, Karl

2013-08-19

Translating evidence into practice is an important final step in the process of evidence-based practice. Medical record audits can be used to examine how well practice compares with published evidence, and identify evidence-practice gaps. After providing audit feedback to professionals, local barriers to practice change can be identified and targetted with focussed behaviour change interventions. This study aimed to identify barriers and enablers to implementing multiple stroke guideline recommendations at one Australian stroke unit. A qualitative methodology was used. A sample of 28 allied health, nursing and medical professionals participated in a group or individual interview. These interviews occurred after staff had received audit feedback and identified areas for practice change. Questions focused on barriers and enablers to implementing guideline recommendations about management of: upper limb sensory impairments, mobility including sitting balance; vision; anxiety and depression; neglect; swallowing; communication; education for stroke survivors and carers; advice about return to work and driving. Qualitative data were analysed for themes using theoretical domains described by Michie and colleagues (2005). Six group and two individual interviews were conducted, involving six disciplines. Barriers were different across disciplines. The six key barriers identified were: (1) Beliefs about capabilities of individual professionals and their discipline, and about patient capabilities (2) Beliefs about the consequences, positive and negative, of implementing the recommendations (3) Memory of, and attention to, best practices (4) Knowledge and skills required to implement best practice; (5) Intention and motivation to implement best practice, and (6) Resources. Some barriers were also enablers to change. For example, occupational therapists required new knowledge and skills (a barrier), to better manage sensation and neglect impairments while physiotherapists generally knew how to implement best-practice mobility rehabilitation (an enabler). Findings add to current knowledge about barriers to change and implementation of multiple guideline recommendations. Major challenges included sexuality education and depression screening. Limited knowledge and skills was a common barrier. Knowledge about specific interventions was needed before implementation could commence, and to maintain treatment fidelity. The provision of detailed online intervention protocols and manuals may help clinicians to overcome the knowledge barrier.

Barriers and enablers to implementing multiple stroke guideline recommendations: a qualitative study

PubMed Central

2013-01-01

Background Translating evidence into practice is an important final step in the process of evidence-based practice. Medical record audits can be used to examine how well practice compares with published evidence, and identify evidence-practice gaps. After providing audit feedback to professionals, local barriers to practice change can be identified and targetted with focussed behaviour change interventions. This study aimed to identify barriers and enablers to implementing multiple stroke guideline recommendations at one Australian stroke unit. Methods A qualitative methodology was used. A sample of 28 allied health, nursing and medical professionals participated in a group or individual interview. These interviews occurred after staff had received audit feedback and identified areas for practice change. Questions focused on barriers and enablers to implementing guideline recommendations about management of: upper limb sensory impairments, mobility including sitting balance; vision; anxiety and depression; neglect; swallowing; communication; education for stroke survivors and carers; advice about return to work and driving. Qualitative data were analysed for themes using theoretical domains described by Michie and colleagues (2005). Results Six group and two individual interviews were conducted, involving six disciplines. Barriers were different across disciplines. The six key barriers identified were: (1) Beliefs about capabilities of individual professionals and their discipline, and about patient capabilities (2) Beliefs about the consequences, positive and negative, of implementing the recommendations (3) Memory of, and attention to, best practices (4) Knowledge and skills required to implement best practice; (5) Intention and motivation to implement best practice, and (6) Resources. Some barriers were also enablers to change. For example, occupational therapists required new knowledge and skills (a barrier), to better manage sensation and neglect impairments while physiotherapists generally knew how to implement best-practice mobility rehabilitation (an enabler). Conclusions Findings add to current knowledge about barriers to change and implementation of multiple guideline recommendations. Major challenges included sexuality education and depression screening. Limited knowledge and skills was a common barrier. Knowledge about specific interventions was needed before implementation could commence, and to maintain treatment fidelity. The provision of detailed online intervention protocols and manuals may help clinicians to overcome the knowledge barrier. PMID:23958136

Characteristics of individuals screening positive for substance use in a welfare setting: implications for welfare and substance-use disorders treatment systems.

PubMed

Morgenstern, Jon; Hogue, Aaron; Dasaro, Christopher; Kuerbis, Alexis; Dauber, Sarah

2008-07-01

This study examined barriers to employability, motivation to abstain from substances and to work, and involvement in multiple service systems among male and female welfare applicants with alcohol- and drug-use problems. A representative sample (N= 1,431) of all persons applying for public assistance who screened positive for substance involvement over a 2-year period in a large urban county were recruited in welfare offices. Legal, education, general health, mental health, employment, housing, and child welfare barriers to employability were assessed, as were readiness to abstain from substance use and readiness to work. Only 1 in 20 participants reported no barrier other than substance use, whereas 70% reported at least two other barriers and 40% reported three or more. Moreover, 70% of participants experienced at least one additional barrier classified as "severe" and 30% experienced two or more. The number and type of barriers differed by gender. Latent class analysis revealed four main barriers-plus-readiness profiles among participants: (1) multiple barriers, (2) work experienced, (3) criminal justice, and (4) unstable housing. Findings suggest that comprehensive coordination among social service systems is needed to address the complex problems of low-income Americans with substance-use disorders. Classifying applicants based on barriers and readiness is a promising approach to developing innovative welfare programs to serve the diverse needs of men and women with substance-related problems.

Astrocytic TYMP and VEGFA drive blood-brain barrier opening in inflammatory central nervous system lesions.

PubMed

Chapouly, Candice; Tadesse Argaw, Azeb; Horng, Sam; Castro, Kamilah; Zhang, Jingya; Asp, Linnea; Loo, Hannah; Laitman, Benjamin M; Mariani, John N; Straus Farber, Rebecca; Zaslavsky, Elena; Nudelman, German; Raine, Cedric S; John, Gareth R

2015-06-01

In inflammatory central nervous system conditions such as multiple sclerosis, breakdown of the blood-brain barrier is a key event in lesion pathogenesis, predisposing to oedema, excitotoxicity, and ingress of plasma proteins and inflammatory cells. Recently, we showed that reactive astrocytes drive blood-brain barrier opening, via production of vascular endothelial growth factor A (VEGFA). Here, we now identify thymidine phosphorylase (TYMP; previously known as endothelial cell growth factor 1, ECGF1) as a second key astrocyte-derived permeability factor, which interacts with VEGFA to induce blood-brain barrier disruption. The two are co-induced NFκB1-dependently in human astrocytes by the cytokine interleukin 1 beta (IL1B), and inactivation of Vegfa in vivo potentiates TYMP induction. In human central nervous system microvascular endothelial cells, VEGFA and the TYMP product 2-deoxy-d-ribose cooperatively repress tight junction proteins, driving permeability. Notably, this response represents part of a wider pattern of endothelial plasticity: 2-deoxy-d-ribose and VEGFA produce transcriptional programs encompassing angiogenic and permeability genes, and together regulate a third unique cohort. Functionally, each promotes proliferation and viability, and they cooperatively drive motility and angiogenesis. Importantly, introduction of either into mouse cortex promotes blood-brain barrier breakdown, and together they induce severe barrier disruption. In the multiple sclerosis model experimental autoimmune encephalitis, TYMP and VEGFA co-localize to reactive astrocytes, and correlate with blood-brain barrier permeability. Critically, blockade of either reduces neurologic deficit, blood-brain barrier disruption and pathology, and inhibiting both in combination enhances tissue preservation. Suggesting importance in human disease, TYMP and VEGFA both localize to reactive astrocytes in multiple sclerosis lesion samples. Collectively, these data identify TYMP as an astrocyte-derived permeability factor, and suggest TYMP and VEGFA together promote blood-brain barrier breakdown. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

(001) 3C SiC/Ni contact interface: In situ XPS observation of annealing induced Ni2Si formation and the resulting barrier height changes

NASA Astrophysics Data System (ADS)

Tengeler, Sven; Kaiser, Bernhard; Chaussende, Didier; Jaegermann, Wolfram

2017-04-01

The electronic states of the (001) 3C SiC/Ni interface prior and post annealing are investigated via an in situ XPS interface experiment, allowing direct observation of the induced band bending and the transformation from Schottky to ohmic behaviour for the first time. A single domain (001) 3C SiC sample was prepared via wet chemical etching. Nickel was deposited on the sample in multiple in situ deposition steps via RF sputtering, allowing observation of the 3C SiC/Ni interface formation. Over the course of the experiments, an upward band bending of 0.35 eV was observed, along with defect induced Fermi level pinning. This indicates a Schottky type contact behaviour with a barrier height of 0.41 eV. The subsequent annealing at 850 °C for 5 min resulted in the formation of a Ni2Si layer and a reversal of the band bending to 0.06 eV downward. Thus explaining the ohmic contact behaviour frequently reported for annealed n-type 3C SiC/Ni contacts.

Canadian Otolaryngology - Head and Neck Surgery clerkship curricula: evolving toward tomorrow’s learners

PubMed Central

2013-01-01

Background Increasing focus is being placed on Clerkship curriculum design and implementation in light of new undergraduate medical education research and accreditation standards. Canadian Otolaryngology-Head and Neck Surgery (OTOHNS) Clerkship programs are continually but independently evolving towards a common goal of improving Clerkship curriculum. Methods An electronic survey was sent to undergraduate OTOHNS directors at all Canadian medical schools (n = 17) examining their Clerkship curricula. Themes included Clerkship format, teaching methods, faculty support and development, program strengths, and barriers. Results Survey response rate was 76%. All responding schools had OTOHNS Clerkship programs ranging in type (mandatory, selective or elective) and length (<1 to 4 weeks). Learning modalities varied. Electronic learning tools were identified as increasingly important to curriculum delivery. Common strengths included wide clinical exposure and one-on-one mentoring. Multiple challenges were identified in curriculum implementation and evaluation. All schools expressed interest in developing national standards, objectives and e-learning resources. Conclusions Significant variation exists in OTOHNS Clerkship experiences between Canadian medical schools. Many schools perceive barriers of insufficient time, space and curriculum standardization. Interested Canadian OTOHNS educators are eager to collaborate to improve the collective OTOHNS Clerkship experience. PMID:23663703

Barriers to Medical Compassion as a Function of Experience and Specialization: Psychiatry, Pediatrics, Internal Medicine, Surgery, and General Practice.

PubMed

Fernando, Antonio T; Consedine, Nathan S

2017-06-01

Compassion is an expectation of patients, regulatory bodies, and physicians themselves. Most research has, however, studied compassion fatigue rather than compassion itself and has concentrated on the role of the physician. The Transactional Model of Physician Compassion suggests that physician, patient, external environment, and clinical factors are all relevant. Because these factors vary both across different specialities and among physicians with differing degrees of experience, barriers to compassion are also likely to vary. We describe barriers to physician compassion as a function of specialization (psychiatry, general practice, surgery, internal medicine, and pediatrics) and physician experience. We used a cross-sectional study using demographic data, specialization, practice parameters, and the Barriers to Physician Compassion Questionnaire. Nonrandom convenience sampling was used to recruit 580 doctors, of whom 444 belonged to the targeted speciality groups. The sample was characterized before conducting a factorial Multivariate Analysis of Covariance and further post hoc analyses. A 5 (speciality grouping) × 2 (more vs. less physician experience) Multivariate Analysis of Covariance showed that the barriers varied as a function of both speciality and experience. In general, psychiatrists reported lower barriers, whereas general practitioners and internal medicine specialists generally reported greater barriers. Barriers were generally greater among less experienced doctors. Documenting and investigating barriers to compassion in different speciality groups have the potential to broaden current foci beyond the physician and inform interventions aimed at enhancing medical compassion. In addition, certain aspects of the training or practice of psychiatry that enhance compassion may mitigate barriers to compassion in other specialities. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Microscopic description of pair transfer between two superfluid Fermi systems: Combining phase-space averaging and combinatorial techniques

NASA Astrophysics Data System (ADS)

Regnier, David; Lacroix, Denis; Scamps, Guillaume; Hashimoto, Yukio

2018-03-01

In a mean-field description of superfluidity, particle number and gauge angle are treated as quasiclassical conjugated variables. This level of description was recently used to describe nuclear reactions around the Coulomb barrier. Important effects of the relative gauge angle between two identical superfluid nuclei (symmetric collisions) on transfer probabilities and fusion barrier have been uncovered. A theory making contact with experiments should at least average over different initial relative gauge-angles. In the present work, we propose a new approach to obtain the multiple pair transfer probabilities between superfluid systems. This method, called phase-space combinatorial (PSC) technique, relies both on phase-space averaging and combinatorial arguments to infer the full pair transfer probability distribution at the cost of multiple mean-field calculations only. After benchmarking this approach in a schematic model, we apply it to the collision 20O+20O at various energies below the Coulomb barrier. The predictions for one pair transfer are similar to results obtained with an approximated projection method, whereas significant differences are found for two pairs transfer. Finally, we investigated the applicability of the PSC method to the contact between nonidentical superfluid systems. A generalization of the method is proposed and applied to the schematic model showing that the pair transfer probabilities are reasonably reproduced. The applicability of the PSC method to asymmetric nuclear collisions is investigated for the 14O+20O collision and it turns out that unrealistically small single- and multiple pair transfer probabilities are obtained. This is explained by the fact that relative gauge angle play in this case a minor role in the particle transfer process compared to other mechanisms, such as equilibration of the charge/mass ratio. We conclude that the best ground for probing gauge-angle effects in nuclear reaction and/or for applying the proposed PSC approach on pair transfer is the collisions of identical open-shell spherical nuclei.

A stepped pressure profile model for internal transport barriers

NASA Astrophysics Data System (ADS)

Hole, Matthew; Hudson, Stuart; Dewar, Robert

2007-11-01

B ∇x et al We develop a multiple interface variational model, comprising multiple Taylor-relaxed plasma regions separated by ideal MHD barriers. The magnetic field in each region is Beltrami, = μ, and the pressure constant. Between these regions the pressure, field strength, and rotational transform may have step changes at the ideal barrier. A principle motivation is the development of a mathematically rigorous ideal MHD model to describe intrinsically 3D equilibria, with nonzero internal pressure, using robust KAM surfaces as the barriers. As each region is locally relaxed however, such a model may also yield reasons for existence of internal transport barriers (ITBs). Focusing on the latter, we build on Hole Nuc. Fus. 47, pp746-753, 2007, which recently studied the stability of a two-interface periodic-cylinder configuration. In this work, we perform a stability scan over pressure and for a two-interface configuration with no jump in , and compare the characteristics of stable equilibria to those of ITB's.

Stationary phase method and delay times for relativistic and non-relativistic tunneling particles

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

Bernardini, A.E.

2009-06-15

The stationary phase method is frequently adopted for calculating tunneling phase times of analytically-continuous Gaussian or infinite-bandwidth step pulses which collide with a potential barrier. This report deals with the basic concepts on deducing transit times for quantum scattering: the stationary phase method and its relation with delay times for relativistic and non-relativistic tunneling particles. After reexamining the above-barrier diffusion problem, we notice that the applicability of this method is constrained by several subtleties in deriving the phase time that describes the localization of scattered wave packets. Using a recently developed procedure - multiple wave packet decomposition - for somemore » specifical colliding configurations, we demonstrate that the analytical difficulties arising when the stationary phase method is applied for obtaining phase (traversal) times are all overcome. In this case, we also investigate the general relation between phase times and dwell times for quantum tunneling/scattering. Considering a symmetrical collision of two identical wave packets with an one-dimensional barrier, we demonstrate that these two distinct transit time definitions are explicitly connected. The traversal times are obtained for a symmetrized (two identical bosons) and an antisymmetrized (two identical fermions) quantum colliding configuration. Multiple wave packet decomposition shows us that the phase time (group delay) describes the exact position of the scattered particles and, in addition to the exact relation with the dwell time, leads to correct conceptual understanding of both transit time definitions. At last, we extend the non-relativistic formalism to the solutions for the tunneling zone of a one-dimensional electrostatic potential in the relativistic (Dirac to Klein-Gordon) wave equation where the incoming wave packet exhibits the possibility of being almost totally transmitted through the potential barrier. The conditions for the occurrence of accelerated and, eventually, superluminal tunneling transmission probabilities are all quantified and the problematic superluminal interpretation based on the non-relativistic tunneling dynamics is revisited. Lessons concerning the dynamics of relativistic tunneling and the mathematical structure of its solutions suggest revealing insights into mathematically analogous condensed-matter experiments using electrostatic barriers in single- and bi-layer graphene, for which the accelerated tunneling effect deserves a more careful investigation.« less

Binational utilization and barriers to care among Mexican American border residents with diabetes.

PubMed

de Heer, Hendrik D; Salinas, Jennifer; Lapeyrouse, Lisa M; Heyman, Josiah; Morera, Osvaldo F; Balcazar, Hector G

2013-09-01

To assess whether U.S.-Mexico border residents with diabetes 1) experience greater barriers to medical care in the United States of America versus Mexico and 2) are more likely to seek care and medication in Mexico compared to border residents without diabetes. A stratified two-stage randomized cross-sectional health survey was conducted in 2009 - 2010 among 1 002 Mexican American households. Diabetes rates were high (15.4%). Of those that had diabetes, most (86%) reported comorbidities. Compared to participants without diabetes, participants with diabetes had slightly greater difficulty paying US$ 25 (P = 0.002) or US$ 100 (P = 0.016) for medical care, and experienced greater transportation and language barriers (P = 0.011 and 0.014 respectively) to care in the United States, but were more likely to have a person/place to go for medical care and receive screenings. About one quarter of participants sought care or medications in Mexico. Younger age and having lived in Mexico were associated with seeking care in Mexico, but having diabetes was not. Multiple financial barriers were independently associated with approximately threefold-increased odds of going to Mexico for medical care or medication. Language barriers were associated with seeking care in Mexico. Being confused about arrangements for medical care and the perception of not always being treated with respect by medical care providers in the United States were both associated with seeking care and medication in Mexico (odds ratios ranging from 1.70 - 2.76). Reporting modifiable barriers to medical care was common among all participants and slightly more common among 1) those with diabetes and 2) those who sought care in Mexico. However, these are statistically independent phenomena; persons with diabetes were not more likely to use services in Mexico. Each set of issues (barriers facing those with diabetes, barriers related to use of services in Mexico) may occur side by side, and both present opportunities for improving access to care and disease management.

Monitoring the Vadose Zone Moisture Regime Below a Surface Barrier

NASA Astrophysics Data System (ADS)

Zhang, Z. F.; Strickland, C. E.; Field, J. G.

2009-12-01

A 6000 m2 interim surface barrier has been constructed over a portion of the T Tank Farm in the Depart of Energy’s Hanford site. The purpose of using a surface barrier was to reduce or eliminate the infiltration of meteoric precipitation into the contaminated soil zone due to past leaks from Tank T-106 and hence to reduce the rate of movement of the plume. As part of the demonstration effort, vadose zone moisture is being monitored to assess the effectiveness of the barrier on the reduction of soil moisture flow. A vadose zone monitoring system was installed to measure soil water conditions at four horizontal locations (i.e., instrument Nests A, B, C, and D) outside, near the edge of, and beneath the barrier. Each instrument nest consists of a capacitance probe with multiple sensors, multiple heat-dissipation units, and a neutron probe access tube used to measure soil-water content and soil-water pressure. Nest A serves as a control by providing subsurface conditions outside the influence of the surface barrier. Nest B provides subsurface measurements to assess barrier edge effects. Nests C and D are used to assess the impact of the surface barrier on soil-moisture conditions beneath it. Monitoring began in September 2006 and continues to the present. To date, the monitoring system has provided high-quality data. Results show that the soil beneath the barrier has been draining from the shallower depth. The lack of climate-caused seasonal variation of soil water condition beneath the barrier indicates that the surface barrier has minimized water exchange between the soil and the atmosphere.

A qualitative study of methamphetamine users' perspectives on barriers and facilitators of drug abstinence.

PubMed

Herbeck, Diane M; Brecht, Mary-Lynn; Christou, Dayna; Lovinger, Katherine

2014-01-01

To better understand methamphetamine (MA) use patterns and the process of recovery, qualitative interviews were conducted with adult MA users (n = 20), comparing a sample that received substance abuse treatment with those who had not received treatment. Respondents provided detailed information on why and how they changed from use to abstinence and factors they considered to be barriers to abstinence. Audio recordings and transcripts were reviewed for common themes. Participants reported a range of mild/moderate to intensely destructive problems, including loss of important relationships and profound changes to who they felt they were at their core; e.g., "I didn't realize how dark and mean I was … I was like a different person." Initial abstinence was often facilitated by multiple external forces (e.g., drug testing, child custody issues, prison, relocation), but sustained abstinence was attributed to shifts in thinking and salient realizations about using. The treatment group reported using more and different resources to maintain their abstinence than the no-treatment group. Findings indicate individualized interventions and multiple, simultaneous approaches and resources were essential in reaching stable abstinence. Understanding long-term users' experiences with MA use, addiction, and abstinence can inform strategies for engaging and sustaining MA users in treatment and recovery.

A Qualitative Study of Methamphetamine Users’ Perspectives on Barriers and Facilitators of Drug Abstinence

PubMed Central

Herbeck, Diane M.; Brecht, Mary-Lynn; Christou, Dayna; Lovinger, Katherine

2014-01-01

To better understand methamphetamine (MA) use patterns and the process of recovery, qualitative interviews were conducted with adult MA users (n=20), comparing a sample that received substance abuse treatment with those who had not received treatment. Respondents provided detailed information on why and how they changed from use to abstinence, and factors they considered to be barriers to abstinence. Audio recordings and transcripts were reviewed for common themes. Participants reported a range of mild/moderate to intensely destructive problems, including loss of important relationships and profound changes to who they felt they were at their core, e.g., “I didn’t realize how dark and mean I was... I was like a different person.” Initial abstinence was often facilitated by multiple external forces (e.g., drug testing, child custody issues, prison, relocation), but sustained abstinence was attributed to shifts in thinking and salient realizations about using. The treatment group reported using more and different resources to maintain their abstinence than the no treatment group. Findings indicate individualized interventions and multiple, simultaneous approaches and resources were essential in reaching stable abstinence. Understanding long-term users’ experiences with MA use, addiction and abstinence can inform strategies for engaging and sustaining MA users in treatment and recovery. PMID:25052880

Overcoming Pedagogical, Social/Cultural, and Attitudinal Barriers to Technology Integration in K-5 Schools

ERIC Educational Resources Information Center

Durff, Lisa

2017-01-01

Technology engages and increases academic achievement for K-5 students, but teachers face attitudinal, social/cultural, and pedagogical barriers when they integrate technology for student learning. Although some teachers overcome these barriers, it remains unclear how they do so. The purpose of this qualitative multiple case study was to analyze…

Conflict on interprofessional primary health care teams--can it be resolved?

PubMed

Brown, Judith; Lewis, Laura; Ellis, Kathy; Stewart, Moira; Freeman, Thomas R; Kasperski, M Janet

2011-01-01

Increasingly, primary health care teams (PHCTs) depend on the contributions of multiple professionals. However, conflict is inevitable on teams. This article examines PHCTs members' experiences with conflict and responses to conflict. This phenomenological study was conducted using in-depth interviews with 121 participants from 16 PHCTs (10 urban and 6 rural) including a wide range of health care professionals. An iterative analysis process was used to examine the verbatim transcripts. The analysis revealed three main themes: sources of team conflict; barriers to conflict resolution; and strategies for conflict resolution. Sources of team conflict included: role boundary issues; scope of practice; and accountability. Barriers to conflict resolution were: lack of time and workload; people in less powerful positions; lack of recognition or motivation to address conflict; and avoiding confrontation for fear of causing emotional discomfort. Team strategies for conflict resolution included interventions by team leaders and the development of conflict management protocols. Individual strategies included: open and direct communication; a willingness to find solutions; showing respect; and humility. Conflict is inherent in teamwork. However, understanding the potential barriers to conflict resolution can assist PHCTs in developing strategies to resolve conflict in a timely fashion.

Barriers and enhancers to dietary behaviour change for Aboriginal people attending a diabetes cooking course.

PubMed

Abbott, Penelope; Davison, Joyce; Moore, Louise; Rubinstein, Raechelle

2010-04-01

Aboriginal people access diabetes and nutrition education less than non-Aboriginal people. Culturally appropriate, effective and accessible diabetes and nutrition education for Aboriginal people is urgently needed. A qualitative approach was used to explore the experiences of Aboriginal people who had attended cooking courses run at the Aboriginal Medical Service Western Sydney between 2002 and 2007. Data from 23 semi-structured interviews were analysed thematically. Despite reported improvements in nutrition knowledge and cooking skills, the ability of participants to implement desired dietary changes varied. A new health diagnosis, such as diabetes, pre-diabetes, heart disease or cancer and the desire of participants to influence their families to lead healthier, diabetes-free lives were strong motivators for dietary change. In contrast, lack of family support for dietary change and a sense of social isolation caused by dietary change strongly impeded some participants' attempts to improve their diets. Other significant barriers were poor oral health and depression, the higher cost of healthier food and generational food preferences. Aboriginal cooking course participants faced multiple barriers to dietary change - social, financial, medical and historical. The family was the most crucial determinant of participant ability to achieve sustained dietary change.

Learner-centred teaching in a non-learner-centred world: An interpretive phenomenological study of the lived experience of clinical nursing faculty.

PubMed

Oyelana, Olabisi; Martin, Donna; Scanlan, Judith; Temple, Beverley

2018-08-01

With the growing complexities in the contemporary health care system, there is a challenge of preparing nurses for the practice demands. To this end, learner-centred teaching has emerged in many nursing curricula in Canada and evidence indicates its effectiveness in developing the essential practice skills in nursing students. It is important to examine the experience of the clinical faculty members who implement learner-centred teaching, as doing so would provide an insight to the factors that may hinder the implementation of learner-centred teaching in the practice settings. This phenomenological study aimed to address two research questions: what does learner-centred teaching mean to clinical nurse faculty? What is the lived experience of clinical nursing faculty who incorporate learner-centred teaching? Ten clinical nurse faculty members who had at least two years of clinical teaching experience volunteered to participate in the study. Data were collected using a semi-structured interview guide and audio recorder. Additional data sources included a demographic survey and a reflective journal. Multiple sub-themes emerged from this study from which three significant themes were consolidated: diversity of meanings, facilitators of LCT, and barriers to LCT. However, an overarching theme of "learner-centred teaching in a non-learner-centred world" was coined from participants' accounts of their experiences of barriers in incorporating LCT in the practice settings. A collaborative effort between faculty and the stakeholders is paramount to a successful implementation of learner-centred teaching in practice settings. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

Parameter study of shipping conditions for the ready-to-use application of a 3D human hemicornea construct in drug absorption studies.

PubMed

Beißner, Nicole; Zorn-Kruppa, Michaela; Reichl, Stephan

2018-01-30

In this study, a shipping protocol for our 3D human hemicornea (HC) construct should be developed to provide quality-maintaining shipping conditions and to allow its ready-to-use application in drug absorption studies. First, the effects of single and multiple parameters, such as the type of shipping container, storage temperature and CO 2 supply, were investigated under controlled laboratory conditions by assessing cell viability via MTT dye reaction and epithelial barrier properties via transepithelial electrical resistance (TEER) measurements. These investigations showed that TEER is more susceptible to shipping parameters than cell viability. Furthermore, the results were used to determine the optimal shipping conditions and critical values for subsequent overnight, real-time shipping experiments. Epithelial barrier properties were then investigated via TEER and the permeation of sodium fluorescein for shipped and not shipped HC. The results underscore that acceleration forces and changes in position may have a great impact on the epithelial barrier of 3D models. Low acceleration values and short changes in position caused only minor impairments. However, combined or intensive separate effects resulted in considerably low yields after shipping. Consequently, barrier-maintaining shipping of 3D in vitro models seems to be challenging, as mechanical forces have to be reduced to a minimum. Copyright © 2017 Elsevier B.V. All rights reserved.

Asymmetric reproductive barriers and mosaic reproductive isolation: insights from Misty lake–stream stickleback

PubMed Central

Räsänen, Katja; Hendry, Andrew P

2014-01-01

Ecological speciation seems to occur readily but is clearly not ubiquitous – and the relative contributions of different reproductive barriers remain unclear in most systems. We here investigate the potential importance of selection against migrants in lake/stream stickleback (Gasterosteus aculeatus) from the Misty Lake system, Canada. This system is of particular interest because one population contrast (Lake vs. Outlet stream) shows very low genetic and morphological divergence, whereas another population contrast (Lake vs. Inlet stream) shows dramatic genetic and morphological divergence apparently without strong and symmetric reproductive barriers. To test whether selection against migrants might solve this “conundrum of missing reproductive isolation”, we performed a fully factorial reciprocal transplant experiment using 225 individually marked stickleback collected from the wild. Relative fitness of the different ecotypes (Lake, Inlet, and Outlet) was assessed based on survival and mass change in experimental enclosures. We found that Inlet fish performed poorly in the lake (selection against migrants in that direction), whereas Lake fish outperformed Inlet fish in all environments (no selection against migrants in the opposite direction). As predicted from their phenotypic and genetic similarity, Outlet and Lake fish performed similarly in all environments. These results suggest that selection against migrants is asymmetric and, together with previous work, indicates that multiple reproductive barriers contribute to reproductive isolation. Similar mosaic patterns of reproductive isolation are likely in other natural systems. PMID:24772291

Implementing stakeholder-informed research in the substance abuse treatment sector: strategies used by Connections, a Canadian knowledge translation and exchange project.

PubMed

Henderson, Joanna; Sword, Wendy; Niccols, Alison; Dobbins, Maureen

2014-05-29

Researcher-stakeholder collaboration has been identified as critical to bridging research and health system change. While collaboration models vary, meaningful stakeholder involvement over time ("integrated knowledge translation") is advocated to improve the relevance of research to knowledge users. This short report describes the integrated knowledge translation efforts of Connections, a knowledge translation and exchange project to improve services for women with substance abuse problems and their children, and implementation barriers and facilitators. Strategies of varying intensities were used to engage diverse stakeholders, including policy makers and people with lived experience, and executive directors, program managers, and service providers from Canadian addiction agencies serving women. Barriers to participation included individual (e.g., interest), organizational (e.g., funding), and system level (e.g., lack of centralized stakeholder database) barriers. Similarly, facilitators included individual (e.g., perceived relevance) and organizational (e.g., support) facilitators, as well as initiative characteristics (e.g., multiple involvement opportunities). Despite barriers, Connections' stakeholder-informed research efforts proved essential for developing clinically relevant and feasible processes, measures, and implementation strategies. Stakeholder-researcher collaboration is possible and robust integrated knowledge translation efforts can be productive. Future work should emphasize developing and evaluating a range of strategies to address stakeholders' knowledge translation needs and to facilitate sustained and meaningful involvement in research.

An exploratory study of how sports and recreation industry personnel perceive the barriers and facilitators of physical activity in children with disability.

PubMed

Shields, Nora; Synnot, Anneliese J

2014-01-01

To explore the perceived barriers and facilitators to participation in physical activity among children with disability in physical activity and community sports from the perspective of sports and recreation industry personnel. A convenient sample of 24 participants was recruited from delegates attending a symposium on physical activity for organisations in the sport and recreation sector in Victoria, Australia. The participants completed a brief questionnaire. Data were analysed by content analysis using an inductive approach. The participants reported 25 facilitators and 20 barriers to participation for children with disability. The top five reported facilitators were: welcoming providers, support and encouragement from parents or others, inclusive providers, adaptable approaches and accessibility of facilities. The top five reported barriers were: inaccessible facilities, non-inclusive providers, transport, lack of relevant opportunities and cost. Sports industry personnel share a similar perspective to families of potential barriers and facilitators to engagement by children with disability in physical activity and community sports. Policy change was not considered as a facilitator of physical activity, even though four of the top five facilitators identified could be implemented through local policy change. Implications for Rehabilitation There are multiple factors that interact with each other which influence the participation by children with disability in physical activity and community sports. The sports and recreation industry should consider policy change as a relevant way to facilitate participation by children with disability in physical activity. More professional development and disability engagement opportunities for sports and recreation industry personnel may help address some of the barriers to participation for children with disability experience.

Understanding the complex interplay of barriers to physical activity amongst black and minority ethnic groups in the United Kingdom: a qualitative synthesis using meta-ethnography.

PubMed

Koshoedo, Sejlo A; Paul-Ebhohimhen, Virginia A; Jepson, Ruth G; Watson, Margaret C

2015-07-12

To conduct a meta-ethnographic analysis of qualitative studies to identify barriers to Black and Minority Ethnic (BME) individuals engaging in physical activity in the UK context. A qualitative synthesis using meta-ethnographic methods to synthesis studies of barriers to engaging in physical activity among BME groups in the UK. A comprehensive search strategy of multiple databases was employed to identify qualitative research studies published up to October 2012. The eleven searched databases included ASSIA, MEDLINE, EMBASE, CINAHL, Health Technology Assessment (HTA), NHS Scotland Library, Physical Activity Health Alliance (PAHA), PsyINFO, Social Services Abstract, Sport discuss and Web of Science. The Noblit and Hare's meta-ethnographic approach was undertaken to develop an inductive and interpretive form of knowledge synthesis. Fourteen papers met the inclusion criteria. The synthesis indicated that barriers to physical activity among BME individuals were influenced by four main concepts: perceptions; cultural expectations; personal barriers; and factors limiting access to facilities. BME individuals had different understandings of physical activity were influenced by migration history, experiences, cultural and health beliefs. This in turn may have a disempowering effect on BME individuals in terms of adopting or maintaining physical activity. These barriers to physical activity were explained at a higher conceptual level by a socio-ecological model. The social construct 'individual perception and understanding of physical activity' was particularly relevant to theoretical models and interventions. Interventions to promote engagement with physical activity need to address perceptions of this behaviour. The elicited concepts and contexts could be used to enhance the development of tailored effective health promotion interventions for BME individuals.

Motivational interviewing as a pedagogical approach in behavioral science education: "walking the talk".

PubMed

Triana, A Catalina; Olson, Michael

2013-01-01

Motivational Interviewing (MI) is an evidence-based approach to facilitating behavior change. This approach has been applied in multiple settings (e.g., healthcare, drug and alcohol treatment, psychotherapy, health and wellness coaching, etc.). This article applies MI in a pedagogical context with medical residents as a semi-directive, learner-centered teaching style for eliciting clinical behavior change. Herein we present the foundational theories that inform this approach, describe the process of teaching, address barriers and challenges, and conclude with a review of performance to date including residents' narrative accounts of their experience with the curriculum.

A Scoping Review of Immigrant Experience of Health Care Access Barriers in Canada.

PubMed

Kalich, Angela; Heinemann, Lyn; Ghahari, Setareh

2016-06-01

Canadian population-based surveys report comparable access to health care services between immigrant and non-immigrant populations, yet other research reports immigrant-specific access barriers. A scoping review was conducted to explore research regarding Canadian immigrants' unique experiences in accessing health care, and was guided by the research question: "What is currently known about the barriers that adult immigrants face when accessing Canadian health care services?" The findings of this study suggest that there are unmet health care access needs specific to immigrants to Canada. In reviewing research of immigrants' health care experiences, the most common access barriers were found to be language barriers, barriers to information, and cultural differences. These findings, in addition to low cultural competency reported by interviewed health care workers in the reviewed articles, indicate inequities in access to Canadian health care services for immigrant populations. Suggestions for future research and programming are discussed.

Advancing drug availability-experiences from Africa.

PubMed

Powell, Richard A; Kaye, Richard Mugula; Ddungu, Henry; Mwangi-Powell, Faith

2010-07-01

International health and drug regulatory authorities acknowledge that analgesics (especially opioids) are insufficiently available for pain management in many countries. In Africa, reported morphine consumption is far below the global mean, with multiple factors hampering opioid supply. Since 2006, the African Palliative Care Association has hosted three regional drug availability workshops across the continent to address this issue. Using an interactive format, the workshops have identified country-specific barriers to opioid and other essential medication accessibility before supporting participants to develop action plans to address recognized impediments. Despite multiple challenges, a number of successes have arisen from the implementation of the plans. However, key issues remain, including the introduction of supportive policy environments, effective educational initiatives, and measures to address supply-chain obstacles impeding drug availability. Copyright 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Influence of in doping in GaN barriers on luminescence properties of InGaN/GaN multiple quantum well LEDs

NASA Astrophysics Data System (ADS)

Wang, Xiaowei; Yang, Jing; Zhao, Degang; Jiang, Desheng; Liu, Zongshun; Liu, Wei; Liang, Feng; Liu, Shuangtao; Xing, Yao; Wang, Wenjie; Li, Mo

2018-02-01

Room-temperature photoluminescence (RT PL) spectra of InGaN/GaN multiple quantum well (MQW) structures grown by metalorganic chemical vapor deposition (MOCVD) was investigated. It is found that with increasing In content in GaN barriers, the FWHM and emission intensity decreases, and the emission wavelength is first red shift and then blue shift. The shrinkage of FWHM and emission wavelength blue shift can be attributed to the reduction of piezoelectric field, and the lower height of potential barrier will make carrier confinement weaker and ground state level lower, which resulting in emission intensity decreasing and wavelength red shift. In addition, doping the barrier with In will induce more inhomogeneous and deeper localized states in InGaN QWs, which also contribute to a red shift of PL emission wavelength.

Reactive barrier system for nitrate removal from mine effluents in northern Sweden: Laboratory experiments

NASA Astrophysics Data System (ADS)

Herbert, Roger

2010-05-01

Laboratory column experiments have been conducted to determine nitrate removal rates from mine effluents by denitrification, with the purpose of providing initial data for the construction of a pilot scale reactive barrier system at the Malmberget iron mine, Sweden. Experiments were conducted at several different flow rates at 5C, 10C and room temperature; annual mean temperatures at the Malmberget site lie close to 0C. Columns were filled with an organic substrate consisting of sawdust mixed with sewage sludge, the source of denitrifying bacteria, supported by oven-dried clay pellets. Apparent denitrification rates, calculated from inflow and outflow nitrate concentrations and column hydraulic residence time, ranged from 5 to 13 mg N/L/d, with the lowest rates corresponding to the 5C experiments. These rates are, however, limited to a certain degree by the low flow rate and the supply of electrons acceptors (i.e. nitrate) to denitrifying bacteria. Results from the column experiment have been used to construct a barrier system in Malmberget, Sweden. Trial runs with the pilot-scale barrier will be conducted during 2010, with the purpose of determining the performance of the barrier as mean air temperatures increase from below to above 0C and saturated flow commences in the barrier. The barrier system is constructed as a rectangular container with steel sheet walls (9m length in flow direction, 1.5m deep), and the flow rate will be adjusted to a hydraulic residence time of 1 day. The pilot-scale barrier system currently lies above ground, but a permanent barrier system would be installed below the ground surface so that the system can be maintained at positive temperatures throughout the year.

Characteristics of Individuals Screening Positive for Substance Use in a Welfare Setting: Implications for Welfare and Substance-Use Disorders Treatment Systems*

PubMed Central

MORGENSTERN, JON; HOGUE, AARON; DASARO, CHRISTOPHER; KUERBIS, ALEXIS; DAUBER, SARAH

2016-01-01

Objective This study examined barriers to employability, motivation to abstain from substances and to work, and involvement in multiple service systems among male and female welfare applicants with alcohol- and drug-use problems. Method A representative sample (N = 1,431) of all persons applying for public assistance who screened positive for substance involvement over a 2-year period in a large urban county were recruited in welfare offices. Legal, education, general health, mental health, employment, housing, and child welfare barriers to employability were assessed, as were readiness to abstain from substance use and readiness to work. Results Only 1 in 20 participants reported no barrier other than substance use, whereas 70% reported at least two other barriers and 40% reported three or more. Moreover, 70% of participants experienced at least one additional barrier classified as “severe” and 30% experienced two or more. The number and type of barriers differed by gender. Latent class analysis revealed four main barriers-plus-readiness profiles among participants: (1) multiple barriers, (2) work experienced, (3) criminal justice, and (4) unstable housing. Conclusions Findings suggest that comprehensive coordination among social service systems is needed to address the complex problems of low-income Americans with substance-use disorders. Classifying applicants based on barriers and readiness is a promising approach to developing innovative welfare programs to serve the diverse needs of men and women with substance-related problems. PMID:18612572

Women and women of color in leadership: complexity, identity, and intersectionality.

PubMed

Sanchez-Hucles, Janis V; Davis, Donald D

2010-04-01

This article describes the challenges that women and women of color face in their quest to achieve and perform in leadership roles in work settings. We discuss the barriers that women encounter and specifically address the dimensions of gender and race and their impact on leadership. We identify the factors associated with gender evaluations of leaders and the stereotypes and other challenges faced by White women and women of color. We use ideas concerning identity and the intersection of multiple identities to understand the way in which gender mediates and shapes the experience of women in the workplace. We conclude with suggestions for research and theory development that may more fully capture the complex experience of women who serve as leaders. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Exploring the facilitators and barriers to engagement in physical activity for people with multiple sclerosis.

PubMed

Kayes, Nicola M; McPherson, Kathryn M; Schluter, Philip; Taylor, Denise; Leete, Marta; Kolt, Gregory S

2011-01-01

To explore the relationship that cognitive behavioural and other previously identified variables have with physical activity engagement in people with multiple sclerosis (MS). This study adopted a cross-sectional questionnaire design. Participants were 282 individuals with MS. Outcome measures included the Physical Activity Disability Survey--Revised, Cognitive and Behavioural Responses to Symptoms Questionnaire, Barriers to Health Promoting Activities for Disabled Persons Scale, Multiple Sclerosis Self-efficacy Scale, Self-Efficacy for Chronic Diseases Scales and Chalder Fatigue Questionnaire. Multivariable stepwise regression analyses found that greater self-efficacy, greater reported mental fatigue and lower number of perceived barriers to physical activity accounted for a significant proportion of variance in physical activity behaviour, over that accounted for by illness-related variables. Although fear-avoidance beliefs accounted for a significant proportion of variance in the initial analyses, its effect was explained by other factors in the final multivariable analyses. Self-efficacy, mental fatigue and perceived barriers to physical activity are potentially modifiable variables which could be incorporated into interventions designed to improve physical activity engagement. Future research should explore whether a measurement tool tailored to capture beliefs about physical activity identified by people with MS would better predict participation in physical activity.

Barrier-free communication in maternity care of allophone migrants: BRIDGE study protocol.

PubMed

Origlia Ikhilor, Paola; Hasenberg, Gabriele; Kurth, Elisabeth; Stocker Kalberer, Barbara; Cignacco, Eva; Pehlke-Milde, Jessica

2018-02-01

To describe communication and access barriers encountered by allophone women of different migration backgrounds in the Swiss maternity care services, from the perspective of users, healthcare professionals and intercultural interpreters. In addition to the challenges of maternal adjustment, pregnant migrant women must also deal with an unfamiliar health service system. Some must overcome language barriers and the stress of uncertain residence status. Limited access to maternity care increases perinatal morbidity and mortality. Almost 10% of foreigners speak none of Switzerland's official languages. Factors that facilitate or hinder communication between migrant women and perinatal healthcare professionals are under-studied and must be understood if we are to overcome those barriers in clinical practice. Qualitative exploratory study with quantitative sub-study. Participants will be drawn from German to speaking regions of Switzerland. We will conduct focus group discussions and semi-structured interviews with users in their own language (Albanian and Tigrinya) and with healthcare professionals and intercultural interpreters (March-June 2016), then perform Thematic Analysis on the data. In the sub-study, midwives will report their experience of using a telephone interpreting service during postnatal home visits in a questionnaire (October 2013-March 2016). Data will be analysed with descriptive statistics. Our study will reveal patterns in communications between allophone migrant women and healthcare providers and communication barriers. By incorporating multiple perspectives, we will describe the challenges all parties face. Our results will inform those who draft recommendations to improve provision of maternity care to allophone women and their families. ClinicalTrials.gov ID: BernUAS NCT02695316. © 2017 John Wiley & Sons Ltd.

Alternating-Composition Layered Ceramic Barrier Coatings

NASA Technical Reports Server (NTRS)

Miller, Robert A.; Zhu, Dongming

2008-01-01

Ceramic thermal and environmental barrier coatings (T/EBCs) that contain multiple layers of alternating chemical composition have been developed as improved means of protecting underlying components of gas-turbine and other heat engines against both corrosive combustion gases and high temperatures.

Experimental study of the penetrating of plates by projectile at low initial speeds

NASA Astrophysics Data System (ADS)

Orlov, M. Yu; Orlova, Yu N.; Smakotin, Ig L.; Glazyrin, V. P.; Orlov, Yu N.

2017-11-01

The research of the penetration process of lightweight plates by a projectile in the range of initial velocities up to 325 m/s was attempted. The projectile was a shell bullet and the barriers were of ice, MDF-panels and plexiglas barriers. The response of barriers to impact loading is studied. High-speed shooting of each experiment is obtained, including photos of the front and rear sides of the barriers. An attempt was made to reproduce the scenario of the destruction of barriers. The results of experiments can be interpreted only as qualitative tests. Projectile was not destroyed.

Care Experiences of Adults With a Dual Diagnosis and Their Family Caregivers

PubMed Central

Nicholas, David B.; Calhoun, Avery; McLaughlin, Anne Marie; Shankar, Janki; Kreitzer, Linda; Uzande, Masimba

2017-01-01

Individuals diagnosed with developmental disability and mental illness (a “dual diagnosis”) contend with multiple challenges and system-related barriers. Using an interpretive description approach, separate qualitative interviews were conducted with adults with a dual diagnosis (n = 7) and their caregiving parents (n = 8) to examine care-related experiences. Results indicate that individuals with a dual diagnosis and their families experience misunderstanding and stigma. Families provide informal complex care amid insufficient and uncoordinated services but are often excluded from formal care planning. A lack of available funding and services further impedes care. While negative care experiences are reported as prevalent, participants also describe instances of beneficial care. Overall, findings indicate a lack of sufficiently targeted resources, leaving families to absorb system-related care gaps. Recommendations include person- and family-centered care, navigation support, and capacity building. Prevention and emergency and crisis care services, along with housing, vocation, and other supports, are needed. Practice and research development regarding life span needs are recommended. PMID:28804747

Racial differences in the association between partner abuse and barriers to prenatal health care among Asian and native Hawaiian/other Pacific Islander women.

PubMed

Ta, Van M; Hayes, Donald

2010-05-01

Prenatal health care (PNC) is associated with positive maternal and infant health outcomes. There is limited knowledge regarding Native Hawaiians/Other Pacific Islanders (NHOPI) and Asian women's access to PNC especially among those with partner abuse (PA) experience. The objectives of this paper were to (1) describe and examine factors associated with PNC access barriers among mothers, by race; and, (2) determine the association between PA and PNC access, by race. We analyzed 2004-2007 data from Hawai'i's Pregnancy Risk Assessment Monitoring System (n = 7,158). The outcome is > or = 1 experience with a PNC access barrier. PA is experience with physical violence from a partner. Descriptive statistics, and bivariate and multivariate logistic regression analyses stratified by race were conducted. The respondents included 35.7% NHOPI, 37.4% Asian, 20.1% White and 6.6% Other. More than 6% experienced PA, and 25.9% reported > or = 1 PNC access barrier. Experience with PA was significantly associated with NHOPI and Asians reporting > or = 1 barrier to accessing PNC, but was non-significant with Whites. Programs should address barriers to accessing PNC, and target NHOPI and Asian mothers with PA experience to reduce the healthcare disparity and improve quality of life.

Understanding Barriers to Parent Involvement in Head Start: A Research-Community Partnership.

ERIC Educational Resources Information Center

Lamb-Parker, Faith; Piotrkowski, Chaya S.; Baker, Amy J. L.; Kessler-Sklar, Susan; Clark, Beryl; Peay, Lenore

2001-01-01

This collaborative study examined barriers to parent involvement in the Head Start program among 68 mothers in New York City. Results revealed the presence of many difficult life experiences for mothers, but few were reported as barriers by many mothers. Five out of 20 experiences were associated with staff ratings of mothers' participation level.…

PReSaFe: A model of barriers and facilitators to patients providing feedback on experiences of safety.

PubMed

De Brún, Aoife; Heavey, Emily; Waring, Justin; Dawson, Pamela; Scott, Jason

2017-08-01

The importance of involving patients in reporting on safety is increasingly recognized. Whilst studies have identified barriers to clinician incident reporting, few have explored barriers and facilitators to patient reporting of safety experiences. This paper explores patient perspectives on providing feedback on safety experiences. Patients (n=28) were invited to take part in semi-structured interviews when given a survey about their experiences of safety following hospital discharge. Transcripts were thematically analysed using NVivo10. Patients were recruited from four hospitals in the UK. Three themes were identified as barriers and facilitators to patient involvement in providing feedback on their safety experiences. The first, cognitive-cultural, found that whilst safety was a priority for most, some felt the term was not relevant to them because safety was the "default" position, and/or because safety could not be disentangled from the overall experience of care. The structural-procedural theme indicated that reporting was facilitated when patients saw the process as straightforward, but that disinclination or perceived inability to provide feedback was a barrier. Finally, learning and change illustrated that perception of the impact of feedback could facilitate or inhibit reporting. When collecting patient feedback on experiences of safety, it is important to consider what may help or hinder this process, beyond the process alone. We present a staged model of prerequisite barriers and facilitators and hypothesize that each stage needs to be achieved for patients to provide feedback on safety experiences. Implications for collecting meaningful data on patients' safety experiences are considered. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Finding medical care for colorectal cancer symptoms: experiences among those facing financial barriers.

PubMed

Thomson, Maria D; Siminoff, Laura A

2015-02-01

Financial barriers can substantially delay medical care seeking. Using patient narratives provided by 252 colorectal cancer patients, we explored the experience of financial barriers to care seeking. Of the 252 patients interviewed, 84 identified financial barriers as a significant hurdle to obtaining health care for their colorectal cancer symptoms. Using verbatim transcripts of the narratives collected from patients between 2008 and 2010, three themes were identified: insurance status as a barrier (discussed by n = 84; 100% of subsample), finding medical care (discussed by n = 30; 36% of subsample) and, insurance companies as barriers (discussed by n = 7; 8% of subsample). Our analysis revealed that insurance status is more nuanced than the categories insured/uninsured and differentially affects how patients attempt to secure health care. While barriers to medical care for the uninsured have been well documented, the experiences of those who are underinsured are less well understood. To improve outcomes in these patients it is critical to understand how financial barriers to medical care are manifested. Even with anticipated changes of the Affordable Care Act, it remains important to understand how perceived financial barriers may be influencing patient behaviors, particularly those who have limited health care options due to insufficient health insurance coverage. © 2014 Society for Public Health Education.

The impact of an online Facebook support group for people with multiple sclerosis on non-active users

PubMed Central

Steadman, Jacqui

2014-01-01

Background Multiple sclerosis (MS) is a debilitating disease and there is little research on support networks for people with MS (PwMS). More specifically, most studies on online support groups focus on those who actively participate in the group, whereas the majority of those who utilise online support groups do so in a passive way. Objectives This study therefore aimed to explore the experiences of non-active users of an online Facebook support group for PwMS. Emphasis was placed on the facilitators and the barriers that were associated with membership to this group. Method An exploratory qualitative research design was implemented, whereby thematic analysis was utilised to examine the ten semi-structured interviews that were conducted. Results Several facilitators were acquired through the online support group; namely emotional support (constant source of support, exposure to negative aspects of the disease), informational support (group as a source of knowledge, quality of information) and social companionship (place of belonging). Some barriers were also identified; namely emotional support (emotions lost online, response to messages, exposure to negative aspects of the disease), informational support (information posted on the group, misuse of group) and social companionship (non-active status) Conclusion These findings demonstrate that the non-active members of the online support group for PwMS have valid reasons for their non-active membership status. More important, the findings suggest that the online Facebook support group provided the group members with an important support network in the form of emotional support, informational support and social companionship, despite their non-active membership status or the barriers that have been identified. PMID:28730005

"A Very Steep Climb": Therapists' Perspectives on Barriers to Disclosure of Child Sexual Abuse Experiences for Men.

PubMed

Gruenfeld, Elizabeth; Willis, Danny G; Easton, Scott D

2017-01-01

Recent studies indicate that men experience unique barriers to disclosure of child sexual abuse. Blind spots held by mental health providers and social service agencies may inadvertently help produce and sustain these barriers. However, therapists who specialize in treating this population may also hold important insights into the barriers clients face. Because delayed and nondisclosure of child sexual abuse have been associated with negative mental health outcomes for adult survivors, understanding these barriers is critical to improve clinical practice and facilitate help-seeking. Using conventional content analysis, this study examined the perceptions of nine therapists who specialize in the treatment of men who were sexually abused in childhood, many of whom are considered pioneers in the field. Analyses identified nine types of barriers, which were organized into three categories: intrapersonal experience (difficult feelings, lack of language, and self-engagement), social milieu (internalized social stigma, negative responses, social loss or judgment, and masculine identity dissonance), and health care environment (structural barriers, relational challenges with therapists, and unhelpful therapeutic strategies). Implications for future research, clinical training, and clinical practice are discussed.

Vicarious resilience in sexual assault and domestic violence advocates.

PubMed

Frey, Lisa L; Beesley, Denise; Abbott, Deah; Kendrick, Elizabeth

2017-01-01

There is little research related to sexual assault and domestic violence advocates' experiences, with the bulk of the literature focused on stressors and systemic barriers that negatively impact efforts to assist survivors. However, advocates participating in these studies have also emphasized the positive impact they experience consequent to their work. This study explores the positive impact. Vicarious resilience, personal trauma experiences, peer relational quality, and perceived organizational support in advocates (n = 222) are examined. Also, overlap among the conceptual components of vicarious resilience is explored. The first set of multiple regressions showed that personal trauma experiences and peer relational health predicted compassion satisfaction and vicarious posttraumatic growth, with organizational support predicting only compassion satisfaction. The second set of multiple regressions showed that (a) there was significant shared variance between vicarious posttraumatic growth and compassion satisfaction; (b) after accounting for vicarious posttraumatic growth, organizational support accounted for significant variance in compassion satisfaction; and (c) after accounting for compassion satisfaction, peer relational health accounted for significant variance in vicarious posttraumatic growth. Results suggest that it may be more meaningful to conceptualize advocates' personal growth related to their work through the lens of a multidimensional construct such as vicarious resilience. Organizational strategies promoting vicarious resilience (e.g., shared organizational power, training components) are offered, and the value to trauma-informed care of fostering advocates' vicarious resilience is discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The contribution of post-copulatory mechanisms to incipient ecological speciation in sticklebacks.

PubMed

Kaufmann, Joshka; Eizaguirre, Christophe; Milinski, Manfred; Lenz, Tobias L

2015-01-01

Ecology can play a major role in species diversification. As individuals are adapting to contrasting habitats, reproductive barriers may evolve at multiple levels. While pre-mating barriers have been extensively studied, the evolution of post-mating reproductive isolation during early stages of ecological speciation remains poorly understood. In diverging three-spined stickleback ecotypes from two lakes and two rivers, we observed differences in sperm traits between lake and river males. Interestingly, these differences did not translate into ecotype-specific gamete precedence for sympatric males in competitive in vitro fertilization experiments, potentially owing to antagonistic compensatory effects. However, we observed indirect evidence for impeded development of inter-ecotype zygotes, possibly suggesting an early stage of genetic incompatibility between ecotypes. Our results show that pre-zygotic post-copulatory mechanisms play a minor role during this first stage of ecotype divergence, but suggest that genetic incompatibilities may arise at early stages of ecological speciation. © 2015 The Author(s) Published by the Royal Society. All rights reserved.

Money is Brain: Financial Barriers and Consequences for Canadian Stroke Patients.

PubMed

Ganesh, Aravind; King-Shier, Kathryn; Manns, Braden J; Hill, Michael D; Campbell, David J T

2017-03-01

Stroke patients of lower socioeconomic status have worse outcomes. It remains poorly understood whether this is due to illness severity or personal or health system barriers. We explored the experiences of stroke patients with financial barriers in a qualitative descriptive pilot study, seeking to capture perceived challenges that interfere with their poststroke health and recovery. We interviewed six adults with a history of stroke and financial barriers in Alberta, Canada, inquiring about their: (1) experiences after stroke; (2) experience of financial barriers; (3) perceived reasons for financial barriers; (4) health consequences of financial barriers; and (5) mechanisms for coping with financial barriers. Two reviewers analyzed data using inductive thematic analysis. The participants developed new or worsened financial circumstances as a consequence of stroke-related disability. Poststroke impairments and financial barriers took a toll on their mental health. They struggled to access several aspects of long-term poststroke care, including allied health professional services, medications, and proper nutrition. They described opportunity costs and tradeoffs when accessing health services. In several cases, they were unaware of health resources available to them and were hesitant to disclose their struggles to their physicians and even their families. Some patients with financial barriers perceive challenges to accessing various aspects of poststroke care. They may have inadequate knowledge of resources available to them and may not disclose their concerns to their health care team. This suggests that providers themselves might consider asking stroke patients about financial barriers to optimize their long-term poststroke care.

Perspectives on Self-Management in Multiple Sclerosis

PubMed Central

Knaster, Elizabeth S.; Johnson, Kurt; McMullen, Kara A.; Ehde, Dawn M.

2011-01-01

The aim of this study was to elucidate the experience of self-management among people with multiple sclerosis (MS) and gather their input to inform a self-management intervention. Twelve people with MS participated in focus groups in which they were asked open-ended questions about MS symptoms, challenges, overcoming challenges, symptom management, and treatment preferences. The results suggest four major themes: 1) “The Everyday Experience of MS,” including comments about symptoms and their impact on functioning; 2) “Motivation for Self-Management,” including descriptions of motivation originating from physical necessity, success with other management techniques, and external sources; 3) “Coping Strategies and Skills,” including descriptions of changing behaviors, expanding social support networks, finding resources, utilizing medical treatment, and monitoring symptoms; and 4) “Vision for a Self-Management Intervention,” including suggestions that an intervention be individualized, be motivating, and provide resources. The results of this study can inform the design and implementation of self-management interventions. Experiences described by participants are consistent with other qualitative reports suggesting the active role people with MS play in managing their condition. Intervention approaches must consider the complex constellation of symptoms associated with MS and provide individualized treatments that enhance the person's ability to manage their symptoms, barriers presented by such symptoms, and their health care. PMID:24453718

Barriers to Electronic Health Record Adoption: a Systematic Literature Review.

PubMed

Kruse, Clemens Scott; Kristof, Caitlin; Jones, Beau; Mitchell, Erica; Martinez, Angelica

2016-12-01

Federal efforts and local initiatives to increase adoption and use of electronic health records (EHRs) continue, particularly since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Roughly one in four hospitals not adopted even a basic EHR system. A review of the barriers may help in understanding the factors deterring certain healthcare organizations from implementation. We wanted to assemble an updated and comprehensive list of adoption barriers of EHR systems in the United States. Authors searched CINAHL, MEDLINE, and Google Scholar, and accepted only articles relevant to our primary objective. Reviewers independently assessed the works highlighted by our search and selected several for review. Through multiple consensus meetings, authors tapered articles to a final selection most germane to the topic (n = 27). Each article was thoroughly examined by multiple authors in order to achieve greater validity. Authors identified 39 barriers to EHR adoption within the literature selected for the review. These barriers appeared 125 times in the literature; the most frequently mentioned barriers were regarding cost, technical concerns, technical support, and resistance to change. Despite federal and local incentives, the initial cost of adopting an EHR is a common existing barrier. The other most commonly mentioned barriers include technical support, technical concerns, and maintenance/ongoing costs. Policy makers should consider incentives that continue to reduce implementation cost, possibly aimed more directly at organizations that are known to have lower adoption rates, such as small hospitals in rural areas.

Application of an ecological framework to examine barriers to the adoption of safer conception strategies by HIV-affected couples.

PubMed

Saleem, Haneefa T; Surkan, Pamela J; Kerrigan, Deanna; Kennedy, Caitlin E

2016-01-01

Safer conception interventions can significantly reduce the risk of horizontal HIV transmission between HIV-serodiscordant partners. However, prior to implementing safer conception interventions, it is essential to understand potential barriers to their adoption so that strategies can be developed to overcome these barriers. This paper examines potential barriers to the adoption of safer conception strategies by HIV-affected couples in Iringa, Tanzania using an ecological framework. We interviewed 30 HIV-positive women, 30 HIV-positive men and 30 health providers engaged in delivering HIV-related services. We also conducted direct observations at five health facilities. Findings suggest that there are multiple barriers to safer conception that operate at the individual, relational, environmental, structural, and super-structural levels. The barriers to safer conception identified are complex and interact across these levels. Barriers at the individual level included antiretroviral adherence, knowledge of HIV status, knowledge and acceptability of safer conception strategies, and poor nutrition. At the relational level, unplanned pregnancies, non-disclosure of status, gendered power dynamics within relationships, and patient-provider interactions posed a threat to safer conception. HIV stigma and distance to health facilities were environmental barriers to safer conception. At the structural level there were multiple barriers to safer conception, including limited safer conception policy guidelines for people living with HIV (PLHIV), lack of health provider training in safer conception strategies and preconception counseling for PLHIV, limited resources, and lack of integration of HIV and sexual and reproductive health services. Poverty and gender norms were super-structural factors that influenced and reinforced barriers to safer conception, which influenced and operated across different levels of the framework. Multi-level interventions are needed to ensure adoption of safer conception strategies and reduce the risk of HIV transmission between partners within HIV-serodiscordant couples.

A survey of the barriers associated with academic-based cancer research commercialization.

PubMed

Vanderford, Nathan L; Weiss, L Todd; Weiss, Heidi L

2013-01-01

Commercialization within the academic setting is associated with many challenges and barriers. Previous studies investigating these challenges/barriers have, in general, broadly focused on multiple disciplines and, oftentimes, several institutions simultaneously. The goal of the study presented here was to analyze a range of barriers that may be broadly associated with commercializing academic-based cancer research. This goal was addressed via a study of the barriers associated with cancer research commercialization at the University of Kentucky (UK). To this end, a research instrument in the form of an electronic survey was developed. General demographic information was collected on study participants and two research questions were addressed: 1) What are the general barriers inhibiting cancer research commercialization at UK? and 2) Would mitigation of the barriers potentially enhance faculty engagement in commercialization activities? Descriptive and statistical analysis of the data reveal that multiple barriers likely inhibit cancer research commercialization at UK with expense, time, infrastructure, and lack of industry partnerships being among the most commonly cited factors. The potential alleviation of these factors in addition to revised University policies/procedures, risk mitigation, more emphasis on commercialization by academia research field, and increased information on how to commercialize significantly correlated with the potential for increased commercialization activity. Furthermore, multivariate logistic regression modeling demonstrated that research commercialization would incrementally increase as barriers to the process are removed and that PhD-holding respondents and respondents in commercialization-supportive research fields would be more likely to commercialize their research upon barrier removal. Overall, as with other disciplines, these data suggest that for innovations derived from academic cancer-research to move more effectively and efficiently into the marketplace, university administrators and external agents, such as policymakers, need to address what are well-documented and defined issues.

A Survey of the Barriers Associated with Academic-based Cancer Research Commercialization

PubMed Central

Vanderford, Nathan L.; Weiss, L. Todd; Weiss, Heidi L.

2013-01-01

Commercialization within the academic setting is associated with many challenges and barriers. Previous studies investigating these challenges/barriers have, in general, broadly focused on multiple disciplines and, oftentimes, several institutions simultaneously. The goal of the study presented here was to analyze a range of barriers that may be broadly associated with commercializing academic-based cancer research. This goal was addressed via a study of the barriers associated with cancer research commercialization at the University of Kentucky (UK). To this end, a research instrument in the form of an electronic survey was developed. General demographic information was collected on study participants and two research questions were addressed: 1) What are the general barriers inhibiting cancer research commercialization at UK? and 2) Would mitigation of the barriers potentially enhance faculty engagement in commercialization activities? Descriptive and statistical analysis of the data reveal that multiple barriers likely inhibit cancer research commercialization at UK with expense, time, infrastructure, and lack of industry partnerships being among the most commonly cited factors. The potential alleviation of these factors in addition to revised University policies/procedures, risk mitigation, more emphasis on commercialization by academia research field, and increased information on how to commercialize significantly correlated with the potential for increased commercialization activity. Furthermore, multivariate logistic regression modeling demonstrated that research commercialization would incrementally increase as barriers to the process are removed and that PhD-holding respondents and respondents in commercialization-supportive research fields would be more likely to commercialize their research upon barrier removal. Overall, as with other disciplines, these data suggest that for innovations derived from academic cancer-research to move more effectively and efficiently into the marketplace, university administrators and external agents, such as policymakers, need to address what are well-documented and defined issues. PMID:23991077

Alleviation of efficiency droop in InGaN/GaN multiple quantum well light-emitting diodes with trapezoidal quantum barriers

NASA Astrophysics Data System (ADS)

Kim, Sang-Jo; Lee, Kwang Jae; Park, Seong-Ju

2018-06-01

We numerically investigated the effects of trapezoidal quantum barriers (QBs) on efficiency droop in InGaN/GaN multiple quantum well (MQW) light-emitting diodes (LEDs). Simulations showed that the electrostatic field in QWs of LEDs with trapezoidal barriers is reduced because of the reduced sheet charge density at the QW-QB interface caused by the thin GaN layer in trapezoidal QBs. Additionally, the InGaN grading region in trapezoidal QBs suppresses hot carrier transport and this enhances efficient carrier injection into the QWs. The electroluminescence intensity of an LED with trapezoidal QBs is increased by 10.2% and 6.7% at 245 A cm‑2 when compared with the intensities of LEDs with square-type GaN barriers and multilayer barriers, respectively. The internal quantum efficiency (IQE) droop of an LED with trapezoidal QBs is 16% at 300 A cm‑2, while LEDs with square-type GaN barriers and multilayer barriers have IQE droop of 31% and 24%, respectively. This IQE droop alleviation in LEDs with trapezoidal QBs is attributed to the reduced energy band bending, efficient hole injection, and more uniform hole distribution in the MQWs that results from reduction of the piezoelectric field by the trapezoidal QBs. These results indicate that the trapezoidal QB in MQWs is promising for enhanced efficiency in high-power GaN-based LEDs.

Neuropsychological assessment of refugees: Methodological and cross-cultural barriers.

PubMed

Veliu, Bahrie; Leathem, Janet

2017-01-01

Cross-cultural research in neuropsychological assessment has primarily focused on Hispanic and African American populations. Less is known about the impact of language, culture, education, socioeconomic factors, and life experiences on assessment for other cultural groups. We highlight the methodological and cross-cultural barriers encountered at each stage of the neuropsychological assessment of Arabic- and Burmese-speaking refugees, who were culturally and linguistically diverse (CALD). A total of 18 refugees (13 men/five women; in their 20-50s) who were victims of torture in their countries of origin, some with post-traumatic stress disorder (PTSD) and now residents in New Zealand, were seen for neuropsychological assessment. Measures were officially translated, back translated, and administered with the assistance of professional interpreters. Multiple challenges arose in terms of administration (e.g., use of interpreters, interactions with the tester, assessment environment, assessment experience, and motivation), scoring, and interpretation (e.g., age appropriate scoring, estimation of prior function, estimation of brain injury severity, obtaining collateral information), the tests themselves, and ecological validity. There are more challenges in the neuropsychological assessment of people who are CALD than can be managed by adhering to current guidelines. The best approach is to find a balance between maintaining assessment integrity and working creatively and sensitively with this group.

Welfare reform, employment, and drug and alcohol use among low-income women.

PubMed

Meara, Ellen

2006-01-01

In 1996 welfare reform legislation transformed income assistance for needy families by imposing work requirements, time-limited benefits, and explicit provisions allowing states to sanction recipients who fail to meet program requirements. Though they represent a minority of the welfare population, women with substance use disorders (SUDs) experience multiple, and more severe, employment barriers than other Temporary Assistance to Needy Families (TANF) recipients. This review of welfare reform, substance abuse, and employment documents the evidence to date regarding the employment patterns of women with SUDs before and after welfare reform, and proposes several topics for further research. Based on higher rates of unemployment, less work experience, and lower earnings when working, women with SUDs have worse employment records than other TANF recipients. Despite elevated employment barriers, women with SUDs left TANF after 1996 as fast as, or faster than, other women. Since the 1996 welfare reform, women with SUDs have increased their employment and earnings, but by less than similar women without SUDs. Future research should describe how specific state welfare policies relate to employment of low-income women with SUDs, how the well-being of these women and their children changes with employment, and how welfare and employment interact to affect access to health insurance among this population.

Pharmacist's role in dispensing opioids for acute and chronic pain.

PubMed

Marlowe, Karen F; Geiler, Richard

2012-10-01

Pain continues to be a serious health care concern in the United States. Patients with chronic pain experience the impact of the disease throughout their lives including their social interactions, family relationships, and in many cases economic productivity. Multiple surveys have found that many pharmacists hold misconceptions regarding opioids, pain disease states, and their understandings of current regulations. Multiple barriers affect the ability of pharmacists to deliver care to patients' prescribed opioid therapy. Inadequate communication between health care professionals and patients is one of the hurdles, which prevents quality care. Increased communication between health care providers including access to health information is one step, which is crucial to improving provision of pharmacotherapy. Finally, the quality of educational opportunities relative to opioids and pain management specifically for pharmacists needs to be increased, and consideration needs to be given for making appropriate pain management education mandatory.

The impact of aging on epithelial barriers.

PubMed

Parrish, Alan R

2017-10-02

The epithelium has many critical roles in homeostasis, including an essential responsibility in establishing tissue barriers. In addition to the fundamental role in separating internal from external environment, epithelial barriers maintain nutrient, fluid, electrolyte and metabolic waste balance in multiple organs. While, by definition, barrier function is conserved, the structure of the epithelium varies across organs. For example, the skin barrier is a squamous layer of cells with distinct structural features, while the lung barrier is composed of a very thin single cell to minimize diffusion space. With the increased focus on age-dependent alterations in organ structure and function, there is an emerging interest in the impact of age on epithelial barriers. This review will focus on the impact of aging on the epithelial barrier of several organs, including the skin, lung, gastrointestinal tract and the kidney, at a structural and functional level.

A situation analysis of public health interventions, barriers, and opportunities for improving maternal nutrition in Bihar, India.

PubMed

Noznesky, Elizabeth A; Ramakrishnan, Usha; Martorell, Reynaldo

2012-06-01

Maternal underweight and anemia are highly prevalent in Bihar, especially among adolescent girls aged 15 to 19 years. Although numerous programs and platforms exist for delivering efficacious interventions for improving maternal nutrition, the coverage and quality of these interventions are low. To examine existing interventions for reducing maternal undernutrition in Bihar and identify barriers to and opportunities for expanding their coverage and quality. The research was conducted in New Delhi and Bihar between May and August 2010. Forty-eight key informant interviews were conducted with policy makers, program managers, and service providers at multiple levels. Secondary data were collected from survey reports and program documents. All data were analyzed thematically. Barriers to the delivery and uptake of interventions to improve maternal nutrition include the shortage of essential inputs, low prioritization of maternal undernutrition, sterilization bias within the family planning program, weak management systems, poverty, gender inequality, caste discrimination, and flooding. In order to overcome barriers and improve service delivery, the current government and its partners have introduced structural reforms within the public health system, launched new programs for underserved groups, developed innovative approaches, and experimented with new technologies. Since coming to power, the Government of Bihar has achieved impressive increases in the coverage of prioritized health services, such as institutional deliveries and immunization. This success presents it with an excellent opportunity to further reduce maternal and infant mortality by turning its attention to the serious problem of maternal undernutrition and low birthweight.

Psychologists and the Transition From Pediatrics to Adult Health Care.

PubMed

Gray, Wendy N; Monaghan, Maureen C; Gilleland Marchak, Jordan; Driscoll, Kimberly A; Hilliard, Marisa E

2015-11-01

Guidelines for optimal transition call for multidisciplinary teams, including psychologists, to address youth and young adults' multifactorial needs. This study aimed to characterize psychologists' roles in and barriers to involvement in transition from pediatric to adult health care. Psychologists were invited via professional listservs to complete an online survey about practice settings, roles in transition programming, barriers to involvement, and funding sources. Participants also responded to open-ended questions about their experiences in transition programs. One hundred participants responded to the survey. Involvement in transition was reported at multiple levels from individual patient care to institutional transition programming, and 65% reported more than one level of involvement. Direct clinical care (88%), transition-related research (50%), and/or leadership (44%) involvement were reported, with 59% reporting more than one role. Respondents often described advocating for their involvement on transition teams. Various sources of funding were reported, yet, 23% reported no funding for their work. Barriers to work in transition were common and included health care systems issues such as poor coordination among providers or lack of a clear transition plan within the clinic/institution. Psychologists assume numerous roles in the transition of adolescents from pediatric to adult health care. With training in health care transition-related issues, psychologists are ideally positioned to partner with other health professionals to develop and implement transition programs in multidisciplinary settings, provided health care system barriers can be overcome. Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

"We're Almost Guests in Their Clinical Care": Inpatient Provider Attitudes Toward Chronic Disease Management.

PubMed

Blecker, Saul; Meisel, Talia; Dickson, Victoria Vaughan; Shelley, Donna; Horwitz, Leora I

2017-03-01

Many hospitalized patients have at least 1 chronic disease that is not optimally controlled. The purpose of this study was to explore inpatient provider attitudes about chronic disease management and, in particular, barriers and facilitators of chronic disease management in the hospital. We conducted a qualitative study of semi-structured interviews of 31 inpatient providers from an academic medical center. We interviewed attending physicians, resident physicians, physician assistants, and nurse practitioners from various specialties about attitudes, experiences with, and barriers and facilitators towards chronic disease management in the hospital. Qualitative data were analyzed using constant comparative analysis. Providers perceived that hospitalizations offer an opportunity to improve chronic disease management, as patients are evaluated by a new care team and observed in a controlled environment. Providers perceived clinical benefits to in-hospital chronic care, including improvements in readmission and length of stay, but expressed concerns for risks related to adverse events and distraction from the acute problem. Barriers included provider lack of comfort with managing chronic diseases, poor communication between inpatient and outpatient providers, and hospital-system focus on patient discharge. A strong relationship with the outpatient provider and involvement of specialists were facilitators of inpatient chronic disease management. Providers perceived benefits to in-hospital chronic disease management for both processes of care and clinical outcomes. Efforts to increase inpatient chronic disease management will need to overcome barriers in multiple domains. Journal of Hospital Medicine 2017;12:162-167. © 2017 Society of Hospital Medicine

Non-local features of a hydrodynamic pilot-wave system

NASA Astrophysics Data System (ADS)

Nachbin, Andre; Couchman, Miles; Bush, John

2016-11-01

A droplet walking on the surface of a vibrating fluid bath constitutes a pilot-wave system of the form envisaged for quantum dynamics by Louis de Broglie: a particle moves in resonance with its guiding wave field. We here present an examination of pilot-wave hydrodynamics in a confined domain. Specifically, we present a one-dimensional water wave model that describes droplets walking in single and multiple cavities. The cavities are separated by a submerged barrier, and so allow for the study of tunneling. They also highlight the non-local dynamical features arising due to the spatially-extended wave field. Results from computational simulations are complemented by laboratory experiments.

Resilience among urban adolescent mothers living with violence: listening to their stories.

PubMed

Kennedy, Angie C

2005-12-01

Using a risk and resilience approach grounded in a multicultural feminist perspective, this qualitative study explores 10 urban adolescent mothers' experiences with multiple forms of violence, the relationships between violence and school, and their resilience, all within the context of welfare reforms. The findings suggest lives rife with simultaneous, often severe violence, the impacts of witnessing parental violence, linkages between family and partner violence, and cumulative violence exposure as a barrier to positive school outcomes. Several young women emerge as resilient, with five distinct factors conceptualized as contributing to resilience. In conclusion, the implications for welfare policies and programs are discussed.

A study of electrically active traps in AlGaN/GaN high electron mobility transistor

NASA Astrophysics Data System (ADS)

Yang, Jie; Cui, Sharon; Ma, T. P.; Hung, Ting-Hsiang; Nath, Digbijoy; Krishnamoorthy, Sriram; Rajan, Siddharth

2013-10-01

We have studied electron conduction mechanisms and the associated roles of the electrically active traps in the AlGaN layer of an AlGaN/GaN high electron mobility transistor structure. By fitting the temperature dependent I-V (Current-Voltage) curves to the Frenkel-Poole theory, we have identified two discrete trap energy levels. Multiple traces of I-V measurements and constant-current injection experiment all confirm that the main role of the traps in the AlGaN layer is to enhance the current flowing through the AlGaN barrier by trap-assisted electron conduction without causing electron trapping.

Creating Livable Communities

ERIC Educational Resources Information Center

Oberlink, Mia R.

2006-01-01

This report identifies barriers to developing livable communities and sheds light on potential methods for overcoming these barriers. It identifies and highlights multiple strategies that may be applied to the design and support of livable community principles. The identified strategies have been initiated by federal and state government agencies…

Multiple-viewing-zone integral imaging using a dynamic barrier array for three-dimensional displays.

PubMed

Choi, Heejin; Min, Sung-Wook; Jung, Sungyong; Park, Jae-Hyeung; Lee, Byoungho

2003-04-21

In spite of many advantages of integral imaging, the viewing zone in which an observer can see three-dimensional images is limited within a narrow range. Here, we propose a novel method to increase the number of viewing zones by using a dynamic barrier array. We prove our idea by fabricating and locating the dynamic barrier array between a lens array and a display panel. By tilting the barrier array, it is possible to distribute images for each viewing zone. Thus, the number of viewing zones can be increased with an increment of the states of the barrier array tilt.

Meningeal mast cells affect early T cell central nervous system infiltration and blood-brain barrier integrity through TNF: a role for neutrophil recruitment?

PubMed

Sayed, Blayne A; Christy, Alison L; Walker, Margaret E; Brown, Melissa A

2010-06-15

Mast cells contribute to the pathogenesis of experimental autoimmune encephalomyelitis, a rodent model of the human demyelinating disease multiple sclerosis. Yet their site and mode of action is unknown. In both diseases, myelin-specific T cells are initially activated in peripheral lymphoid organs. However, for disease to occur, these cells must enter the immunologically privileged CNS through a breach in the relatively impermeable blood-brain barrier. In this study, we demonstrate that a dense population of resident mast cells in the meninges, structures surrounding the brain and spinal cord, regulate basal CNS barrier function, facilitating initial T cell CNS entry. Through the expression of TNF, mast cells recruit an early wave of neutrophils to the CNS. We propose that neutrophils in turn promote the blood-brain barrier breach and together with T cells lead to further inflammatory cell influx and myelin damage. These findings provide specific targets for intervention in multiple sclerosis as well as other immune-mediated CNS diseases.

Production of atmospheric pressure diffuse nanosecond pulsed dielectric barrier discharge using the array needles-plate electrode in air

NASA Astrophysics Data System (ADS)

Yang, De-zheng; Wang, Wen-chun; Jia, Li; Nie, Dong-xia; Shi, Heng-chao

2011-04-01

In this paper, a bidirectional high pulse voltage with 20 ns rising time is employed to generate an atmospheric pressure diffuse dielectric barrier discharge using the array needles-plate electrode configuration. Both double needle and multiple needle electrode configurations nanosecond pulsed dielectric barrier discharges are investigated. It is found that a diffuse discharge plasma with low gas temperature can be obtained, and the plasma volume increases with the increase of the pulse peak voltage, but remains almost constant with the increase of the pulse repetition rate. In addition to showing the potential application on a topographically nonuniform surface treatment of the discharge, the multiple needle-plate electrode configuration with different needle-plate electrode gaps are also employed to generate diffuse discharge plasma.

PERCEIVED RACIAL DISCRIMINATION AMONG HOME HEALTH AIDES: EVIDENCE FROM A NATIONAL SURVEY.

PubMed

Lee, Doohee; Muslin, Ivan; McInerney, Marjorie

2016-01-01

Home health aides are one of our essential human resources in the U.S. long-term care industry but understanding whether home health aides experience racial discrimination in the workplace and, if so, which personal/organizational factors are associated at the national level has been unnoticed. Using a nationally representative sample (n=3377), we attempt to investigate the association between racial discrimination and personal and organizational factors. The study found the 13.5% prevalence rate of racial discrimination. The study findings from multiple regression analysis reveal that black home care aides are more likely than white aides to experience racial discrimination in the workplace, suggesting that racial disparity may be an additional barrier to our home health care industry. National chain affiliation and low income were also found to be associated with perceived racial discrimination.

Exploring perceptions of instructors about childbirth preparation training courses: A qualitative study.

PubMed

Otogara, Marzieh; Karimi-Shahanjarini, Akram; Hazavehei, Seyed Mohammad Mehdi; Poorolajal, Jalal; Radnia, Nahid; Akrami, Forouzan; Bagheri, Fahimeh

2017-04-01

Childbirth preparation training courses on maternal and neonatal health increase awareness, and capability of pregnant women in overcoming fear and anxiety and managing labor pains. To identify the affecting factors and barriers of these courses from the perspective of their instructors. This qualitative study of the content analysis type, has been conducted on 16 certified teachers of the training courses of the Hamadan city in 2015. Data were collected by semi-structured in-depth interviews and were then analyzed by using MAXQDA10 application. Participants' experiences are indicated on three main themes including the objectives of the course, facilitators and barriers. The main objectives of the course were reported as to improve maternal and newborn health, promote natural childbirth and preparedness for parenting and breastfeeding. The main facilitators of the successful implementation include observing educational standards, strengthening the communication and relationship between mothers and staff, mobilization, and the role of instructor. The major barriers are reported as inadequate support from management system, insufficient intra-sector collaboration, poor attitude of obstetricians and physicians, inadequate access, theory-practice gap and not intended to labor naturally. The results of our study show that multiple factors are involved in the participation of pregnant women in antenatal classes. Promoting natural childbirth requires intra-sector and inter-sectoral collaboration, as well as the community participation.

A simple cage-autonomous method for the maintenance of the barrier status of germ-free mice during experimentation.

PubMed

Hecht, G; Bar-Nathan, C; Milite, G; Alon, I; Moshe, Y; Greenfeld, L; Dotsenko, N; Suez, J; Levy, M; Thaiss, C A; Dafni, H; Elinav, E; Harmelin, A

2014-10-01

The use of germ-free (GF) isolators for microbiome-related research is exponentially increasing, yet limited by its cost, isolator size and potential for trans-contamination. As such, current isolator technology is highly limiting to researchers engaged in short period experiments involving multiple mouse strains and employing a variety of mono-inoculated microorganisms. In this study, we evaluate the use of positive pressure Isocages as a solution for short period studies (days to 2-3 weeks) of experimentation with GF mice at multiple simultaneous conditions. We demonstrate that this new Isocage technology is cost-effective and room-sparing, and enables maintenance of multiple simultaneous groups of GF mice. Using this technology, transferring GF mice from isolators to Isocage racks for experimentation, where they are kept under fully germ-free conditions, enables parallel inoculation with different bacterial strains and simultaneous experimentation with multiple research conditions. Altogether, the new GF Isocage technology enables the expansion of GF capabilities in a safe and cost-effective manner that can facilitate the growth, elaboration and flexibility of microbiome research. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Comparative Analysis: Potential Barriers to Career Participation by North American Physicians in Global Health

PubMed Central

Rhee, Daniel S.; Heckman, Jennifer E.

2014-01-01

Physician interest in global health, particularly among family physicians, is reflected by an increasing proliferation of field training and service experiences. However, translating initial training involvement into a defined and sustainable global health career remains difficult and beset by numerous barriers. Existing global health literature has largely examined training experiences and related ethical considerations while neglecting the role of career development in global health. To explore this, this paper extrapolates potential barriers to global health career involvement from existing literature and compares these to salary and skills requirements for archetypal physician positions in global health, presenting a framework of possible barriers to sustained physician participation in global health work. Notable barriers identified include financial limitations, scheduling conflicts, security/family concerns, skills limitations, limited awareness of opportunities, and specialty choice, with family practice often closely aligned with global health experience. Proposed solutions include financial support, protected time, family relocation support, and additional training. This framework delineates barriers to career involvement in global health by physicians. Further research regarding these barriers as well as potential solutions may help direct policy and initiatives to better utilize physicians, particularly family physicians, as a valuable global health human resource. PMID:25405030

Progressive multiple sclerosis: from pathogenic mechanisms to treatment.

PubMed

Correale, Jorge; Gaitán, María I; Ysrraelit, María C; Fiol, Marcela P

2017-03-01

During the past decades, better understanding of relapsing-remitting multiple sclerosis disease mechanisms have led to the development of several disease-modifying therapies, reducing relapse rates and severity, through immune system modulation or suppression. In contrast, current therapeutic options for progressive multiple sclerosis remain comparatively disappointing and challenging. One possible explanation is a lack of understanding of pathogenic mechanisms driving progressive multiple sclerosis. Furthermore, diagnosis is usually retrospective, based on history of gradual neurological worsening with or without occasional relapses, minor remissions or plateaus. In addition, imaging methods as well as biomarkers are not well established. Magnetic resonance imaging studies in progressive multiple sclerosis show decreased blood-brain barrier permeability, probably reflecting compartmentalization of inflammation behind a relatively intact blood-brain barrier. Interestingly, a spectrum of inflammatory cell types infiltrates the leptomeninges during subpial cortical demyelination. Indeed, recent magnetic resonance imaging studies show leptomeningeal contrast enhancement in subjects with progressive multiple sclerosis, possibly representing an in vivo marker of inflammation associated to subpial demyelination. Treatments for progressive disease depend on underlying mechanisms causing central nervous system damage. Immunity sheltered behind an intact blood-brain barrier, energy failure, and membrane channel dysfunction may be key processes in progressive disease. Interfering with these mechanisms may provide neuroprotection and prevent disability progression, while potentially restoring activity and conduction along damaged axons by repairing myelin. Although most previous clinical trials in progressive multiple sclerosis have yielded disappointing results, important lessons have been learnt, improving the design of novel ones. This review discusses mechanisms involved in progressive multiple sclerosis, correlations between histopathology and magnetic resonance imaging studies, along with possible new therapeutic approaches. © The Author (2016). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The multiple sclerosis work difficulties questionnaire: translation and cross-cultural adaptation to Turkish and assessment of validity and reliability.

PubMed

Kahraman, Turhan; Özdoğar, Asiye Tuba; Honan, Cynthia Alison; Ertekin, Özge; Özakbaş, Serkan

2018-05-09

To linguistically and culturally adapt the Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) for use in Turkey, and to examine its reliability and validity. Following standard forward-back translation of the MSWDQ-23, it was administered to 124 people with multiple sclerosis (MS). Validity was evaluated using related outcome measures including those related to employment status and expectations, disability level, fatigue, walking, and quality of life. Randomly selected participants were asked to complete the MSWDQ-23 again to assess test-retest reliability. Confirmatory factor analysis on the MSWDQ-23 demonstrated a good fit for the data, and the internal consistency of each subscale was excellent. The test-retest reliability for the total score, psychological/cognitive barriers, physical barriers, and external barriers subscales were high. The MSWDQ-23 and its subscales were positively correlated with the employment, disability level, walking, and fatigue outcome measures. This study suggests that the Turkish version of MSWDQ-23 has high reliability and adequate validity, and it can be used to determine the difficulties faced by people with multiple sclerosis in workplace. Moreover, the study provides evidence about the test-retest reliability of the questionnaire. Implications for rehabilitation Multiple sclerosis affects young people of working age. Understanding work-related problems is crucial to enhance people with multiple sclerosis likelihood of maintaining their job. The Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) is a valid and reliable measure of perceived workplace difficulties in people with multiple sclerosis: we presented its validation to Turkish. Professionals working in the field of vocational rehabilitation may benefit from using the MSWDQ-23 to predict the current work outcomes and future employment expectations.

Reactive diffusion in the presence of a diffusion barrier: Experiment and model

NASA Astrophysics Data System (ADS)

Mangelinck, D.; Luo, T.; Girardeaux, C.

2018-05-01

Reactions in thin films and diffusion barriers are important for applications such as protective coatings, electrical contact, and interconnections. In this work, the effect of a barrier on the kinetics of the formation for a single phase by reactive diffusion is investigated from both experimental and modeling point of views. Two types of diffusion barriers are studied: (i) a thin layer of W deposited between a Ni film and Si substrate and (ii) Ni alloy films, Ni(1%W) and Ni(5%Pt), that form a diffusion barrier during the reaction with the Si substrate. The effect of the barriers on the kinetics of δ-Ni2Si formation is determined by in situ X ray diffraction and compared to models that explain the kinetic slowdown induced by both types of barrier. A linear parabolic growth is found for the deposited barrier with an increasing linear contribution for increasing barrier thickness. On the contrary, the growth is mainly parabolic for the barrier formed by the reaction between an alloy film and the substrate. The permeability of the two types of barrier is determined and discussed. The developed models fit well with the dedicated model experiments, leading to a better understanding of the barrier effect on the reactive diffusion and allowing us to predict the barrier behaviour in various applications.

Barrier experiment: Shock initiation under complex loading

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

Menikoff, Ralph

2016-01-12

The barrier experiments are a variant of the gap test; a detonation wave in a donor HE impacts a barrier and drives a shock wave into an acceptor HE. The question we ask is: What is the trade-off between the barrier material and threshold barrier thickness to prevent the acceptor from detonating. This can be viewed from the perspective of shock initiation of the acceptor subject to a complex pressure drive condition. Here we consider key factors which affect whether or not the acceptor undergoes a shock-to-detonation transition. These include the following: shock impedance matches for the donor detonation wavemore » into the barrier and then the barrier shock into the acceptor, the pressure gradient behind the donor detonation wave, and the curvature of detonation front in the donor. Numerical simulations are used to illustrate how these factors affect the reaction in the acceptor.« less

Redefining Authentic Research Experiences in Introductory Biology Laboratories and Barriers to Their Implementation

ERIC Educational Resources Information Center

Spell, Rachelle M.; Guinan, Judith A.; Miller, Kristen R.; Beck, Christopher W.

2014-01-01

Incorporating authentic research experiences in introductory biology laboratory classes would greatly expand the number of students exposed to the excitement of discovery and the rigor of the scientific process. However, the essential components of an authentic research experience and the barriers to their implementation in laboratory classes are…

Personal, interpersonal and structural challenges to accessing HIV testing, treatment and care services among female sex workers, men who have sex with men and transgenders in Karnataka state, South India.

PubMed

Beattie, Tara S H; Bhattacharjee, Parinita; Suresh, M; Isac, Shajy; Ramesh, B M; Moses, Stephen

2012-10-01

Despite high HIV prevalence rates among most-at-risk groups, utilisation of HIV testing, treatment and care services was relatively low in Karnataka prior to 2008. The authors aimed to understand the barriers to and identify potential solutions for improving HIV service utilisation. Focus group discussions were carried out among homogeneous groups of female sex workers, men who have sex with men and transgenders, and programme peer educators in six districts across Karnataka in March and April 2008. 26 focus group discussions were conducted, involving 302 participants. Participants had good knowledge about HIV and HIV voluntary counselling and testing (VCT) services, but awareness of other HIV services was low. The fear of the psychological impact of a positive HIV test result and the perceived repercussions of being seen accessing HIV services were key personal and interpersonal barriers to HIV service utilisation. Previous experiences of discrimination at government healthcare services, coupled with discriminatory attitudes and behaviours by VCT staff, were key structural barriers to VCT service uptake among those who had not been HIV tested. Among those who had used government-managed prevention of parent to child transmission and antiretroviral treatment services, poor physical facilities, long waiting times, lack of available treatment, the need to give bribes to receive care and discriminatory attitudes of healthcare staff presented additional structural barriers. Embedding some HIV care services within existing programmes for vulnerable populations, as well as improving service quality at government facilities, are suggested to help overcome the multiple barriers to service utilisation. Increasing the uptake of HIV testing, treatment and care services is key to improving the quality and longevity of the lives of HIV-infected individuals.

Treatment of Solid Rocket Motors that Complies with Established Protocols to Ensure Planetary Protection

NASA Technical Reports Server (NTRS)

Stefanski, Philip L.; Soler-Luna, Adrian

2017-01-01

This presentation discusses recent work being conducted by the National Aeronautics and Space Administration (NASA) at Marshall Space Flight Center (MSFC) to evaluate various methods that could be employed to provide for planetary protection of those solar system bodies that are candidates for extraterrestrial life, thus preventing contamination of such bodies. MSFC is presently involved in the development phase of the Europa Lander De-Orbital Stage (DOS) braking motor. In order to prevent bio-contamination of this Jovian satellite, three paths are currently being considered. The first is (1) Bio-Reduction of those microscopic organisms in or on the vehicle (in this case a solid rocket motor (SRM)) that might otherwise be transported during the mission. Possible methods being investigated include heat sterilization, application or incorporation of biocide materials, and irradiation. While each method can be made to work, effects on the SRM's components (propellant, liner, insulation, etc.) could well prove deleterious. A second path would be use of (2) Bio-Barrier material(s). So long as such barrier(s) can maintain their integrity, planetary protection should be afforded. Under the harsh conditions encountered during extended spaceflight (vacuum, temperature extremes, radiation), however, such barrier(s) could well experience a breach. Finally, a third path would be to perform (3) Pyrotechnic Sterilization of the SRM during its end-of-mission phase. Multiple pyrotechnic units would be triggered to ensure activation of such an event and provide for a final sterilization before vehicle impact. In light of Europa's stringent bio-reduction targets, the final and best choice to minimize risk will probably be some combination of the above.

"The Idea of Accessibility and the Reality of Accessibility Are Very Different!" Using a Wheelchair Experience to Teach Preservice Special Educators about Accessibility

ERIC Educational Resources Information Center

Coleman, Mari Beth; Cady, Jo Ann; Rider, Robert A.

2015-01-01

P-12 students who have mobility limitations often face environmental and social barriers that have an impact on educational performance; thus, teachers who work with these students need to have an understanding of these barriers. One potential way for teachers to understand environmental and social barriers is to experience them from a first-hand…

Factors influencing nurses' attitudes toward simulation-based education.

PubMed

Decarlo, Deborah; Collingridge, Dave S; Grant, Carrie; Ventre, Kathleen M

2008-01-01

To identify barriers to nurses' participation in simulation, and to determine whether prior simulation exposure, professional experience, and practice location influence their tendency to perceive specific issues as barriers. We also sought to identify nurses' educational priorities, and to determine whether these were influenced by years of experience or practice location. We surveyed full-time and part-time nurses in a university-affiliated children's hospital to gather data on professional demographics, simulation exposure, perceived barriers to participation in simulation, and training priorities. A total of 523 of 936 (56%) eligible nurses completed the survey. Binary logistic regression analysis revealed that "simulation is 'not the real thing'" was selected as a barrier more often by nurses with prior simulation experience (P = 0.02), fewer years in practice (P = 0.02), and employment in non-acute care areas of the hospital (P = 0.03). "Unfamiliarity with equipment" was reported more often by nurses with less experience (P = 0.01). "Stressful or intimidating environment" was selected more often by those who work in non-acute care areas (P < 0.01). "Providing opportunities to manage rare events" was suggested as a training priority by nurses with less experience (P = 0.08) and by those practicing in acute care areas (P = 0.03). We identified several barriers to nurses' participation in simulation training. Nurses' tendency to name specific issues as barriers is related to prior simulation exposure, years of experience, and area of hospital practice. Rehearsing rare event management is a priority for less-experienced nurses and those in acute care areas.

Barriers and Facilitators to HIV Testing Among Zambian Female Sex Workers in Three Transit Hubs.

PubMed

Chanda, Michael M; Perez-Brumer, Amaya G; Ortblad, Katrina F; Mwale, Magdalene; Chongo, Steven; Kamungoma, Nyambe; Kanchele, Catherine; Fullem, Andrew; Barresi, Leah; Bärnighausen, Till; Oldenburg, Catherine E

2017-07-01

Zambia has a generalized HIV epidemic, and HIV is concentrated along transit routes. Female sex workers (FSWs) are disproportionately affected by the epidemic. HIV testing is the crucial first step for engagement in HIV care and HIV prevention activities. However, to date little work has been done with FSWs in Zambia, and little is known about barriers and facilitators to HIV testing in this population. FSW peer educators were recruited through existing sex worker organizations for participation in a trial related to HIV testing among FSWs. We conducted five focus groups with FSW peer educators (N = 40) in three transit towns in Zambia (Livingstone, Chirundu, and Kapiri Mposhi) to elicit community norms related to HIV testing. Emerging themes demonstrated barriers and facilitators to HIV testing occurring at multiple levels, including individual, social network, and structural. Stigma and discrimination, including healthcare provider stigma, were a particularly salient barrier. Improving knowledge, social support, and acknowledgment of FSWs and women's role in society emerged as facilitators to testing. Interventions to improve HIV testing among FSWs in Zambia will need to address barriers and facilitators at multiple levels to be maximally effective.

Patterns of perceived barriers to medical care in older adults: a latent class analysis.

PubMed

Thorpe, Joshua M; Thorpe, Carolyn T; Kennelty, Korey A; Pandhi, Nancy

2011-08-03

This study examined multiple dimensions of healthcare access in order to develop a typology of perceived barriers to healthcare access in community-dwelling elderly. Secondary aims were to define distinct classes of older adults with similar perceived healthcare access barriers and to examine predictors of class membership to identify risk factors for poor healthcare access. A sample of 5,465 community-dwelling elderly was drawn from the 2004 wave of the Wisconsin Longitudinal Study. Perceived barriers to healthcare access were measured using items from the Group Health Association of America Consumer Satisfaction Survey. We used latent class analysis to assess the constellation of items measuring perceived barriers in access and multinomial logistic regression to estimate how risk factors affected the probability of membership in the latent barrier classes. Latent class analysis identified four classes of older adults. Class 1 (75% of sample) consisted of individuals with an overall low level of risk for perceived access problems (No Barriers). Class 2 (5%) perceived problems with the availability/accessibility of healthcare providers such as specialists or mental health providers (Availability/Accessibility Barriers). Class 3 (18%) perceived problems with how well their providers' operations arise organized to accommodate their needs and preferences (Accommodation Barriers). Class 4 (2%) perceived problems with all dimension of access (Severe Barriers). Results also revealed that healthcare affordability is a problem shared by members of all three barrier groups, suggesting that older adults with perceived barriers tend to face multiple, co-occurring problems. Compared to those classified into the No Barriers group, those in the Severe Barrier class were more likely to live in a rural county, have no health insurance, have depressive symptomatology, and speech limitations. Those classified into the Availability/Accessibility Barriers group were more likely to live in rural and micropolitan counties, have depressive symptomatology, more chronic conditions, and hearing limitations. Those in the Accommodation group were more likely to have depressive symptomatology and cognitive limitations. The current study identified a typology of perceived barriers in healthcare access in older adults. The identified risk factors for membership in perceived barrier classes could potentially assist healthcare organizations and providers with targeting polices and interventions designed to improve access in their most vulnerable older adult populations, particularly those in rural areas, with functional disabilities, or in poor mental health.

Formation of multiple levels of porous silicon for buried insulators and conductors in silicon device technologies

DOEpatents

Blewer, Robert S.; Gullinger, Terry R.; Kelly, Michael J.; Tsao, Sylvia S.

1991-01-01

A method of forming a multiple level porous silicon substrate for semiconductor integrated circuits including anodizing non-porous silicon layers of a multi-layer silicon substrate to form multiple levels of porous silicon. At least one porous silicon layer is then oxidized to form an insulating layer and at least one other layer of porous silicon beneath the insulating layer is metallized to form a buried conductive layer. Preferably the insulating layer and conductive layer are separated by an anodization barrier formed of non-porous silicon. By etching through the anodization barrier and subsequently forming a metallized conductive layer, a fully or partially insulated buried conductor may be fabricated under single crystal silicon.

Barriers of and facilitators to physician recommendation of colorectal cancer screening.

PubMed

Guerra, Carmen E; Schwartz, J Sanford; Armstrong, Katrina; Brown, Jamin S; Halbert, Chanita Hughes; Shea, Judy A

2007-12-01

Colorectal cancer screening (CRCS) has been demonstrated to be effective and is consistently recommended by clinical practice guidelines. However, only slightly over half of all Americans have ever been screened. Patients cite physician recommendation as the most important motivator of screening. This study explored the barriers of and facilitators to physician recommendation of CRCS. A 3-component qualitative study to explore the barriers of and facilitators to physician recommendation of CRCS: in-depth, semistructured interviews with 29 purposively sampled, community- and academic-based primary care physicians; chart-stimulated recall, a technique that utilizes patient charts to probe physician recall and provide context about the barriers of and facilitators to physician recommendation of CRCS during actual clinic encounters; and focus groups with 18 academic primary care physicians. Grounded theory techniques of analysis were used. All the participating physicians were aware of and recommended CRCS. The overwhelmingly preferred test was colonoscopy. Barriers of physician recommendation of CRCS included patient comorbidities, prior patient refusal of screening, physician forgetfulness, acute care visits, lack of time, and lack of reminder systems and test tracking systems. Facilitators to physician recommendation of CRCS included patient request, patient age 50-59, physician positive attitudes about CRCS, physician prioritization of screening, visits devoted to preventive health, reminders, and incentives. There are multiple physician, patient, and system barriers to recommending CRCS. Thus, interventions may need to target barriers at multiple levels to successfully increase physician recommendation of CRCS.

Evaluation of Gastrointestinal Leakage in Multiple Enteric Inflammation Models in Chickens.

PubMed

Kuttappan, Vivek A; Vicuña, Eduardo A; Latorre, Juan D; Wolfenden, Amanda D; Téllez, Guillermo I; Hargis, Billy M; Bielke, Lisa R

2015-01-01

Enteric inflammation models can help researchers' study methods to improve health and performance and evaluate various growth promoters and dietary formulations targeted to improve performance in poultry. Oral administration of fluorescein isothiocyanate-dextran (FITC-d; 3-5 kDa) and its pericellular mucosal epithelial leakage are an established marker to evaluate enteric inflammation in multiple species. The present study evaluated different methods to induce gut inflammation in poultry based on FITC-d leakage. Four independent experiments were completed with different inflammation treatment groups, and serum FITC-d and/or retention of FITC-d in GI tract were determined. In experiment 1 (n = 10 birds/treatment, broilers, processed at 14 days), groups included control (CON), dextran sodium sulfate (DSS; drinking water at 0.75%) and feed restriction (FRS; 24 h before processing). Experiment 2 (n = 14 birds/treatment, leghorns, processed at 7 days) included CON, DSS, FRS, and rye-based diet (RBD). In experiments 3 and 4 (n = 15 birds/treatment, broilers, processed at 7 days), groups were CON, DSS, high fat diet (HFD), FRS, and RBD. In all experiments, FRS and RBD treatments showed significantly higher serum FITC-d levels compared to the respective CON. This indicates that FRS and RBD results in disruption of the intact barrier of the gastrointestinal tract (GIT), resulting in increased gut permeability. DSS and HFD groups showed elevation of serum FITC-d levels although the magnitude of difference from respective CON was inconsistent between experiments. FRS was the only treatment which consistently showed elevated retention of FITC-d in GIT in all experiments. The results from present studies showed that FRS and RBD, based on serum FITC-d levels, can be robust models to induce gut leakage in birds in different age and species/strains.

Atomic Theory and Multiple Combining Proportions: The Search for Whole Number Ratios.

PubMed

Usselman, Melvyn C; Brown, Todd A

2015-04-01

John Dalton's atomic theory, with its postulate of compound formation through atom-to-atom combination, brought a new perspective to weight relationships in chemical reactions. A presumed one-to-one combination of atoms A and B to form a simple compound AB allowed Dalton to construct his first table of relative atomic weights from literature analyses of appropriate binary compounds. For such simple binary compounds, the atomic theory had little advantages over affinity theory as an explanation of fixed proportions by weight. For ternary compounds of the form AB2, however, atomic theory made quantitative predictions that were not deducible from affinity theory. Atomic theory required that the weight of B in the compound AB2 be exactly twice that in the compound AB. Dalton, Thomas Thomson and William Hyde Wollaston all published within a few years of each other experimental data that claimed to give the predicted results with the required accuracy. There are nonetheless several experimental barriers to obtaining the desired integral multiple proportions. In this paper I will discuss replication experiments which demonstrate that only Wollaston's results are experimentally reliable. It is likely that such replicability explains why Wollaston's experiments were so influential.

The Ocean as a teaching tool: the first MOOC on Ocean Literacy

NASA Astrophysics Data System (ADS)

Santin, Selvaggia; Santoro, Francesca

2017-04-01

Education its broader understanding (in both formal and informal settings) serves as a high potential channel to reach young citizens. As a lack of sufficient 'Ocean Literacy' has been identified in many countries, this clearly presents a barrier for citizens to engage in ocean responsible behaviour or consider ocean-related careers. In order to sensitize and enable teachers and students to incorporate ocean literacy into educational programmes we build up a first Massive Open Online Course on Emma Platform, an European Multiple MOOC Aggregator that provides a system for the delivery of free, open, online courses in multiple languages from different European universities. Almost 500 students were enrolled from all over the world and we proposed a multi-perspective approach building on the UNESCO experience in the field of education for sustainable development. The course had two sections: a narrative format which introduces to the Ocean Literacy principles, focusing on how to incorporate them into lessons with tips, advice, references and activities; and an interactive section with webinairs which covers contemporary and emerging issues such as seafood, marine pollution and human health, simulating a "real-world experiences" with a problems-solutions approach.

Velocity barrier-controlled of spin-valley polarized transport in monolayer WSe2 junction

NASA Astrophysics Data System (ADS)

Qiu, Xuejun; Lv, Qiang; Cao, Zhenzhou

2018-05-01

In this work, we have theoretically investigated the influence of velocity barrier on the spin-valley polarized transport in monolayer (ML) WSe2 junction with a large spin-orbit coupling (SOC). Both the spin-valley resolved transmission probabilities and conductance are strong dependent on the velocity barrier, as the velocity barrier decreases to 0.06, a spin-valley polarization of exceeding 90% is observed, which is distinct from the ML MoS2 owing to incommensurable SOC. In addition, the spin-valley polarization is further increased above 95% in a ML WSe2 superlattice, in particular, it's found many extraordinary velocity barrier-dependent transport gaps for multiple barrier due to evanescent tunneling. Our results may open an avenue for the velocity barrier-controlled high-efficiency spin and valley polarizations in ML WSe2-based electronic devices.

Tacit Knowledge Barriers within Franchise Organizations

ERIC Educational Resources Information Center

Cumberland, Denise M.; Githens, Rod P.

2010-01-01

This paper reviews knowledge management in the context of a franchise business operation, with a focus on tacit knowledge barriers. In a franchise organization, the transfer of knowledge occurs on multiple levels and has an added level of complexity because of the number of partners and relationships. Tacit knowledge transfer should occur…

Experiences of care by Australians with a diagnosis of borderline personality disorder

PubMed Central

McMahon, J.

2015-01-01

Accessible summary Borderline personality disorder (BPD) is a complex and challenging mental health condition for the person and service providers who support them.This paper reports on the results of a survey of 153 people with a diagnosis of BPD about their experiences of attempting to receive support in managing this mental health condition. It provides their perceptions of a range of experiences not reported in the existing literature, including general practitioner roles, urban and rural differences, public and private hospital differences, and comparison of usefulness of support across multiple support types.People with a diagnosis of BPD continue to experience significant discrimination when attempting to get their needs met within both public and private health services. Further education for nurses and other health professionals is indicated to address pervasive negative attitudes towards people with a diagnosis of BPD. Abstract There is limited understanding of the experience of seeking and receiving treatment and care by people with a diagnosis of borderline personality disorder (BPD), their perceptions of barriers to care and the quality of services they receive. This study aimed to explore these experiences from the perspective of Australians with this diagnosis. An invitation to participate in an online survey was distributed across multiple consumer and carer organizations and mental health services, by the Private Mental Health Consumer Carer Network (Australia) in 2011. Responses from 153 people with a diagnosis of BPD showed that they experience significant challenges and discrimination when attempting to get their needs met within both public and private health services, including general practice. Seeking help from hospital emergency departments during crises was particularly challenging. Metropolitan and rural differences, and gender differences, were also apparent. Community supports were perceived as inadequate to meet their needs. This study provides data on a range of experiences not reported in existing literature, including general practitioner roles, urban and rural differences, public and private hospital differences, and comparison of usefulness of support across multiple support types. Its findings can help inform better training for health professionals and better care for this population. PMID:26122817

HIV Stigma, Retention in Care, and Adherence Among Older Black Women Living With HIV.

PubMed

Sangaramoorthy, Thurka; Jamison, Amelia M; Dyer, Typhanye V

Stigma is recognized as a barrier to the prevention, care, and treatment of HIV, including engagement in the HIV care continuum. HIV stigma in older Black women may be compounded by preexisting social inequities based on gender, age, and race. Using semi-structured interviews and survey questionnaires, we explore experiences of HIV stigma, retention in care, and antiretroviral therapy (ART) adherence in 35 older Black women with HIV from Prince George's County, Maryland. Study findings indicated that older Black women experienced high levels of HIV stigma, retention in care, and ART adherence. Findings suggest that experiences of HIV stigma were intensified for older Black women due to multiple stigmatized social positions. Participants also reported experiences of marginalization in health care that hindered retention in care and ART adherence. Interventions aimed at improving HIV prevention, care, and treatment outcomes should incorporate HIV stigma reduction strategies as core elements. Copyright © 2017 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

Influence of the geometry of protective barriers on the propagation of shock waves

NASA Astrophysics Data System (ADS)

Sochet, I.; Eveillard, S.; Vinçont, J. Y.; Piserchia, P. F.; Rocourt, X.

2017-03-01

The protection of industrial facilities, classified as hazardous, against accidental or intentional explosions represents a major challenge for the prevention of personal injury and property damage, which also involves social and economic issues. We consider here the use of physical barriers against the effects of these explosions, which include the pressure wave, the projection of fragments and the thermal flash. This approach can be recommended for the control of major industrial risks, but no specific instructions are available for its implementation. The influence of a protective barrier against a detonation-type explosion is studied in small-scale experiments. The effects of overpressure are examined over the entire path of the shock wave across the barrier and in the downstream zone to be protected. Two series of barrier structures are studied. The first series (A) of experiments investigates two types of barrier geometry with dimensions based on NATO recommendations. These recommendations stipulate that the barrier should be 2 m higher than the charge height, the thickness at the crest should be more than 0.5 m, while its length should be equal to twice the protected structure length and the bank slope should be equivalent to the angle of repose of the soil. The second series (B) of experiments investigates the influence of geometrical parameters of the barrier (thickness at the crest and inclination angles of the front and rear faces) on its protective effects. This project leads to an advance in our understanding of the physical phenomena involved in the propagation of blast waves resulting from an external explosion, in the area around a protective physical barrier. The study focuses on the dimensioning of protective barriers against overpressure effects arising from detonation and shows the advantage of using a barrier with a vertical front or rear face.

A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: findings from a scoping review.

PubMed

Fang, Mei Lan; Sixsmith, Judith; Sinclair, Shane; Horst, Glen

2016-05-18

Multiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool. To explore attitudes, behaviours and patterns to utilization of EoL care by culturally and spiritually diverse groups and identify gaps in EoL care practice and delivery methods, a scoping review and thematic analysis of article content was conducted. Fourteen electronic databases and websites were searched between June-August 2014 to identify English-language peer-reviewed publications and grey literature (including reports and other online resources) published between 2004-2014. The search identified barriers and enablers at the systems, community and personal/family levels. Primary barriers include: cultural differences between healthcare providers; persons approaching EoL and family members; under-utilization of culturally-sensitive models designed to improve EoL care; language barriers; lack of awareness of cultural and religious diversity issues; exclusion of families in the decision-making process; personal racial and religious discrimination; and lack of culturally-tailored EoL information to facilitate decision-making. This review highlights that most research has focused on decision-making. There were fewer studies exploring different cultural and spiritual experiences at the EoL and interventions to improve EoL care. Interventions evaluated were largely educational in nature rather than service oriented.

A radio frequency coaxial feedthrough

DOEpatents

Owens, T.L.

1987-12-07

An improved radio frequency coaxial transmission line vacuum feedthrough is provided based on the use of a half-wavelength annular dielectric pressure barrier disk, or multiple disks comprising an effective half wavelength structure to eliminate reflection from the barrier surfaces. Gas-tight seals are formed about the outer and inner diameter surfaces of the barrier disk using a sealing technique which generates radial forces sufficient to form seals by forcing the conductor walls against the surfaces of the barrier disks in a manner which does not deform the radii of the inner and outer conductors, thereby preventing enhancement of the electric field at the barrier faces which limits the voltage and power handling capabilities of a feedthrough.

Radio frequency coaxial feedthrough

DOEpatents

Owens, Thomas L.

1989-01-17

An improved radio frequency coaxial transmission line vacuum feed-through provided based on the use of a half-wavelength annular dielectric pressure barrier disk, or multiple disks comprising an effective half wavelength structure to eliminate reflections from the barrier surfaces. Gas-tight seals are formed about the outer and inner diameter surfaces of the barrier disk using a sealing technique which generates radial forces sufficient to form seals by forcing the conductor walls against the surfaces of the barrier disks in a manner which does not deform the radii of the inner and outer conductors, thereby preventing enhancement of the electric field at the barrier faces which limits voltage and power handling capabilities of a feedthrough.

Opening Health Data: What Do Researchers Want? Early Experiences With New York's Open Health Data Platform.

PubMed

Martin, Erika G; Helbig, Natalie; Birkhead, Guthrie S

2015-01-01

Governments are rapidly developing open data platforms to improve transparency and make information more accessible. New York is a leader, with currently the only state platform devoted to health. Although these platforms could build public health departments' capabilities to serve more researchers, agencies have little guidance on releasing meaningful and usable data. Structured focus groups with researchers and practitioners collected stakeholder feedback on potential uses of open health data and New York's open data strategy. Researchers and practitioners attended a 1-day November 2013 workshop on New York State's open health data resources. After learning about the state's open data platform and vision for open health data, participants were organized into 7 focus groups to discuss the essential elements of open data sets, practical challenges to obtaining and using health data, and potential uses of open data. Participants included 33 quantitative health researchers from State University of New York campuses and private partners and 10 practitioners from the New York State Department of Health. There was low awareness of open data, with 67% of researchers reporting never using open data portals prior to the workshop. Participants were interested in data sets that were geocoded, longitudinal, or aggregated to small area granularity and capabilities to link multiple data sets. Multiple environmental conditions and barriers hinder their capacity to use health data for research. Although open data platforms cannot address all barriers, they provide multiple opportunities for public health research and practice, and participants were overall positive about the state's efforts to release open data. Open data are not ideal for some researchers because they do not contain individually identifiable data, indicating a need for tiered data release strategies. However, they do provide important new opportunities to facilitate research and foster collaborations among agencies, researchers, and practitioners.

An Acoustic Charge Transport Imager for High Definition Television Applications: Reliability Modeling and Parametric Yield Prediction of GaAs Multiple Quantum Well Avalanche Photodiodes. Degree awarded Oct. 1997

NASA Technical Reports Server (NTRS)

Hunt, W. D.; Brennan, K. F.; Summers, C. J.; Yun, Ilgu

1994-01-01

Reliability modeling and parametric yield prediction of GaAs/AlGaAs multiple quantum well (MQW) avalanche photodiodes (APDs), which are of interest as an ultra-low noise image capture mechanism for high definition systems, have been investigated. First, the effect of various doping methods on the reliability of GaAs/AlGaAs multiple quantum well (MQW) avalanche photodiode (APD) structures fabricated by molecular beam epitaxy is investigated. Reliability is examined by accelerated life tests by monitoring dark current and breakdown voltage. Median device lifetime and the activation energy of the degradation mechanism are computed for undoped, doped-barrier, and doped-well APD structures. Lifetimes for each device structure are examined via a statistically designed experiment. Analysis of variance shows that dark-current is affected primarily by device diameter, temperature and stressing time, and breakdown voltage depends on the diameter, stressing time and APD type. It is concluded that the undoped APD has the highest reliability, followed by the doped well and doped barrier devices, respectively. To determine the source of the degradation mechanism for each device structure, failure analysis using the electron-beam induced current method is performed. This analysis reveals some degree of device degradation caused by ionic impurities in the passivation layer, and energy-dispersive spectrometry subsequently verified the presence of ionic sodium as the primary contaminant. However, since all device structures are similarly passivated, sodium contamination alone does not account for the observed variation between the differently doped APDs. This effect is explained by the dopant migration during stressing, which is verified by free carrier concentration measurements using the capacitance-voltage technique.

Strategies for developing sustainable health research capacity in low and middle-income countries: a prospective, qualitative study investigating the barriers and enablers to locally led clinical trial conduct in Ethiopia, Cameroon and Sri Lanka

PubMed Central

Franzen, Samuel R P; Chandler, Clare; Siribaddana, Sisira; Atashili, Julius; Angus, Brian; Lang, Trudie

2017-01-01

Objectives In 2013, the WHO stated that unless low-income and middle-income countries (LMICs) become producers of research, health goals would be hard to achieve. Among the capacities required to build a local evidence base, ability to conduct clinical trials is important. There is no evidence-based guidance for the best ways to develop locally led trial capacity. This research aims to identify the barriers and enablers to locally led clinical trial conduct in LMICs and determine strategies for their sustainable development. Design Prospective, multiple case study design consisting of interviews (n=34), focus group discussions (n=13) and process mapping exercises (n=10). Setting Case studies took place in Ethiopia (2011), Cameroon (2012) and Sri Lanka (2013). Participants Local health researchers with previous experiences of clinical trials or stakeholders with an interest in trials were purposively selected through registration searches and snowball sampling (n=100). Primary and secondary outcome measures Discussion notes and transcripts were analysed using thematic coding analysis. Key themes and mechanisms were identified. Results Institutions and individuals were variably successful at conducting trials, but there were strong commonalities in the barriers and enablers across all levels and functions of the research systems. Transferable mechanisms were summarised into the necessary conditions for trial undertaking, which included: awareness of research, motivation, knowledge and technical skills, leadership capabilities, forming collaborations, inclusive trial operations, policy relevance and uptake and macro and institutional strengthening. Conclusions Barriers and enablers to locally led trial undertaking exist at all levels and functions of LMIC research systems. Establishing the necessary conditions to facilitate this research will require multiple, coordinated interventions that seek to resolve them in a systemic manner. The strategies presented in the discussion provide an evidence-based framework for a self-sustaining capacity development approach. This represents an important contribution to the literature that will be relevant for research funders, users and producers. PMID:29030412

Why are we not evaluating multiple competing hypotheses in ecology and evolution?

PubMed Central

Avgar, Tal; Fryxell, John M.

2017-01-01

The use of multiple working hypotheses to gain strong inference is widely promoted as a means to enhance the effectiveness of scientific investigation. Only 21 of 100 randomly selected studies from the ecological and evolutionary literature tested more than one hypothesis and only eight tested more than two hypotheses. The surprising rarity of application of multiple working hypotheses suggests that this gap between theory and practice might reflect some fundamental issues. Here, we identify several intellectual and practical barriers that discourage us from using multiple hypotheses in our scientific investigation. While scientists have developed a number of ways to avoid biases, such as the use of double-blind controls, we suspect that few scientists are fully aware of the potential influence of cognitive bias on their decisions and they have not yet adopted many techniques available to overcome intellectual and practical barriers in order to improve scientific investigation. PMID:28280578

Lower Aerobic Endurance Linked to History of Depression in Multiple Sclerosis: Preliminary Observations.

PubMed

Chapman, Kimberly R; Anderson, Jason R; Calvo, Dayana; Pollock, Brandon S; Petersen, Jennifer; Gerhart, Hayden; Ridgel, Angela; Spitznagel, Mary Beth

2018-06-01

Despite the demonstrated benefits of exercise in multiple sclerosis (MS), this population shows low rates of physical activity. Understanding barriers to exercise in persons with MS is important. The current study examined the relationship between lifetime history of depression, current depressive symptoms, and aerobic endurance in persons with relapsing-remitting MS to determine whether depression might be one such barrier. Thirty-one participants with relapsing-remitting MS self-reported current depressive symptoms and history of depression. Aerobic endurance was assessed via 2-Minute Step Test. Linear regression demonstrated that lifetime history of depression predicted lower aerobic fitness whereas current depressive symptoms did not. Findings suggest a possible role of lifetime depression as a barrier to exercise in MS and highlight the importance of effective treatment of depression in this population to reduce its potential impact on exercise adherence.

Security barriers with automated reconnaissance

DOEpatents

McLaughlin, James O; Baird, Adam D; Tullis, Barclay J; Nolte, Roger Allen

2015-04-07

An intrusion delaying barrier includes primary and secondary physical structures and can be instrumented with multiple sensors incorporated into an electronic monitoring and alarm system. Such an instrumented intrusion delaying barrier may be used as a perimeter intrusion defense and assessment system (PIDAS). Problems with not providing effective delay to breaches by intentional intruders and/or terrorists who would otherwise evade detection are solved by attaching the secondary structures to the primary structure, and attaching at least some of the sensors to the secondary structures. By having multiple sensors of various types physically interconnected serves to enable sensors on different parts of the overall structure to respond to common disturbances and thereby provide effective corroboration that a disturbance is not merely a nuisance or false alarm. Use of a machine learning network such as a neural network exploits such corroboration.

“I don’t know enough to feel comfortable using them:” Women’s knowledge of and perceived barriers to long acting reversible contraceptives on a college campus

PubMed Central

Ela, Elizabeth; Zochowski, Melissa K.; Caldwell, Amy; Moniz, Michelle; McAndrew, Laura; Steel, Monique; Challa, Sneha; Dalton, Vanessa K.; Ernst, Susan

2016-01-01

Objective To assess multiple dimensions of long acting reversible contraception (LARC) knowledge and perceived multi-level barriers to LARC use among a sample of college women. Study Design We conducted an internet-based study of 1,982 female undergraduates at a large mid-western university. Our 55-item survey used a multi-level framework to measure young women’s understanding of, experiences with intrauterine devices (IUD) and implants and their perceived barriers to LARC at individual, health systems, and community levels. The survey included a 20-item knowledge scale. We estimated and compared LARC knowledge scores and barriers using descriptive, bivariate, and linear regression statistics. Results Few college women had used (5%) or heard of (22%) LARC, and most self-reported “little” or “no” knowledge of IUDs (79%) and implants (88%). Women answered 50% of LARC knowledge items correctly (mean 10.4, range 0–20), and scores differed across sociodemographic groups (p-values<0.04). Factors associated with scores in multivariable models included race/ethnicity, program year, sorority participation, religious affiliation and service attendance, employment status, sexual orientation, and contraceptive history. Perceived barriers to IUDs included: not wanting a foreign object in body (44%); not knowing enough about the method (42%); preferring a “controllable” method (42%); cost (27%); and not being in a long-term relationship (23%). Implant results were similar. “Not knowing enough” was women’s primary reason for IUD (18%) and implant (22%) nonuse. Conclusion Lack of knowledge (both perceived and actual) was the most common barrier among many perceived individual, systems, and community-level factors precluding these college women’s LARC use. Findings can inform innovative, multi-level interventions to improve understanding, acceptability, and uptake of LARC on campuses. PMID:26879627

Barriers to and Facilitators of Alcohol Use Disorder Pharmacotherapy in Primary Care: A Qualitative Study in Five VA Clinics.

PubMed

Williams, Emily C; Achtmeyer, Carol E; Young, Jessica P; Berger, Douglas; Curran, Geoffrey; Bradley, Katharine A; Richards, Julie; Siegel, Michael B; Ludman, Evette J; Lapham, Gwen T; Forehand, Mark; Harris, Alex H S

2018-03-01

Three medications are FDA-approved and recommended for treating alcohol use disorders (AUD) but they are not offered to most patients with AUD. Primary care (PC) may be an optimal setting in which to offer and prescribe AUD medications, but multiple barriers are likely. This qualitative study used social marketing theory, a behavior change approach that employs business marketing techniques including "segmenting the market," to describe (1) barriers and facilitators to prescribing AUD medications in PC, and (2) beliefs of PC providers after they were segmented into groups more and less willing to prescribe AUD medications. Qualitative, interview-based study. Twenty-four providers from five VA PC clinics. Providers completed in-person semi-structured interviews, which were recorded, transcribed, and analyzed using social marketing theory and thematic analysis. Providers were divided into two groups based on consensus review. Barriers included lack of knowledge and experience, beliefs that medications cannot replace specialty addiction treatment, and alcohol-related stigma. Facilitators included training, support for prescribing, and behavioral staff to support follow-up. Providers more willing to prescribe viewed prescribing for AUD as part of their role as a PC provider, framed medications as a potentially effective "tool" or "foot in the door" for treating AUD, and believed that providing AUD medications in PC might catalyze change while reducing stigma and addressing other barriers to specialty treatment. Those less willing believed that medications could not effectively treat AUD, and that treating AUD was the role of specialty addiction treatment providers, not PC providers, and would require time and expertise they do not have. We identified barriers to and facilitators of prescribing AUD medications in PC, which, if addressed and/or capitalized on, may increase provision of AUD medications. Providers more willing to prescribe may be the optimal target of a customized implementation intervention to promote changes in prescribing.

Virtual reality exergaming as adjunctive therapy in a sub-acute stroke rehabilitation setting: facilitators and barriers.

PubMed

Nguyen, Ai-Vi; Ong, Yau-Lok Austin; Luo, Cindy Xin; Thuraisingam, Thiviya; Rubino, Michael; Levin, Mindy F; Kaizer, Franceen; Archambault, Philippe S

2018-03-12

To identify the facilitators and barriers perceived by clinicians to using an Exergaming Room as adjunct to conventional therapy. Phenomenological qualitative study using an interpretive description methodology. Ten clinicians (four physical therapists, six occupational therapists) from the Stroke Program at the Jewish Rehabilitation Hospital (nine female, one male, age range 25-50 years old) who referred clients to the Exergaming Room. Ten to twenty minute semi-structured interviews were conducted with each clinician. Convenience sampling was used. A thematic analysis was performed on the data collected by grouping all the open codes into facilitators and barriers, and then categorized into levels, themes and subthemes. Facilitators and barriers were divided into three levels: organizational, individual and technological. Major facilitators at the organizational level were: institutional support; at the individual level: personal experience of referring clinician, presence of an expert clinician, and relevance of the Exergaming Room for stroke clients; and at the technological level: perceived ease of use of the exergames and possibility of providing additional therapy. Key barriers to successful implementation of the Exergaming Room at the organizational level were: scheduling difficulties and lack of staffing; at the individual level: client functional limitations; at the technological level: low precision in motion capture of the exergame systems. Multiple factors affect the implementation of new technology in rehabilitation settings. In order to successfully integrate exergame systems into practice, institutions are encouraged to take the identified factors (facilitators and barriers) into account. Implications for Rehabilitation Clinicians who have referred individuals with stroke to an "exergames" room over a 1-year period at a rehabilitation hospital have found the service to be highly relevant to their clients. The presence of an expert clinician, who evaluates the clients and builds an exergames activity program, was seen as an important facilitator by referring clinicians in the use of this service. An ideal Exergames Room should offer a wide variety of activities, including some that focus on motor, cognitive and/or communications abilities.

Accelerating cancer therapy development: the importance of combination strategies and collaboration. Summary of an Institute of Medicine workshop.

PubMed

LoRusso, Patricia M; Canetta, Renzo; Wagner, John A; Balogh, Erin P; Nass, Sharyl J; Boerner, Scott A; Hohneker, John

2012-11-15

Cancer cells contain multiple genetic changes in cell signaling pathways that drive abnormal cell survival, proliferation, invasion, and metastasis. Unfortunately, patients treated with single agents inhibiting only one of these pathways--even if showing an initial response--often develop resistance with subsequent relapse or progression of their cancer, typically via the activation of an alternative uninhibited pathway. Combination therapies offer the potential for inhibiting multiple targets and pathways simultaneously to more effectively kill cancer cells and prevent or delay the emergence of drug resistance. However, there are many unique challenges to developing combination therapies, including devising and applying appropriate preclinical tests and clinical trial designs, prioritizing which combination therapies to test, avoiding overlapping toxicity of multiple agents, and overcoming legal, cultural, and regulatory barriers that impede collaboration among multiple companies, organizations, and/or institutions. More effective strategies to efficiently develop combination cancer therapies are urgently needed. Thus, the Institute of Medicine's National Cancer Policy Forum recently convened a workshop with the goal of identifying barriers that may be impeding the development of combination investigational cancer therapies, as well as potential solutions to overcome those barriers, improve collaboration, and ultimately accelerate the development of promising combinations of investigational cancer therapies. ©2012 AACR.

Low-income children's reported motivators of and barriers to healthy eating behaviors: a focus group study.

PubMed

Kaye, Lillian B; Tucker, Carolyn M; Bragg, Marie A; Estampador, Angela C

2011-01-01

Despite national attention to the childhood obesity epidemic, there are few US-based studies that directly ask children--especially children from low-income families and from multiple racial/ethnic groups--why they do or do not engage in healthy eating behaviors. The purpose of this study was to identify motivators of and barriers to healthy eating behaviors, as reported by black, Hispanic, and white children from low-income families. Six gender- and race/ethnicity-concordant focus groups were conducted with 37 children who were aged 9 to 12 years and from families with an annual household income of $40000 or less. Multiple strategies were used to employ a culturally sensitive approach to both data collection and data analysis (eg, a team of culturally diverse researchers utilized inductive qualitative analysis to analyze focus group transcripts). The motivators of and barriers to healthy eating behaviors most commonly reported across the 6 focus groups included social influence, taste, issues of availability, weight concerns, and the desire to be healthy. A variety of less commonly reported motivators and barriers were also discussed. Findings were generally similar across gender and race/ethnicity. Children in this age range can indeed identify a variety of motivators and barriers that influence their engagement in healthy eating behaviors. Interventions targeting obesity and eating behaviors should include an assessment of children's own perceived motivators of and barriers to healthy eating.

Adherence to Medication Regimens among Low-Income Patients with Multiple Comorbid Chronic Conditions

ERIC Educational Resources Information Center

Mishra, Shiraz I.; Gioia, Deborah; Childress, Saltanat; Barnet, Beth; Webster, Ramothea L.

2011-01-01

This qualitative study sought to explore facilitators and barriers to adherence to multiple medications among low-income patients with comorbid chronic physical and mental health conditions. The 50 focus group participants identified personal/contextual and health system factors as major impediments to adherence to multiple medications. These…

Barriers to Transition-related Healthcare among Korean Transgender Adults: Focused on Gender Identity Disorder Diagnosis, Hormone Therapy, and Sex Reassignment Surgery.

PubMed

Lee, Hyemin; Park, Jooyoung; Choi, Bokyoung; Yi, Horim; Kim, Seung-Sup

2018-02-27

Previous literature has documented that transgender people may encounter barriers when they use transition-related healthcare services. This study aims to investigate the experiences of transition-related healthcare and the barriers to those services among transgender adults in South Korea. In 2017, we conducted a nationwide cross-sectional survey of 278 transgender adults in South Korea. We assessed the prevalence of transition-related healthcare such as Gender Identity Disorder (GID) diagnosis, hormone therapy, and sex reassignment surgery. To understand the barriers to those procedures, we asked the participants for their reason not to receive each of the three procedures. We also examined their experiences of and reasons for using non-prescribed hormone medication. We found that 91.0% have been diagnosed with GID (N=253/278), 88.0% have received hormone therapy (N=243/276), and 42.4% had any type of sex reassignment surgery (N=115/271). Cost was the most common barrier to transition-related healthcare among the Korean transgender adults. Other common barriers were identified: Negative experiences in healthcare settings, lack of healthcare professionals and facilities, and social stigma against transgender people. Among those who have taken hormone therapy, 25.1% (N=61/243) reported that they had experience of purchasing hormone medication without medical prescription. Our findings suggest that transgender people face barriers to transition-related healthcare in South Korea. These barriers may preclude transgender individuals from safely accessing to transition-related healthcare. Improving access to transition-related healthcare requires institutional interventions including expanding national health insurance coverage on those procedures and providing transition-related training programs for healthcare professionals in South Korea.

Primary care clinicians' experiences with treatment decision making for older persons with multiple conditions.

PubMed

Fried, Terri R; Tinetti, Mary E; Iannone, Lynne

2011-01-10

Clinicians are caring for an increasing number of older patients with multiple diseases in the face of uncertainty concerning the benefits and harms associated with guideline-directed interventions. Understanding how primary care clinicians approach treatment decision making for these patients is critical to the design of interventions to improve the decision-making process. Focus groups were conducted with 40 primary care clinicians (physicians, nurse practitioners, and physician assistants) in academic, community, and Veterans Affairs-affiliated primary care practices. Participants were given open-ended questions about their approach to treatment decision making for older persons with multiple medical conditions. Responses were organized into themes using qualitative content analysis. The participants were concerned about their patients' ability to adhere to complex regimens derived from guideline-directed care. There was variability in beliefs regarding, and approaches to balancing, the benefits and harms of guideline-directed care. There was also variability regarding how the participants involved patients in the process of decision making, with clinicians describing conflicts between their own and their patients' goals. The participants listed a number of barriers to making good treatment decisions, including the lack of outcome data, the role of specialists, patient and family expectations, and insufficient time and reimbursement. The experiences of practicing clinicians suggest that they struggle with the uncertainties of applying disease-specific guidelines to their older patients with multiple conditions. To improve decision making, they need more data, alternative guidelines, approaches to reconciling their own and their patients' priorities, the support of their subspecialist colleagues, and an altered reimbursement system.

"Homelessness and trauma go hand-in-hand": pathways to homelessness among women veterans.

PubMed

Hamilton, Alison B; Poza, Ines; Washington, Donna L

2011-01-01

Veterans comprise a disproportionate fraction of the nation's homeless population, with women veterans up to four times more likely to be homeless than non-veteran women. This paper provides a grounded description of women veterans' pathways into homelessness. Three focus groups were held in Los Angeles, California, with a total of 29 homeless women veterans. Five predominant "roots" (precipitating experiences) initiated pathways toward homelessness: 1) childhood adversity, 2) trauma and/or substance abuse during military service, 3) post-military abuse, adversity, and/or relationship termination, 4) post-military mental health, substance abuse, and/or medical problems, and 5) unemployment. Contextual factors, which promoted development of homelessness in the setting of primary roots, included women veterans' "survivor instinct," lack of social support and resources, sense of isolation, pronounced sense of independence, and barriers to care. These contextual factors also reinforced persistence of the roots of post-military adversity and mental health and substance abuse problems, serving to maintain cycles of chronic homelessness. Collectively, these multiple, interacting roots and contextual factors form a "web of vulnerability" that is a target for action. Multiple points along the pathways to homelessness represent critical junctures for VA and community-based organizations to engage in prevention or intervention efforts on behalf of women veterans. Considering the multiple, interconnected challenges that these women veterans described, solutions to homelessness should address multiple risk factors, include trauma-informed care that acknowledges women veterans' traumatic experiences, and incorporate holistic responses that can contribute to healing and recovery. Published by Elsevier Inc.

Leadership and followership in the healthcare workplace: exploring medical trainees’ experiences through narrative inquiry

PubMed Central

Gordon, Lisi J; Rees, Charlotte E; Ker, Jean S; Cleland, Jennifer

2015-01-01

Objectives To explore medical trainees’ experiences of leadership and followership in the interprofessional healthcare workplace. Design A qualitative approach using narrative interviewing techniques in 11 group and 19 individual interviews with UK medical trainees. Setting Multisite study across four UK health boards. Participants Through maximum variation sampling, 65 medical trainees were recruited from a range of specialties and at various stages of training. Participants shared stories about their experiences of leadership and followership in the healthcare workplace. Methods Data were analysed using thematic and narrative analysis. Results We identified 171 personal incident narratives about leadership and followership. Participants most often narrated experiences from the position of follower. Their narratives illustrated many factors that facilitate or inhibit developing leadership identities; that traditional medical and interprofessional hierarchies persist within the healthcare workplace; and that wider healthcare systems can act as barriers to distributed leadership practices. Conclusions This paper provides new understandings of the multiple ways in which leadership and followership is experienced in the healthcare workplace and sets out recommendations for future leadership educational practices and research. PMID:26628525

Spanish nurses' attitudes towards research and perceived barriers and facilitators of research utilisation: a comparative survey of nurses with and without experience as principal investigators.

PubMed

Moreno-Casbas, Teresa; Fuentelsaz-Gallego, Carmen; de Miguel, Angel Gil; González-María, Esther; Clarke, Sean P

2011-07-01

To examine attitudes towards research and perceived barriers and facilitators of research utilisation in clinical practice in a broad cross-section of Spanish nurses. Nurses' attitudes towards research are critical in determining whether study findings are used to improve practice. Cross-sectional comparative survey in Hospitals, Primary Care Centres and University-affiliated schools of nursing. Surveys were completed by 917 nurses: 69 who received funding from the Spanish national agency (1998-2004) and a nationally representative sample of 848 nurses who did not have the same research experience (the Comparison group). Two instruments (BARRIERS and Attitudes towards nursing research) were translated and culturally adapted for use in Spain. A descriptive analysis of demographic and practice characteristics was performed. Total scale scores, as well as subscale scores, were computed and compared across the two groups using one-way analysis of variance (anova) and multivariate analysis of variance (manova) with post hoc tests. Pearson product-moment correlation coefficients were computed between the total tool scores and subscales measuring barriers and attitudes in both groups. The investigators differed from other nurses on several demographic and work characteristics (more males, older age and more likely to work a fixed day shift schedule). On the whole, investigators showed more favourable attitudes but perceived several elements as posing greater barriers to research utilisation than the Comparison groups. Across all respondents, issues related to the quality of research were rated as the greatest barriers to research utilisation, followed by organisational barriers, barriers involving the communication of findings and finally, those related to nurses' values, awareness and skills. Very similar profiles of perceptions and attitudes regarding research were found in these samples of Spanish nurses relative to those from other countries in earlier reports. Nurses who had experience conducting research demonstrated more favourable research-related attitudes and perceived barriers differently than those without such experience. Understanding different organisational and experience perspectives is important to identify challenges and opportunities to ensure research utilisation in clinical practice. © 2011 Blackwell Publishing Ltd.

Provider Experiences with Chronic Care Management (CCM) Services and Fees: A Qualitative Research Study.

PubMed

O'Malley, Ann S; Sarwar, Rumin; Keith, Rosalind; Balke, Patrick; Ma, Sai; McCall, Nancy

2017-12-01

Support for ongoing care management and coordination between office visits for patients with multiple chronic conditions has been inadequate. In January 2015, Medicare introduced the Chronic Care Management (CCM) payment policy, which reimburses providers for CCM activities for Medicare beneficiaries occurring outside of office visits. To explore the experiences, facilitators, and challenges of practices providing CCM services, and their implications going forward. Semi-structured telephone interviews from January to April 2016 with 71 respondents. Sixty billing and non-billing providers and practice staff knowledgeable about their practices' CCM services, and 11 professional society representatives. Practice respondents noted that most patients expressed positive views of CCM services. Practice respondents also perceived several patient benefits, including improved adherence to treatment, access to care team members, satisfaction, care continuity, and care coordination. Facilitators of CCM provision included having an in-practice care manager, patient-centered medical home recognition, experience developing care plans, patient trust in their provider, and supplemental insurance to cover CCM copayments. Most billing practices reported few problems obtaining patients' consent for CCM, though providers felt that CMS could better facilitate consent by marketing CCM's goals to beneficiaries. Barriers reported by professional society representatives and by billing and non-billing providers included inadequacy of CCM payments to cover upfront investments for staffing, workflow modification, and time needed to manage complex patients. Other barriers included inadequate infrastructure for health information exchange with other providers and limited electronic health record capabilities for documenting and updating care plans. Practices owned by hospital systems and large medical groups faced greater bureaucracy in implementing CCM than did smaller, independent practices. Improving providers' experiences with and uptake of CCM will require addressing several challenges, including the upfront investment for CCM set-up and the time required to provide CCM to more complex patients.

War experiences, general functioning and barriers to care among former child soldiers in Northern Uganda: the WAYS study.

PubMed

Amone-P'Olak, Kennedy; Jones, Peter; Meiser-Stedman, Richard; Abbott, Rosemary; Ayella-Ataro, Paul Stephen; Amone, Jackson; Ovuga, Emilio

2014-12-01

Exposure to war is associated with considerable risks for long-term mental health problems (MHP) and poor functioning. Yet little is known about functioning and mental health service (MHS) use among former child soldiers (FCS). We assessed whether different categories of war experiences predict functioning and perceived need for, sources of and barriers to MHS among FCS. Data were drawn from an on-going War-affected Youths (WAYS) cohort study of FCS in Uganda. Participants completed questionnaires about war experiences, functioning and perceived need for, sources of and barriers to MHS. Regression analyses and parametric tests were used to assess between-group differences. Deaths, material losses, threat to loved ones and sexual abuse significantly predicted poor functioning. FCS who received MHS function better than those who did not. Females reported more emotional and behavioural problems and needed MHS more than males. FCS who function poorly indicated more barriers to MHS than those who function well. Stigma, fear of family break-up and lack of health workers were identified as barriers to MHS. Various war experiences affect functioning differently. A significant need for MHS exists amidst barriers to MHS. Nevertheless, FCS are interested in receiving MHS and believe it would benefit them. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

It Comes With the Job: Work Organizational, Job Design, and Self-Regulatory Barriers to Improving the Health Status of Train Drivers.

PubMed

Naweed, Anjum; Chapman, Janine; Allan, Matthew; Trigg, Joshua

2017-03-01

This study aimed to examine the impacts of key barriers to improving the occupational health status of Australian train drivers. From May to June, 2015, five semi-structured qualitative focus groups were conducted with 29 train drivers from South Australian, Victorian, and New South Wales-based rail organizations in Australia. Occupational health was impeded by multiple barriers regarding sleep (patterns/fatigue), diet (planning/context), mental health (occupational stress), rostering (low autonomy), sedentary time, low fitness motivation, and family/social life conflicts. Work organizational barriers included communication issues, low organizational support, and existing social norms. Job design barriers included rostering, fatigue, stimulant reliance, and family/social life imbalances. Self-regulatory barriers included dietary and exercise patterns habits and patterns. Occupational health interventions for Australian train drivers must address work organizational, job design, and self-regulatory barriers to healthier lifestyle behaviors.

Access to cancer screening for women with mobility disabilities.

PubMed

Angus, Jan; Seto, Lisa; Barry, Nancy; Cechetto, Naomi; Chandani, Samira; Devaney, Julie; Fernando, Sharmini; Muraca, Linda; Odette, Fran

2012-03-01

Women with mobility disabilities are less likely to access cancer screening, even when they have a primary care provider. The Gateways to Cancer Screening project was initiated to document the challenges for women with disabilities in their access and experiences of screening for breast, cervical and colorectal cancer. The study followed the tenets of participatory action research. Five peer-led focus groups were held with 24 women with mobility disabilities. Study participants identified multiple and interacting institutional barriers to cancer screening. Their discussions highlighted the complex work of (1) arranging and attending health-related appointments, (2) confronting normative assumptions about women's bodies and (3) securing reliable health care and information. These overlapping, mutually reinforcing issues interact to shape how women with disabilities access and experience cancer screening. We explore implications for redesign of cancer screening services and education of health providers, providing specific recommendations suggested by our participants and the findings.

Voices of University Students with Disabilities: Inclusive Education on the Tertiary Level -- A Reality or a Distant Dream?

ERIC Educational Resources Information Center

Strnadová, Iva; Hájková, Vanda; Kvetonová, Lea

2015-01-01

Twenty-four university students with disabilities were interviewed about their experiences studying at Czech universities. The interviews were analysed using the grounded theory approach. The most commonly experienced barriers faced by these students were institutional barriers, attitudinal barriers, and disability-specific barriers. The types of…

Predictors of Health Service Barriers for Older Chinese Immigrants in Canada

ERIC Educational Resources Information Center

Lai, Daniel W. L.; Chau, Shirley B. Y.

2007-01-01

Elderly people from ethnic minority groups often experience different barriers in accessing health services. Earlier studies on access usually focused on types and frequency but failed to address the predictors of service barriers. This study examined access barriers to health services faced by older Chinese immigrants in Canada. Factor analysis…

Language barriers and professional identity: A qualitative interview study of newly employed international medical doctors and Norwegian colleagues.

PubMed

Skjeggestad, Erik; Gerwing, Jennifer; Gulbrandsen, Pål

2017-08-01

To explore how language barriers influence communication and collaboration between newly-employed international medical doctors and Norwegian health personnel. Interviews were conducted with 16 doctors who had recently started working in Norway and 12 Norwegian born health personnel who had extensive experience working with international medical doctors. Analyses were consistent with principles of systematic text condensation. All participants experienced that language barriers caused difficulties in their everyday collaboration. Furthermore, the participants' descriptions of "language barriers" encompassed a wide range of topics, including semantics (e.g., specialized professional vocabulary, system knowledge), pragmatics (e.g., using language in doctor-patient and interprofessional interactions), and specific culturally sensitive topics. All participants described that language barriers provoked uncertainty about a doctor's competence. Newly employed international medical doctors and their colleagues are concerned by ineffective communication due to language barriers. Experiences of language barriers threaten professional identity as a competent and effective doctor. Newly employed doctors who are non-native speakers could benefit from support in understanding and handling the array of barriers related to language. Copyright © 2017 Elsevier B.V. All rights reserved.

Perceived environmental barriers to outdoor mobility and changes in sense of autonomy in participation outdoors among older people: a prospective two-year cohort study.

PubMed

Rantakokko, Merja; Portegijs, Erja; Viljanen, Anne; Iwarsson, Susanne; Kauppinen, Markku; Rantanen, Taina

2017-08-01

The aim was to study whether perceived environmental barriers to outdoor mobility affect changes in sense of autonomy in participation outdoors among community-dwelling older people over a two-year period. Community-dwelling people aged 75-90 years (n = 848) in central Finland were interviewed on two occasions, face-to-face at baseline and over the telephone two years later. Perceived environmental barriers to outdoor mobility were assessed using a 15-item structured questionnaire, and the sum scores categorized into tertiles (0, 1 and 2 or more barriers). Autonomy in participation outdoors was assessed with the 'Impact on Participation and Autonomy' (IPA) questionnaire using the autonomy outdoors subscale (score range 0-20, higher scores indicating more restricted autonomy). Scores for autonomy in participation outdoors were available for 848 participants at baseline (mean 6.2, SD = 3.8) and for 748 participants at the two-year follow-up (mean 6.7, SD = 3.9). At baseline, those reporting multiple environmental barriers had the most restricted autonomy, while those reporting no environmental barriers had the least restricted autonomy (p < .001). Over the follow-up, autonomy in participation outdoors declined more among those reporting multiple environmental barriers compared to those reporting none (age- and sex-adjusted group*time β = .629, s.e. = .277, p = .023). Adjustment for cognitive functioning, education, number of chronic conditions and change in walking difficulty did not influence the association. Perceived environmental barriers to outdoor mobility accelerate the decline in autonomy in participation outdoors among older community-dwelling people. Understanding factors affecting autonomy can help in finding ways to support the sense of autonomy as people age.

The patient work system: An analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers

PubMed Central

Holden, Richard J.; Schubert, Christiane C.; Mickelson, Robin S.

2014-01-01

Human factors and ergonomics approaches have been successfully applied to study and improve the work performance of healthcare professionals. However, there has been relatively little work in “patient-engaged human factors,” or the application of human factors to the health-related work of patients and other nonprofessionals. This study applied a foundational human factors tool, the systems model, to investigate the barriers to self-care performance among chronically ill elderly patients and their informal (family) caregivers. A Patient Work System model was developed to guide the collection and analysis of interviews, surveys, and observations of patients with heart failure (n=30) and their informal caregivers (n=14). Iterative analyses revealed the nature and prevalence of self-care barriers across components of the Patient Work System. Person-related barriers were common and stemmed from patients’ biomedical conditions, limitations, knowledge deficits, preferences, and perceptions as well as the characteristics of informal caregivers and healthcare professionals. Task barriers were also highly prevalent and included task difficulty, timing, complexity, ambiguity, conflict, and undesirable consequences. Tool barriers were related to both availability and access of tools and technologies and their design, usability, and impact. Context barriers were found across three domains—physical-spatial, social-cultural, and organizational—and multiple “spaces” such as “at home,” “on the go,” and “in the community.” Barriers often stemmed not from single factors but from the interaction of several work system components. Study findings suggest the need to further explore multiple actors, context, and interactions in the patient work system during research and intervention design, as well as the need to develop new models and measures for studying patient and family work. PMID:25479983

The patient work system: an analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers.

PubMed

Holden, Richard J; Schubert, Christiane C; Mickelson, Robin S

2015-03-01

Human factors and ergonomics approaches have been successfully applied to study and improve the work performance of healthcare professionals. However, there has been relatively little work in "patient-engaged human factors," or the application of human factors to the health-related work of patients and other nonprofessionals. This study applied a foundational human factors tool, the systems model, to investigate the barriers to self-care performance among chronically ill elderly patients and their informal (family) caregivers. A Patient Work System model was developed to guide the collection and analysis of interviews, surveys, and observations of patients with heart failure (n = 30) and their informal caregivers (n = 14). Iterative analyses revealed the nature and prevalence of self-care barriers across components of the Patient Work System. Person-related barriers were common and stemmed from patients' biomedical conditions, limitations, knowledge deficits, preferences, and perceptions as well as the characteristics of informal caregivers and healthcare professionals. Task barriers were also highly prevalent and included task difficulty, timing, complexity, ambiguity, conflict, and undesirable consequences. Tool barriers were related to both availability and access of tools and technologies and their design, usability, and impact. Context barriers were found across three domains-physical-spatial, social-cultural, and organizational-and multiple "spaces" such as "at home," "on the go," and "in the community." Barriers often stemmed not from single factors but from the interaction of several work system components. Study findings suggest the need to further explore multiple actors, contexts, and interactions in the patient work system during research and intervention design, as well as the need to develop new models and measures for studying patient and family work. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Blood-Brain Barrier Permeability and Monocyte Infiltration in Experimental Allergic Encephalomyelitis

ERIC Educational Resources Information Center

Floris, S.; Blezer, E. L. A.; Schreibelt, G.; Dopp, E.; van der Pol, S. M. A.; Schadee-Eestermans, I. L.; Nicolay, K.; Dijkstra, C. D.; de Vries, H. E.

2004-01-01

Enhanced cerebrovascular permeability and cellular infiltration mark the onset of early multiple sclerosis lesions. So far, the precise sequence of these events and their role in lesion formation and disease progression remain unknown. Here we provide quantitative evidence that blood-brain barrier leakage is an early event and precedes massive…

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

ERIC Educational Resources Information Center

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

2010-01-01

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

From Teachers to Students: What Influences Early Childhood Educators to Pursue College Education

ERIC Educational Resources Information Center

Deutsch, Francine M.; Riffin, Catherine A.

2013-01-01

Underpaid and overworked, preschool teachers face multiple barriers in pursuing higher education. In the present study, we explored how logistical and financial barriers hinder early childhood education teachers and teacher's aides from taking college courses, as well as how academic self-concept and social support influence current enrollment.…

Development of a screening tool to identify female survivors of gender-based violence in a humanitarian setting: qualitative evidence from research among refugees in Ethiopia

PubMed Central

2013-01-01

Background High levels of gender-based violence (GBV) persist among conflict-affected populations and within humanitarian settings and are paralleled by under-reporting and low service utilization. Novel and evidence-based approaches are necessary to change the current state of GBV amongst these populations. We present the findings of qualitative research, which were used to inform the development of a screening tool as one potential strategy to identify and respond to GBV for females in humanitarian settings. Methods Qualitative research methods were conducted from January-February 2011 to explore the range of experiences of GBV and barriers to reporting GBV among female refugees. Individual interview participants (n=37) included female refugees (≥15 years), who were survivors of GBV, living in urban or one of three camps settings in Ethiopia, and originating from six conflict countries. Focus group discussion participants (11 groups; 77 participants) included health, protection and community service staff working in the urban or camp settings. Interviews and discussions were conducted in the language of preference, with assistance by interpreters when needed, and transcribed for analysis by grounded-theory technique. Results Single and multiple counts of GBV were reported and ranged from psychological and social violence; rape, gang rape, sexual coercion, and other sexual violence; abduction; and physical violence. Domestic violence was predominantly reported to occur when participants were living in the host country. Opportunistic violence, often manifested by rape, occurred during transit when women depended on others to reach their destination. Abduction within the host country, and often across borders, highlighted the constant state of vulnerability of refugees. Barriers to reporting included perceived and experienced stigma in health settings and in the wider community, lack of awareness of services, and inability to protect children while mothers sought services. Conclusions Findings demonstrate that GBV persists across the span of the refugee experience, though there is a transition in the range of perpetrators and types of GBV that are experienced. Further, survivors experience significant individual and system barriers to disclosure and service utilization. The findings suggest that routine GBV screening by skilled service providers offers a strategy to confidentially identify and refer survivors to needed services within refugee settings, potentially enabling survivors to overcome existing barriers. PMID:23758886

Interprofessional communication with hospitalist and consultant physicians in general internal medicine: a qualitative study

PubMed Central

2012-01-01

Background Studies in General Internal Medicine [GIM] settings have shown that optimizing interprofessional communication is important, yet complex and challenging. While the physician is integral to interprofessional work in GIM there are often communication barriers in place that impact perceptions and experiences with the quality and quantity of their communication with other team members. This study aims to understand how team members’ perceptions and experiences with the communication styles and strategies of either hospitalist or consultant physicians in their units influence the quality and effectiveness of interprofessional relations and work. Methods A multiple case study methodology was used. Thirty-one semi-structured interviews were conducted with physicians, nurses and other health care providers [e.g. physiotherapist, social worker, etc.] working across 5 interprofessional GIM programs. Questions explored participants’ experiences with communication with all other health care providers in their units, probing for barriers and enablers to effective interprofessional work, as well as the use of communication tools or strategies. Observations in GIM wards were also conducted. Results Three main themes emerged from the data: [1] availability for interprofessional communication, [2] relationship-building for effective communication, and [3] physician vs. team-based approaches. Findings suggest a significant contrast in participants’ experiences with the quantity and quality of interprofessional relationships and work when comparing the communication styles and strategies of hospitalist and consultant physicians. Hospitalist staffed GIM units were believed to have more frequent and higher caliber interprofessional communication and collaboration, resulting in more positive experiences among all health care providers in a given unit. Conclusions This study helps to improve our understanding of the collaborative environment in GIM, comparing the communication styles and strategies of hospitalist and consultant physicians, as well as the experiences of providers working with them. The implications of this research are globally important for understanding how to create opportunities for physicians and their colleagues to meaningfully and consistently participate in interprofessional communication which has been shown to improve patient, provider, and organizational outcomes. PMID:23198855

"Chipping away": non-consumer researcher perspectives on barriers to collaborating with consumers in mental health research.

PubMed

Happell, Brenda; Gordon, Sarah; Bocking, Julia; Ellis, Pete; Roper, Cath; Liggins, Jackie; Scholz, Brett; Platania-Phung, Chris

2018-04-30

Collaboration between researchers who have lived experience of mental illness and services (consumer researchers) and mental health researchers without (other mental health researchers) is an emergent development in research. Inclusion of consumer perspectives is crucial to ensuring the ethics, relevancy and validity of mental health research; yet widespread and embedded consumer collaboration of this nature is known to be impeded by attitudinal and organisational factors. Limited research describes consumer researchers' experiences of barriers. Other mental health researchers are key players in the co-production process yet there is also a paucity of research reporting their views on barriers to collaborating with consumers. To explore other researchers' views and experiences on partnering with consumer mental health researchers in Australia and New Zealand. Exploratory qualitative design. Eleven semi-structured interviews were conducted with mental health researchers. Interviews were recorded, transcribed and thematically analysed. Four themes concerning barriers to collaborating with consumers (hierarchies, status quo, not understanding, paternalism), and one theme on addressing the barriers (constantly chipping away) were identified. It is suggested that multifaceted strategies for advancing collaboration with consumers are most effective. It is imperative to attend to several barriers simultaneously to redress the inherent power disparity.

Work-related asthma, financial barriers to asthma care, and adverse asthma outcomes: asthma call-back survey, 37 states and District of Columbia, 2006 to 2008.

PubMed

Knoeller, Gretchen E; Mazurek, Jacek M; Moorman, Jeanne E

2011-12-01

Proper asthma management and control depend on patients having affordable access to healthcare yet financial barriers to asthma care are common. To examine associations of work-related asthma (WRA) with financial barriers to asthma care and adverse asthma outcomes. Cross-sectional, random-digit-dial survey conducted in 37 states and District of Columbia. A total of 27,927 ever-employed adults aged ≥18 years with current asthma. Prevalence ratios (PR) for the associations of WRA with financial barriers to asthma care and of WRA with adverse asthma outcomes stratified by financial barriers. Persons with WRA were significantly more likely than those with non-WRA to have at least 1 financial barrier to asthma care [PR, 1.66; 95% confidence interval (CI), 1.43-1.92]. Individuals with WRA were more likely to experience adverse asthma outcomes such as asthma attack (PR, 1.31; 95% CI, 1.22-1.40), urgent treatment for worsening asthma (PR, 1.57; 95% CI, 1.39-1.78), asthma-related emergency room visit (PR, 1.69; 95% CI, 1.41-2.03), and very poorly controlled asthma (PR, 1.54; 95% CI: 1.36-1.75). After stratifying for financial barriers to asthma care, the associations did not change. Financial barriers to asthma care should be considered in asthma management, and individuals with WRA are more likely to experience financial barriers. However, individuals with WRA are more likely to experience adverse asthma outcomes than individuals with non-WRA, regardless of financial barriers. Additional studies are needed to identify medical, behavioral, occupational, or environmental factors associated with adverse asthma outcomes among individuals with WRA.

Overcoming Barriers to Skills Training in Borderline Personality Disorder: A Qualitative Interview Study.

PubMed

Barnicot, Kirsten; Couldrey, Laura; Sandhu, Sima; Priebe, Stefan

2015-01-01

Despite evidence suggesting that skills training is an important mechanism of change in dialectical behaviour therapy, little research exploring facilitators and barriers to this process has been conducted. The study aimed to explore clients' experiences of barriers to dialectical behaviour therapy skills training and how they felt they overcame these barriers, and to compare experiences between treatment completers and dropouts. In-depth qualitative interviews were conducted with 40 clients with borderline personality disorder who had attended a dialectical behaviour therapy programme. A thematic analysis of participants' reported experiences found that key barriers to learning the skills were anxiety during the skills groups and difficulty understanding the material. Key barriers to using the skills were overwhelming emotions which left participants feeling unable or unwilling to use them. Key ways in which participants reported overcoming barriers to skills training were by sustaining their commitment to attending therapy and practising the skills, personalising the way they used them, and practising them so often that they became an integral part of their behavioural repertoire. Participants also highlighted a number of key ways in which they were supported with their skills training by other skills group members, the group therapists, their individual therapist, friends and family. Treatment dropouts were more likely than completers to describe anxiety during the skills groups as a barrier to learning, and were less likely to report overcoming barriers to skills training via the key processes outlined above. The findings of this qualitative study require replication, but could be used to generate hypotheses for testing in further research on barriers to skills training, how these relate to dropout, and how they can be overcome. The paper outlines several such suggestions for further research.

Overcoming Barriers to Skills Training in Borderline Personality Disorder: A Qualitative Interview Study

PubMed Central

Barnicot, Kirsten; Couldrey, Laura; Sandhu, Sima; Priebe, Stefan

2015-01-01

Despite evidence suggesting that skills training is an important mechanism of change in dialectical behaviour therapy, little research exploring facilitators and barriers to this process has been conducted. The study aimed to explore clients’ experiences of barriers to dialectical behaviour therapy skills training and how they felt they overcame these barriers, and to compare experiences between treatment completers and dropouts. In-depth qualitative interviews were conducted with 40 clients with borderline personality disorder who had attended a dialectical behaviour therapy programme. A thematic analysis of participants’ reported experiences found that key barriers to learning the skills were anxiety during the skills groups and difficulty understanding the material. Key barriers to using the skills were overwhelming emotions which left participants feeling unable or unwilling to use them. Key ways in which participants reported overcoming barriers to skills training were by sustaining their commitment to attending therapy and practising the skills, personalising the way they used them, and practising them so often that they became an integral part of their behavioural repertoire. Participants also highlighted a number of key ways in which they were supported with their skills training by other skills group members, the group therapists, their individual therapist, friends and family. Treatment dropouts were more likely than completers to describe anxiety during the skills groups as a barrier to learning, and were less likely to report overcoming barriers to skills training via the key processes outlined above. The findings of this qualitative study require replication, but could be used to generate hypotheses for testing in further research on barriers to skills training, how these relate to dropout, and how they can be overcome. The paper outlines several such suggestions for further research. PMID:26465757

Patient perspectives on peer mentoring: type 1 diabetes management in adolescents and young adults.

PubMed

Lu, Yang; Pyatak, Elizabeth A; Peters, Anne L; Wood, Jamie R; Kipke, Michele; Cohen, Marisa; Sequeira, Paola A

2015-02-01

The purpose of the study was to identify attitudes and topics relevant to peer mentoring as an adherence-promoting intervention for adolescents and young adults (YAs) with type 1 diabetes (T1D). Self-administered survey data were collected in 2 diabetes clinics from a convenience sample of adolescents as prospective mentees (ages 13-18) and YAs as prospective mentors (ages 19-25) with T1D. Survey topics included demographics, disease history, glycemic control, adherence, depression, barriers to disease management, social support, and interest in peer mentoring. Descriptive statistical analyses, thematic coding, and stepwise multivariate logistic regression were performed. A majority of the 54 adolescents and 46 YAs expressed interest in a peer mentoring program. Having supportive friends and living in a large household positively predicted adolescent interest in having a peer mentor. Approximately one-third of all participants experienced social barriers to diabetes management. For adolescents, barriers included inflexible schedules, unfamiliar foods, and the embarrassment of checking blood glucose in front of others. Young adults reported barriers in tracking food consumption and remembering to check blood glucose. Various diabetes management skills were in high demand by adolescents, who especially desired to learn about managing T1D on their own and in college. Participants were open to multiple communication modes, including in-person meetings, phone, text messaging, and social media. Many adolescents and young adults with T1D are interested in peer mentoring as a way to facilitate learning and sharing essential diabetes management skills and experiences. © 2014 The Author(s).

The Future of Opioid Agonist Therapies in Ukraine: a Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment

PubMed Central

Bojko, Martha J.; Mazhnaya, Alyona; Marcus, Ruthanne; Makarenko, Iuliia; Islam, Zahedul; Filippovych, Sergey; Dvoriak, Sergii; Altice, Frederick L.

2016-01-01

Opioid agonist therapies (OAT) to treat opioid addiction in people who inject drugs (PWID) began in Ukraine in 2004. Scale-up of OAT, however, has been hampered by both low enrollment and high attrition. To better understand the factors influencing OAT retention among PWID in Ukraine, qualitative data from 199 PWIDs were collected during 25 focus groups conducted in five Ukrainian cities from February-April 2013. The experiences of PWID who were currently or previously on OAT or currently trying to access OAT were analyzed to identify entry and retention barriers encountered. Transcribed data were analyzed using a grounded theory approach. Individual beliefs about OAT, particularly misaligned treatment goals between clients and providers, influenced PWID's treatment seeking behaviors. Multiple programmatic and structural issues, including inconvenient hours and treatment site locations, complicated dosing regimens, inflexible medication dispensing guidelines, and mistreatment by clinic and medical staff also strongly influenced OAT retention. Findings suggest the need for both programmatic and policy-level structural changes such as revising legal regulations covering OAT dispensing, formalizing prescription dosing policies and making OAT more available through other sites, including primary care settings as a way to improve treatment retention. Quality improvement interventions that target treatment settings could also be deployed to overcome healthcare delivery barriers. Additional patient education and medical professional development around establishing realistic treatment goals as well as community awareness campaigns that address the myths and fears associated with OAT can be leveraged to overcome individual, family and community-level barriers. PMID:27211995

The Future of Opioid Agonist Therapies in Ukraine: A Qualitative Assessment of Multilevel Barriers and Ways Forward to Promote Retention in Treatment.

PubMed

Bojko, Martha J; Mazhnaya, Alyona; Marcus, Ruthanne; Makarenko, Iuliia; Islam, Zahedul; Filippovych, Sergey; Dvoriak, Sergii; Altice, Frederick L

2016-07-01

Opioid agonist therapies (OAT) to treat opioid addiction in people who inject drugs (PWID) began in Ukraine in 2004. Scale-up of OAT, however, has been hampered by both low enrollment and high attrition. To better understand the factors influencing OAT retention among PWID in Ukraine, qualitative data from 199 PWIDs were collected during 25 focus groups conducted in five Ukrainian cities from February to April 2013. The experiences of PWID who were currently or previously on OAT or currently trying to access OAT were analyzed to identify entry and retention barriers encountered. Transcribed data were analyzed using a grounded theory approach. Individual beliefs about OAT, particularly misaligned treatment goals between clients and providers, influenced PWID's treatment seeking behaviors. Multiple programmatic and structural issues, including inconvenient hours and treatment site locations, complicated dosing regimens, inflexible medication dispensing guidelines, and mistreatment by clinic and medical staff also strongly influenced OAT retention. Findings suggest the need for both programmatic and policy-level structural changes such as revising legal regulations covering OAT dispensing, formalizing prescription dosing policies and making OAT more available through other sites, including primary care settings as a way to improve treatment retention. Quality improvement interventions that target treatment settings could also be deployed to overcome healthcare delivery barriers. Additional patient education and medical professional development around establishing realistic treatment goals as well as community awareness campaigns that address the myths and fears associated with OAT can be leveraged to overcome individual, family and community-level barriers. Copyright © 2016 Elsevier Inc. All rights reserved.

Patient Perspectives on Peer Mentoring: Type 1 Diabetes Management in Adolescents and Young Adults

PubMed Central

Lu, Yang; Pyatak, Elizabeth A.; Peters, Anne L.; Wood, Jamie R.; Kipke, Michele; Cohen, Marisa; Sequeira, Paola A.

2014-01-01

Purpose The purpose of the study was to identify attitudes and topics relevant to peer mentoring as an adherence-promoting intervention for adolescents and young adults (YAs) with type 1 diabetes (T1D). Methods Self-administered survey data were collected in two diabetes clinics from a convenience sample of adolescents as prospective mentees (ages 13–18) and YAs as prospective mentors (ages 19–25) with T1D. Survey topics included demographics, disease history, glycemic control, adherence, depression, barriers to disease management, social support, and interest in peer mentoring. Descriptive statistical analyses, thematic coding, and stepwise multivariate logistic regression were performed. Results A majority of the 54 adolescents and 46 YAs expressed interest in a peer mentoring program. Having supportive friends and living in a large household positively predicted adolescent interest in having a peer mentor. Approximately one third of all participants experienced social barriers to diabetes management. For adolescents, barriers included inflexible schedules, unfamiliar foods, and the embarrassment of checking blood glucose in front of others. Young adults reported barriers in tracking food consumption and remembering to check blood glucose. Various diabetes management skills were in high demand by adolescents, who especially desired to learn about managing T1D on their own and in college. Participants were open to multiple communication modes, including in-person meetings, phone, text messaging, and social media. Conclusions Many adolescents and young adults with T1D are interested in peer mentoring as a way to facilitate learning and sharing essential diabetes management skills and experiences. PMID:25394732

Simultaneous flow of gas and water in a damage-susceptible argillaceous rock

NASA Astrophysics Data System (ADS)

Nguyen, T. S.

2011-12-01

A research project has been initiated by the Canadian Nuclear Safety Commission (CNSC) to study the influence of gas generation and migration on the long term safety of deep geological repositories for radioactive wastes. Such facilities rely on multiple barriers to isolate and contain the wastes. Depending on the level of radioactivity of the wastes, those barriers include some or all of the following: corrosion and structurally resistant containers, low permeability seals around the emplacements rooms, galleries and shaft, and finally the host rock formations. Large quantities of gas may be generated from the degradation of the waste forms or the corrosion of the containers. The generated gas pressures, if sufficiently large, can induce cracks and microcracks in the engineered and natural barriers and affect their containment functions. The author has developed a mathematical model to simulate the above effects. The model must be calibrated and validated with laboratory and field experiments in order to provide confidence in its future use for assessing the effects of gas on the long term safety of nuclear wastes repositories. The present communication describes the model and its use in the simulation of laboratory and large scale in-situ gas injection experiments in an argillaceous rock, known as Opalinus clay, from Mont Terri, Switzerland. Both the laboratory and in-situ experiments show that the gas flow rate substantially increases when the injection pressure is higher than the confining stress. The above observation seems to indicate that at high gas injection pressures, damage could possibly be induced in the rock formation resulting in an important increase in its permeability. In order to simulate the experiments, we developed a poro-elastoplastic model, with the consideration of two compressible pore fluids (water and gas). The bulk movement of the pore fluids is assumed to obey the generalized Darcy's law, and their respective degree of saturation is represented by the Van Genuchten's functions. The solid skeleton is assumed to be elastoplastic, with degradation of the strength and elastic modulus accompanied by an increase in permeability when damage is accumulated. The model can predict the three distinct flow regimes found in the experiments: a low flow regime where gas movement is restricted to the injection zone, a moderate flow regime when damage is limited, and a high flow regime when damage induces a substantial increase in the permeability.

Anomalously high potentials observed on ISEE

NASA Technical Reports Server (NTRS)

Whipple, E. C.; Krinsky, I. S.; Torbert, R. B.; Olsen, R. C.

1985-01-01

Data from two electric field experiments and from the plasma composition experiment on ISEE-1 are used to show that the spacecraft charged to close to -70 V in sunlight at 0700 UT on March 17, 1978. Data from the electron spectrometer experiment show that there was a potential barrier of -10 to -20 V about the spacecraft during this event. The potential barrier was effective in turning back emitted photoelectrons to the spacecraft. The stringent electrostatic cleanliness specifications imposed on ISEE make the presence of differential charging unlikely. Modeling of this event is required to determine if the barrier was produced by the presence of space charge.

Cancer survivorship care-planning: Practice, research, and policy implications for social work.

PubMed

Wagner, Richard W; Pritzker, Suzanne

2016-01-01

Increasing numbers of cancer survivors are living longer than 5 years from their diagnosis date. This has resulted in a growing population of cancer survivors, expected to reach 19 million by 2024. Survivors frequently experience late effects caused by cancer and its treatment, reducing survivors' quality of life in multiple domains. Survivorship care-plans may aid the many physical, psychosocial, and financial needs that emerge posttreatment. However, the lack of reimbursement mechanisms, the limited amount of effectiveness research, and minimal guidelines for content and delivery are barriers to the widespread provision of survivorship care-plans. Challenges and opportunities for social work practice, research, and policy are identified and discussed.

Biological intrusion of low-level-waste trench covers

NASA Astrophysics Data System (ADS)

Hakonson, T. E.; Gladney, E. S.

The long-term integrity of low-level waste shallow land burialsites is dependent on the interaction of physical, chemical, and biological factors that modify the waste containment system. The need to consider biological processes as being potentially important in reducing the integrity of waste burial site cover treatment is demonstrated. One approach to limiting biological intrusion through the waste cover is to apply a barrier within the profile to limit root and animal penetration with depth. Experiments in the Los Alamos Experimental Engineered Test Facility were initiated to develop and evaluate biological barriers that are effective in minimizing intrusion into waste trenches. The experiments that are described employ four different candidate barrier materials of geologic origin. Experimental variables that will be evaluated, in addition to barrier type, are barrier depth and sil overburden depth.

Kinetics and dynamics of the C(3P) + H2O reaction on a full-dimensional accurate triplet state potential energy surface.

PubMed

Li, Jun; Xie, Changjian; Guo, Hua

2017-08-30

A full dimensional accurate potential energy surface (PES) for the C( 3 P) and H 2 O reaction is developed based on ∼34 000 data points calculated at the level of the explicitly correlated unrestricted coupled cluster method with single, double, and perturbative triple excitations with the augmented correlation-consistent polarized triple zeta basis set (CCSD(T)-F12a/AVTZ). The PES is invariant with respect to the permutation of the two hydrogen atoms and the total root mean square error (RMSE) of the fit is only 0.31 kcal mol -1 . The PES features two barriers in the entrance channel and several potential minima, as well as multiple product channels. The rate coefficients of this reaction calculated using a transition-state theory and quasi-classical trajectory (QCT) method are small near room temperature, consistent with experiments. The reaction dynamics is also investigated with QCT on the new PES, which found that the reactivity is constrained by the entrance barriers and the final product branching is not statistical.

An Integrated and Collaborative Approach for NASA Earth Science Data

NASA Technical Reports Server (NTRS)

Murphy, K.; Lowe, D.; Behnke, J.; Ramapriyan, H.; Behnke, J.; Sofinowski, E.

2012-01-01

Earth science research requires coordination and collaboration across multiple disparate science domains. Data systems that support this research are often as disparate as the disciplines that they support. These distinctions can create barriers limiting access to measurements, which could otherwise enable cross-discipline Earth science. NASA's Earth Observing System Data and Information System (EOSDIS) is continuing to bridge the gap between discipline-centric data systems with a coherent and transparent system of systems that offers up to date and engaging science related content, creates an active and immersive science user experience, and encourages the use of EOSDIS earth data and services. The new Earthdata Coherent Web (ECW) project encourages cohesiveness by combining existing websites, data and services into a unified website with a common look and feel, common tools and common processes. It includes cross-linking and cross-referencing across the Earthdata site and NASA's Distributed Active Archive Centers (DAAC), and by leveraging existing EOSDIS Cyber-infrastructure and Web Service technologies to foster re-use and to reduce barriers to discovering Earth science data (http://earthdata.nasa.gov).

Pharmacists' perspectives on collaborating with community health workers in diabetes care.

PubMed

Rojas, Enrique; Gerber, Ben S; Tilton, Jessica; Rapacki, Lauren; Sharp, Lisa K

2015-01-01

To qualitatively assess pharmacists' perspectives on the barriers and facilitators of collaborating with community health workers (CHWs) when caring for patients with diabetes. Eight pharmacists were invited to participate in a focus group. All pharmacists had worked with CHWs for 12 months as part of a larger study. Seven pharmacists participated in a single focus group while one pharmacist participated in an individual interview. Data were analyzed by two investigators to identify common themes. Perceived barriers included issues associated with maintaining patient confidentiality, pharmacists' level of comfort with CHWs, uncertainty about CHW roles, and inconsistent communication between pharmacists and CHWs. However, pharmacists reported that the care model fostered improvement in patient-pharmacist communication, patient adherence to medication, and assessment of patients' overall condition. Pharmacists expressed positive attitudes and experiences in working with CHWs caring for a minority patient population with poorly controlled diabetes. Most believed that CHWs acted as facilitators and aided them in producing positive clinical outcomes by addressing the multiple psychosocial and contextual dimensions of patient health. Developing approaches for more frequent and effective communication between pharmacists and CHWs was the primary perceived challenge.

Needles, Jabs and Jags: a qualitative exploration of barriers and facilitators to child and adult immunisation uptake among Gypsies, Travellers and Roma.

PubMed

Jackson, Cath; Bedford, Helen; Cheater, Francine M; Condon, Louise; Emslie, Carol; Ireland, Lana; Kemsley, Philippa; Kerr, Susan; Lewis, Helen J; Mytton, Julie; Overend, Karen; Redsell, Sarah; Richardson, Zoe; Shepherd, Christine; Smith, Lesley; Dyson, Lisa

2017-03-14

Gypsies, Travellers and Roma (referred to as Travellers) are less likely to access health services including immunisation. To improve immunisation rates, it is necessary to understand what helps and hinders individuals in these communities in taking up immunisations. This study had two aims. 1. Investigate the views of Travellers in the UK on the barriers and facilitators to acceptability and uptake of immunisations and explore their ideas for improving immunisation uptake; 2. Examine whether and how these responses vary across and within communities, and for different vaccines (childhood and adult). This was a qualitative, cross-sectional interview study informed by the Social Ecological Model. Semi-structured interviews were conducted with 174 Travellers from six communities: Romanian Roma, English Gypsy/Irish Travellers (Bristol), English Gypsy (York), Romanian/Slovakian Roma, Scottish Show people (Glasgow) and Irish Traveller (London). The focus was childhood and selected adult vaccines. Data were analysed using the Framework approach. Common accounts of barriers and facilitators were identified across all six Traveller communities, similar to those documented for the general population. All Roma communities experienced additional barriers of language and being in a new country. Men and women described similar barriers and facilitators although women spoke more of discrimination and low literacy. There was broad acceptance of childhood and adult immunisation across and within communities, with current parents perceived as more positive than their elders. A minority of English-speaking Travellers worried about multiple/combined childhood vaccines, adult flu and whooping cough and described barriers to booking and attending immunisation. Cultural concerns about antenatal vaccines and HPV vaccination were most evident in the Bristol English Gypsy/Irish Traveller community. Language, literacy, discrimination, poor school attendance, poverty and housing were identified as barriers across different communities. Trustful relationships with health professionals were important and continuity of care valued. The experience of many Travellers in this study, and the context through which they make health decisions, is changing. This large study identified key issues that should be considered when taking action to improve uptake of immunisations in Traveller families and reduce the persistent inequalities in coverage. Current Controlled Trials ISRCTN20019630 .

Sexual Harassment in Medical Schools: The Challenge of Covert Retaliation as a Barrier to Reporting.

PubMed

Binder, Renee; Garcia, Paul; Johnson, Bonnie; Fuentes-Afflick, Elena

2018-05-22

Although Title IX, the federal law prohibiting sexual harassment in educational institutions, was enacted in 1972, sexual harassment continues to be distressingly common in medical training. In addition, many women who experience sexual harassment do not report their experiences to authorities within the medical school.In this article, the authors review the literature on the prevalence of sexual harassment in medical schools since Title IX was enacted and on the cultural and legal changes that have occurred during that period that have affected behaviors. These changes include decreased tolerance for harassing behavior, increased legal responsibility assigned to institutions, and a significant increase in the number of female medical students, residents, and faculty. The authors then discuss persisting barriers to reporting sexual harassment, including fears of reprisals and retaliation, especially covert retaliation. They define covert retaliation as vindictive comments made by a person accused of sexual harassment about his or her accuser in a confidential setting, such as a grant review, award selection, or search committee.The authors concluding by highlighting institutional and organizational approaches to decreasing sexual harassment and overt retaliation, and they propose other approaches to decreasing covert retaliation. These initiatives include encouraging senior faculty members to intervene and file bystander complaints when they witness inappropriate comments or behaviors as well as group reporting when multiple women are harassed by the same person.

Perspectives of hospital emergency department staff on trauma-informed care for injured children: An Australian and New Zealand analysis.

PubMed

Hoysted, Claire; Babl, Franz E; Kassam-Adams, Nancy; Landolt, Markus A; Jobson, Laura; Curtis, Sarah; Kharbanda, Anupam B; Lyttle, Mark D; Parri, Niccolò; Stanley, Rachel; Alisic, Eva

2017-09-01

To examine Australian and New Zealand emergency department (ED) staff's training, knowledge and confidence regarding trauma-informed care for children after trauma, and barriers to implementation. ED staff's perspectives on trauma-informed care were assessed using a web-based self-report questionnaire. Participants included 468 ED staff (375 nursing and 111 medical staff) from hospitals in Australia and New Zealand. Data analyses included descriptive statistics, χ 2 tests and multiple regressions. Over 90% of respondents had not received training in trauma-informed care and almost all respondents (94%) wanted training in this area. While knowledge was associated with a respondent's previous training and profession, confidence was associated with the respondent's previous training, experience level and workplace. Dominant barriers to the implementation of trauma-informed care were lack of time and lack of training. There is a need and desire for training and education of Australian and New Zealand ED staff in trauma-informed care. This study demonstrates that experience alone is not sufficient for the development of knowledge of paediatric traumatic stress reactions and trauma-informed care practices. Existing education materials could be adapted for use in the ED and to accommodate the training preferences of Australian and New Zealand ED staff. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Women's views and knowledge regarding healthcare seeking for gestational diabetes in the postpartum period: A systematic review of qualitative/survey studies.

PubMed

Van Ryswyk, Emer; Middleton, Philippa; Shute, Elen; Hague, William; Crowther, Caroline

2015-11-01

To identify factors influencing postpartum healthcare seeking, from the perspective of women who have experienced gestational diabetes mellitus (GDM). Systematic review that searched PubMed, Web of Science, EMBASE and CINAHL on 27th February 2013. Qualitative studies and surveys, with women as participants, which reported pre-specified outcomes, including barriers and facilitators to healthcare seeking for GDM after birth, were included. Two authors independently extracted data and assessed quality. Results were thematically synthesised. Forty-two studies were included, with data from 7949 women in several countries. The diagnosis of GDM was sometimes a concerning or upsetting experience. A need for more specific information about GDM to be available around the time of diagnosis was identified. Women had varied experiences of antenatal GDM care and management, ranging from very positive to difficult and confusing. Non-judgemental and positively focussed care was preferred. While women were often knowledgeable about type 2 diabetes risk and prevention, they faced multiple barriers to undertaking preventive behaviours. A need for lifestyle change support and more pro-active postpartum care was identified. Provision of improved GDM education, as well as positive and pro-active care from diagnosis until postpartum follow-up may increase healthcare seeking by women with recent GDM. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

In vivo measurements of skin barrier: comparison of different methods and advantages of laser scanning microscopy

NASA Astrophysics Data System (ADS)

Patzelt, A.; Sterry, W.; Lademann, J.

2010-12-01

A major function of the skin is to provide a protective barrier at the interface between external environment and the organism. For skin barrier measurement, a multiplicity of methods is available. As standard methods, the determination of the transepidermal water loss (TEWL) as well as the measurement of the stratum corneum hydration, are widely accepted, although they offer some obvious disadvantages such as increased interference liability. Recently, new optical and spectroscopic methods have been introduced to investigate skin barrier properties in vivo. Especially, laser scanning microscopy has been shown to represent an excellent tool to study skin barrier integrity in many areas of relevance such as cosmetology, occupation, diseased skin, and wound healing.

"It was an education in portion size". Experience of eating a healthy diet and barriers to long term dietary change.

PubMed

Macdiarmid, J I; Loe, J; Kyle, J; McNeill, G

2013-12-01

The aim of the study was to explore the expectations and experience of actually eating a healthy diet and using this experience to identify barriers to healthy eating and sustainable dietary change. Fifty participants (19-63 yrs) were provided with a healthy diet (i.e. complied with dietary recommendations) for three consecutive days. Afterwards a semi-structured interview was carried out to explore expectations, experience and barriers to healthy eating. Using a thematic analysis approach eight dominant themes emerged from the interviews. Four related to expectations and experience of healthy eating; realisation of what are appropriate portion sizes, an expectation to feel hungry, surprise that healthy diets comprised normal food, the desire for sweet snacks (e.g. chocolate). This demonstrated there are some misconception about healthy eating and distorted views of portion size. Four more themes emerged relating to barriers to healthy eating; competing priorities, social, peer and time pressure, importance of value for money, a lack of desire to cook. Poor knowledge of healthy eating or a lack of cooking skills were the least common barrier, suggesting that future interventions and policy to improve dietary intakes need to focus on social, cultural and economic issues rather than on lack of knowledge or skills. Copyright © 2013 Elsevier Ltd. All rights reserved.

Physical Activity During and After Adjuvant Treatment for Breast Cancer: An Integrative Review of Women’s Experiences

PubMed Central

Browall, Maria; Mijwel, Sara; Rundqvist, Helen; Wengström, Yvonne

2016-01-01

Background: In oncology, physical activity (PA) is recognized to improve psychological and physiological functions. Motivating women with breast cancer to sustain a physically active lifestyle is important for promoting positive health after diagnosis. To review and synthesize what is known about how women with breast cancer experience supervised and unsupervised PA during and after adjuvant treatment. PubMed, PsycINFO, and CINAHL were searched, yielding 994 citations. The final review included 17 articles published between 2004 and 2014 in English. The CASP (Critical Appraisal Skills Programme) instrument was used to appraise quality. Results: Exercise is experienced as a positive element with multiple benefits. However, maintaining a physically active lifestyle during and after chemotherapy is sometimes challenging. Reported benefits of PA include feeling empowered, and improving and reclaiming health. Facilitators to PA comprised exercising with peers and skilled instructors. Barriers included social factors and lack of information. Conclusions: Findings highlight the importance of incorporating PA programs from a patient experience perspective as routine treatment. Health care professionals play a crucial “gateway” role in providing information on implementation and benefits of PA. Providing support and educated advice about how to safely start or continue regular PA to minimize symptoms, reduce morbidity, and increase well-being during or after treatment is vital for women with breast cancer. Implications for Practice: Health care professionals need increased knowledge of the breast cancer patients’ perspectives on facilitators and barriers to PA during and after treatment, in order to provide sufficient support for women to stay physically active during a breast cancer illness. PMID:28008778

Successful African American women in science: A narrative inquiry

NASA Astrophysics Data System (ADS)

Petty, Cailisha L.

This study used narrative inquiry as a methodology to explore the lived experiences of five African American women in science across the academic spectrum, from doctoral candidate to full professor. The research questions guiding the inquiry included one overarching question and three sub-questions: What are the lifestories of successful African American women in science?; a) How do successful African American women in science define themselves?; b) What have been the facilitators and barriers encountered by successful African American women in science?; and c) What have been the systems of support for African American women in science? The study was theoretically positioned within the frameworks of Critical Race Theory and Black Feminist Thought. The two theories were used to guide all aspects of the study including methodology, data collection, and analysis. Data included eleven 40-60 minute semi-structured interview transcripts as well as the participants' Curriculum Vitae. The study design and data analysis were built upon Clandinin and Connelly's (2000) and Clandinin's (2006) model of narrative inquiry which explores narratives as a means to understand experience. Analysis and interpretation created three dominant narratives: Scientific Beginnings, An Unexpected Journey, and Lift as You Climb. Each narrative set explores multiple stories that describe storylines which aligned with the participants' goals of who they were and who they were becoming as scientists; and, storylines of tension which ran counter to the women's goals and aspirations. Barriers and support systems are revealed, as well as the meanings the participants made of their experiences and how it affected their lives.

Single Versus Multiple Events Error Potential Detection in a BCI-Controlled Car Game With Continuous and Discrete Feedback.

PubMed

Kreilinger, Alex; Hiebel, Hannah; Müller-Putz, Gernot R

2016-03-01

This work aimed to find and evaluate a new method for detecting errors in continuous brain-computer interface (BCI) applications. Instead of classifying errors on a single-trial basis, the new method was based on multiple events (MEs) analysis to increase the accuracy of error detection. In a BCI-driven car game, based on motor imagery (MI), discrete events were triggered whenever subjects collided with coins and/or barriers. Coins counted as correct events, whereas barriers were errors. This new method, termed ME method, combined and averaged the classification results of single events (SEs) and determined the correctness of MI trials, which consisted of event sequences instead of SEs. The benefit of this method was evaluated in an offline simulation. In an online experiment, the new method was used to detect erroneous MI trials. Such MI trials were discarded and could be repeated by the users. We found that, even with low SE error potential (ErrP) detection rates, feasible accuracies can be achieved when combining MEs to distinguish erroneous from correct MI trials. Online, all subjects reached higher scores with error detection than without, at the cost of longer times needed for completing the game. Findings suggest that ErrP detection may become a reliable tool for monitoring continuous states in BCI applications when combining MEs. This paper demonstrates a novel technique for detecting errors in online continuous BCI applications, which yields promising results even with low single-trial detection rates.

African American Women Aspiring to the Superintendency: Lived Experiences and Barriers

ERIC Educational Resources Information Center

Angel, Roma B.; Killacky, Jim; Johnson, Patricia R.

2013-01-01

Focused on the absence of a viable population of African American women in the superintendency, this study addressed barriers described by 10 credentialed, district-level Southern women who hold advanced education degrees coupled with years of leadership experience. This phenomenological study used interview methodology to uncover the lived…

Breaking down barriers: exploring the potential for social care practice with trans survivors of domestic abuse.

PubMed

Rogers, Michaela

2016-01-01

There is increasing recognition that domestic abuse takes place outside the heteronormative paradigm of social life. This paper presents a discussion of the findings of doctoral research which explores trans people's experiences of domestic abuse, their social care needs and whether these are met by domestic abuse agencies. This paper foregrounds debate on the intersections of domestic abuse, trans communities and social care provision as this research, and previous studies, suggests that trans survivors do not seek out or benefit from social care intervention. Qualitative data, collected via narrative interviews, were collected during 2012 from participants mainly located in the United Kingdom (two participants were based in the United States). A total of 24 interviews were undertaken with trans people (n = 15) and social care practitioners (n = 9). Data were examined using a voice-centred relational technique. The findings reveal that barriers are multiple and complex but work could be undertaken to encourage help-seeking behaviours. Barriers include expectations of a transphobic response and 'Othering' practices; lack of entitlement felt by trans people; lack of knowledge/misunderstandings about trans social care needs; heteronormative bias of existing services; and practitioner attitudes fixed to notions about gender as binary. The paper ends by proposing a framework for practice with trans survivors which incorporates a person-centred, narrative approach. © 2015 John Wiley & Sons Ltd.

Factors influencing speech and language outcomes of children with early identified severe/profound hearing loss: Clinician-identified facilitators and barriers.

PubMed

Fulcher, Anne Nivelles; Purcell, Alison; Baker, Elise; Munro, Natalie

2015-06-01

Early identification of severe/profound childhood hearing loss (HL) gives these children access to hearing devices and early intervention to facilitate improved speech and language outcomes. Predicting which infants will go on to achieve such outcomes remains difficult. This study describes clinician identified malleable and non-malleable factors that may influence speech and language outcomes for children with severe/profound HL. Semi-structured interviews were conducted with six experienced auditory verbal clinicians. A collective case study design was implemented. The interviews were transcribed and coded into themes using constant comparative analysis. Clinicians identified that, for children with severe/profound HL, early identification, early amplification and commencing auditory-verbal intervention under 6 months of age may facilitate child progress. Possible barriers were living in rural/remote areas, the clinicians' lack of experience and confidence in providing intervention for infants under age 6-months and belonging to a family with a culturally and linguistically diverse (CALD) background. The results indicate that multiple factors need to be considered by clinicians working with children with HL and their families to determine how each child functions within their own environment and personal contexts, consistent with the International Classification of Functioning, Disability and Health (ICF) framework. Such an approach is likely to empower clinicians to carefully balance potential barriers to, and facilitators of, optimal speech and language outcomes for all children with HL.

Exploring perceptions of instructors about childbirth preparation training courses: A qualitative study

PubMed Central

Otogara, Marzieh; Karimi-Shahanjarini, Akram; Hazavehei, Seyed Mohammad Mehdi; Poorolajal, Jalal; Radnia, Nahid; Akrami, Forouzan; Bagheri, Fahimeh

2017-01-01

Background Childbirth preparation training courses on maternal and neonatal health increase awareness, and capability of pregnant women in overcoming fear and anxiety and managing labor pains. Objective To identify the affecting factors and barriers of these courses from the perspective of their instructors. Methods This qualitative study of the content analysis type, has been conducted on 16 certified teachers of the training courses of the Hamadan city in 2015. Data were collected by semi-structured in-depth interviews and were then analyzed by using MAXQDA10 application. Results Participants’ experiences are indicated on three main themes including the objectives of the course, facilitators and barriers. The main objectives of the course were reported as to improve maternal and newborn health, promote natural childbirth and preparedness for parenting and breastfeeding. The main facilitators of the successful implementation include observing educational standards, strengthening the communication and relationship between mothers and staff, mobilization, and the role of instructor. The major barriers are reported as inadequate support from management system, insufficient intra-sector collaboration, poor attitude of obstetricians and physicians, inadequate access, theory-practice gap and not intended to labor naturally. Conclusion The results of our study show that multiple factors are involved in the participation of pregnant women in antenatal classes. Promoting natural childbirth requires intra-sector and inter-sectoral collaboration, as well as the community participation. PMID:28607658

The self-management experience of patients with type 2 diabetes and chronic kidney disease: A qualitative study.

PubMed

Shirazian, Shayan; Crnosija, Natalie; Weinger, Katie; Jacobson, Alan M; Park, Joonho; Tanenbaum, Molly L; Gonzalez, Jeffrey S; Mattana, Joseph; Hammock, Amy C

2016-03-01

The purpose of this study was to explore views related to the self-management of type 2 diabetes and chronic kidney disease. We conducted three semi-structured focus groups in participants with type 2 diabetes and chronic kidney disease. Interviews were transcribed, coded, and analyzed using thematic analysis. Credibility was supported through triangulation of data sources and the use of multiple investigators from different disciplines. Twenty-three adults participated. Three major themes were identified: emotional reactions to health state, the impact of family dynamics on self-management, and the burden of self-management regimens. Family dynamics were found to be a barrier and support to self-management, while complicated self-management regimens were found to be a barrier. Additionally, participants expressed several emotional reactions related to their CKD status, including regret related to having developed CKD and distress related both to their treatment regimens and the future possibility of dialysis. This exploratory study of patients with type 2 diabetes and chronic kidney disease describes barriers and supports to self-management and emotional reactions to chronic kidney disease status. Future research should confirm these findings in a larger population and should include family members and/or health care providers to help further define problems with self-management in patients with type 2 diabetes and chronic kidney disease. © The Author(s) 2015.

Persistent barriers to care; a qualitative study to understand women's experiences in areas served by the midwives service scheme in Nigeria.

PubMed

Exley, Josephine; Pitchforth, Emma; Okeke, Edward; Glick, Peter; Abubakar, Isa Sadeeq; Chari, Amalavoyal; Bashir, Usman; Gu, Kun; Onwujekwe, Obinna

2016-08-19

The Nigerian Midwives Service Scheme (MSS) is an ambitious human resources project created in 2009 to address supply side barriers to accessing care. Key features include the recruitment and deployment of newly qualified, unemployed and retired midwives to rural primary healthcare centres (PHCs) to ensure improved access to skilled care. This study aimed to understand, from multiple perspectives, the views and experiences of childbearing women living in areas where it has been implemented. A qualitative study was undertaken as part of an impact evaluation of the MSS in three states from three geo-political regions of Nigeria. Semi-structured interviews were conducted around nine MSS PHCs with women who had given birth in the past six months, midwives working in the PHCs and policy makers. Focus group discussions were held with wider community members. Coding and analysis of the data was performed in NVivo10 based on the constant comparative approach. The majority of participants reported that there had been positive improvements in maternity care as a result of an increasing number of midwives. However, despite improvements in the perceived quality of care and an apparent willingness to give birth in a PHC, more women gave birth at home than intended. There were some notable differences between states, with a majority of women in one northern state favouring home birth, which midwives and community members commented stemmed from low levels of awareness. The principle reason cited by women for home birth was the sudden onset of labour. Financial barriers, the lack of essential drugs and equipment, lack of transportation and the absence of staff, particularly at night, were also identified as barriers to accessing care. Our research highlights a number of barriers to accessing care exist, which are likely to have limited the potential for the MSS to have an impact. It suggests that in addition to scaling up the workforce through the MSS, efforts are also needed to address the determinants of care seeking. For the MSS this means that the while the supply side, through the provision of skilled attendance, still needs to be strengthened, this should not be in isolation of addressing demand-side factors.

Quantification of Fine-grained Sediment Concentration in the Aquatic Environment Using Optical and Acoustic Sensors: Insight from Lab Experiments

NASA Astrophysics Data System (ADS)

Xu, K.; Champagne, B. N.

2017-12-01

The transport of sediment in the coastal zone and continental shelf is highly impacted by fluvial and oceanographic dynamics. In Louisiana, the Mississippi River delivers a bulk of water, sediment, and nutrients to the coast. However, coastal land loss highlights the importance of the sediment deposited at the mouth of the river. Sediment is the foundation to build land and suspended sediment concentration (SSC) tracks the delivery, deposition, and erosion of sediment. On a more applicable scale, variables such as SSC can be used to calculate sediment transport flux, an important parameter for projects such as sediment diversions and barrier island restoration. In order to rely on suspended sediment concentration (SSC) as continuous data, lab experiments are needed to establish the relationship between turbidity and SSC. Factors such as sensor type (optical or acoustic) and grain size (coarse or fine) can greatly impact the estimated SSC. In this study, fine-grained sediment was collected from multiple sites in coastal Louisiana and used to calibrate both optical backscatter (OBS) and acoustic backscatter (ABS) sensors to establish the relationship between sensor type and accuracy of the SSC estimation. Multiple grain-size analyses using a Laser Diffraction Particle Size Analyzer helped determine the effects of sensor accuracy regarding grain size. The results of these experiments were combined in order to establish the calibration curves of SSC. Our results indicated that the OBS-3A sensor's turbidity data were more correlated with the SSC than the OBS-5+'s data. Possible explanations for this could be due to differences between the instruments' measuring ranges and their sensitivity to various grain sizes. This technology development has a broad impact to the studies of sediment delivery, transport, and deposition in multiple types of coastal protection and restoration projects.

InGaP Heterojunction Barrier Solar Cells

NASA Technical Reports Server (NTRS)

Welser, Roger E.

2010-01-01

A new solar-cell structure utilizes a single, ultra-wide well of either gallium arsenide (GaAs) or indium-gallium-phosphide (InGaP) in the depletion region of a wide bandgap matrix, instead of the usual multiple quantum well layers. These InGaP barrier layers are effective at reducing diode dark current, and photogenerated carrier escape is maximized by the proper design of the electric field and barrier profile. With the new material, open-circuit voltage enhancements of 40 and 100 mV (versus PIN control systems) are possible without any degradation in short-circuit current. Basic tenets of quantum-well and quantum- dot solar cells are utilized, but instead of using multiple thin layers, a single wide well works better. InGaP is used as a barrier material, which increases open current, while simultaneously lowering dark current, reducing both hole diffusion from the base, and space charge recombination within the depletion region. Both the built-in field and the barrier profile are tailored to enhance thermionic emissions, which maximizes the photocurrent at forward bias, with a demonstrated voltage increase. An InGaP heterojunction barrier solar cell consists of a single, ultra-wide GaAs, aluminum-gallium-arsenide (AlGaAs), or lower-energy-gap InGaP absorber well placed within the depletion region of an otherwise wide bandgap PIN diode. Photogenerated electron collection is unencumbered in this structure. InGaAs wells can be added to the thick GaAs absorber layer to capture lower-energy photons.

An automated approach for extracting Barrier Island morphology from digital elevation models

NASA Astrophysics Data System (ADS)

Wernette, Phillipe; Houser, Chris; Bishop, Michael P.

2016-06-01

The response and recovery of a barrier island to extreme storms depends on the elevation of the dune base and crest, both of which can vary considerably alongshore and through time. Quantifying the response to and recovery from storms requires that we can first identify and differentiate the dune(s) from the beach and back-barrier, which in turn depends on accurate identification and delineation of the dune toe, crest and heel. The purpose of this paper is to introduce a multi-scale automated approach for extracting beach, dune (dune toe, dune crest and dune heel), and barrier island morphology. The automated approach introduced here extracts the shoreline and back-barrier shoreline based on elevation thresholds, and extracts the dune toe, dune crest and dune heel based on the average relative relief (RR) across multiple spatial scales of analysis. The multi-scale automated RR approach to extracting dune toe, dune crest, and dune heel based upon relative relief is more objective than traditional approaches because every pixel is analyzed across multiple computational scales and the identification of features is based on the calculated RR values. The RR approach out-performed contemporary approaches and represents a fast objective means to define important beach and dune features for predicting barrier island response to storms. The RR method also does not require that the dune toe, crest, or heel are spatially continuous, which is important because dune morphology is likely naturally variable alongshore.

Leisure-Time Physical Activity: Experiences of College Students With Disabilities.

PubMed

Devine, Mary Ann

2016-04-01

College years are an experimental phase in young adulthood and can lay the foundation for lifelong behaviors. One type of behavior developed during these years is the use of leisure-time physical activity (LTPA). LTPA experiences of typical college students have been examined, but there is a lack of studies examining the experiences of students with disabilities. The purpose of this inquiry is to understand the experiences of college students with disabilities and their LTPA, with focus on factors that facilitate or create barriers to engagement. Grounded theory was used to understand LTPA with undergraduates with mobility or visual impairments. Results indicated a theme of culture of physical activity and disability as they received a message that engagement in LTPA was "unnecessary" or "heroic," which altered their LTPA experiences. Barriers to LTPA can be understood through a social relational lens to recognize the multidimensionality of barriers and facilitators to LTPA.

Liquid spray experiments

NASA Astrophysics Data System (ADS)

Lapham, Gary; McHugh, John

When waves on the ocean surface interact with a solid object, the result is often a complex pattern of spray. The solid object may be a coastal barrier such as a breakwater, or a ship or drilling rig. Another spray-related case is the presence of large industrial tanks of liquid, and often dangerous liquids, that exist around the world. Tens of thousands of such tanks are rapidly becoming obsolete. Recent experience has shown that when such tanks burst, the resulting spray may shoot several hundreds of meters from the tank. These tanks often have a wall or dam (barrier) surrounding them in an attempt to contain any leakage, catastrophic or otherwise. When the tank bursts it is akin to the dam-break problem. A wall of water rushes forth and impinges on the barrier creating spray. Previous experiments (McHugh and Watt, 1998) considered the related configuration of a solitary wave impinging on a vertical wall. The present experiments more closely model the bursting tank case, and treat the effect of the distance between the tank and barrier. Results show that there is a sweet spot where height and horizontal distance of spray droplets are maximized. This ideal distance between tank and barrier is constant when scaled by the initial tank depth.

Developing a national dental education research strategy: priorities, barriers and enablers

PubMed Central

Barton, Karen L; Dennis, Ashley A; Rees, Charlotte E

2017-01-01

Objectives This study aimed to identify national dental education research (DER) priorities for the next 3–5 years and to identify barriers and enablers to DER. Setting Scotland. Participants In this two-stage online questionnaire study, we collected data with multiple dental professions (eg, dentistry, dental nursing and dental hygiene) and stakeholder groups (eg, learners, clinicians, educators, managers, researchers and academics). Eighty-five participants completed the Stage 1 qualitative questionnaire and 649 participants the Stage 2 quantitative questionnaire. Results Eight themes were identified at Stage 1. Of the 24 DER priorities identified, the top three were: role of assessments in identifying competence; undergraduate curriculum prepares for practice and promoting teamwork. Following exploratory factor analysis, the 24 items loaded onto four factors: teamwork and professionalism, measuring and enhancing performance, dental workforce issues and curriculum integration and innovation. Barriers and enablers existed at multiple levels: individual, interpersonal, institutional structures and cultures and technology. Conclusions This priority setting exercise provides a necessary first step to developing a national DER strategy capturing multiple perspectives. Promoting DER requires improved resourcing alongside efforts to overcome peer stigma and lack of valuing and motivation. PMID:28360237

The Health Action Process Approach as a motivational model for physical activity self-management for people with multiple sclerosis: a path analysis.

PubMed

Chiu, Chung-Yi; Lynch, Ruth T; Chan, Fong; Berven, Norman L

2011-08-01

To evaluate the Health Action Process Approach (HAPA) as a motivational model for physical activity self-management for people with multiple sclerosis (MS). Quantitative descriptive research design using path analysis. One hundred ninety-five individuals with MS were recruited from the National Multiple Sclerosis Society and a neurology clinic at a university teaching hospital in the Midwest. Outcome was measured by the Physical Activity Stages of Change Instrument, along with measures for nine predictors (severity, action self-efficacy, outcome expectancy, risk perception, perceived barriers, intention, maintenance self-efficacy, action and coping planning, and recovery self-efficacy). The respecified HAPA physical activity model fit the data relatively well (goodness-of-fit index = .92, normed fit index = .91, and comparative fit index = .93) explaining 38% of the variance in physical activity. Recovery self-efficacy, action and coping planning, and perceived barriers directly contributed to the prediction of physical activity. Outcome expectancy significantly influenced intention and the relationship between intention and physical activity is mediated by action and coping planning. Action self-efficacy, maintenance self-efficacy, and recovery self-efficacy directly or indirectly affected physical activity. Severity of MS and action self-efficacy had an inverse relationship with perceived barriers and perceived barriers influenced physical activity. Empirical support was found for the proposed HAPA model of physical activity for people with MS. The HAPA model appears to provide useful information for clinical rehabilitation and health promotion interventions.

Multiple kinetic k-essence, phantom barrier crossing and stability

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

Sur, Sourav; Das, Saurya, E-mail: sourav.sur@uleth.ca

We investigate models of dark energy with purely kinetic multiple k-essence sources that allow for the crossing of the phantom divide line, without violating the conditions of stability. It is known that with more than one kinetic k-field one can possibly construct dark energy models whose equation of state parameter w{sub X} crosses -1 (the phantom barrier) at recent red-shifts, as indicated by the Supernova Ia and other observational probes. However, such models may suffer from cosmological instabilities, as the effective speed of propagation c{sub X} of the dark energy density perturbations may become imaginary while the w{sub X} =more » -1 barrier is crossed. Working out the expression for c{sub X} we show that multiple kinetic k-essence fields do indeed lead to a w{sub X} = -1 crossing dark energy model, satisfying the stability criterion c{sub X}{sup 2} {>=} 0 as well as the condition c{sub X} {<=} 1 (in natural units), which implies that the dark energy is not super-luminal. As a specific example, we construct a phantom barrier crossing model involving three k-fields for which c{sub X} is a constant, lying between 0 and 1. The model fits well with the latest Supernova Ia Union data, and the best fit shows that w{sub X} crosses -1 at red-shift z {approx} 0.2, whereas the dark energy density nearly tracks the matter density at higher red-shifts.« less

Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: a comprehensive review.

PubMed

Shahid, Shaouli; Taylor, Emma V; Cheetham, Shelley; Woods, John A; Aoun, Samar M; Thompson, Sandra C

2018-05-08

Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples' preferences, needs, opportunities and barriers to palliative care. A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly's hierarchy of evidence-for-practice in qualitative research. Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples' experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. The results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas.

Signature-based store checking buffer

DOEpatents

Sridharan, Vilas; Gurumurthi, Sudhanva

2015-06-02

A system and method for optimizing redundant output verification, are provided. A hardware-based store fingerprint buffer receives multiple instances of output from multiple instances of computation. The store fingerprint buffer generates a signature from the content included in the multiple instances of output. When a barrier is reached, the store fingerprint buffer uses the signature to verify the content is error-free.

A survey of homework use, experience of barriers to homework, and attitudes about the barriers to homework among couples and family therapists.

PubMed

Dattilio, Frank M; Kazantzis, Nikolaos; Shinkfield, Gregg; Carr, Amanda G

2011-04-01

Homework is a therapeutic process that has strong theoretical and empirical basis, but existing research has focused on "compliance" rather than considering the broader and more clinically meaningful construct of "engagement." Absent in the literature is empirical study of the barriers to engagement or study of homework use among couple and family therapists (CFTs). The current study investigates the frequency and type of homework, as well as the influence of homework compliance, quality of compliance, and experience of barriers to compliance on CFTs' attitudes and beliefs toward barriers to homework completion for couples and families. Results indicated CFTs (N=226 AAMFT Clinical members) use homework more often with couples than with families, and CFTs report greater homework compliance and quality of compliance for couples when compared to families. A path analysis examining compliance, quality of compliance, and barriers to compliance as predictors of attitudes/beliefs toward barriers revealed no significant findings. A discussion presents implications for future research and practice for homework in couple and family therapy. © 2011 American Association for Marriage and Family Therapy.

Tunable valley polarization by a gate voltage when an electron tunnels through multiple line defects in graphene.

PubMed

Liu, Zhe; Jiang, Liwei; Zheng, Yisong

2015-02-04

By means of an appropriate wave function connection condition, we study the electronic structure of a line defect superlattice of graphene with the Dirac equation method. We obtain the analytical dispersion relation, which can simulate well the tight-binding numerical result about the band structure of the superlattice. Then, we generalize this theoretical method to study the electronic transmission through a potential barrier where multiple line defects are periodically patterned. We find that there exists a critical incident angle which restricts the electronic transmission through multiple line defects within a specific incident angle range. The critical angle depends sensitively on the potential barrier height, which can be modulated by a gate voltage. As a result, non-trivial transmissions of K and K' valley electrons are restricted, respectively, in two distinct ranges of the incident angle. Our theoretical result demonstrates that a gate voltage can act as a feasible measure to tune the valley polarization when electrons tunnel through multiple line defects.

Academics' Perceptions of the Challenges and Barriers to Implementing Research-Based Experiences for Undergraduates

ERIC Educational Resources Information Center

Brew, Angela; Mantai, Lilia

2017-01-01

How can universities ensure that strategic aims to integrate research and teaching through engaging students in research-based experiences be effectively realised within institutions? This paper reports on the findings of a qualitative study exploring academics' perceptions of the challenges and barriers to implementing undergraduate research.…

Development and Exploration of the Experiences with Classism Scale

ERIC Educational Resources Information Center

Thompson, Mindi N.; Subich, Linda M.

2013-01-01

The examination of barriers in relation to college students' vocational choice and development is an important area of research, but the barrier of classism is relatively underexamined. This may be due to the deficiencies in measurement, so we describe herein the development of a new measure, the Experiences with Classism scale (EWCS). The EWCS…

Modeling the impact of solid noise barriers on near road air quality

EPA Science Inventory

Studies based on field measurements, wind tunnel experiments, and controlled tracer gas releases indicate that solid, roadside noise barriers can lead to reductions in downwind near-road air pollutant concentrations. A tracer gas study showed that a solid barrier reduced pollutan...

Micro heat barrier

DOEpatents

Marshall, Albert C.; Kravitz, Stanley H.; Tigges, Chris P.; Vawter, Gregory A.

2003-08-12

A highly effective, micron-scale micro heat barrier structure and process for manufacturing a micro heat barrier based on semiconductor and/or MEMS fabrication techniques. The micro heat barrier has an array of non-metallic, freestanding microsupports with a height less than 100 microns, attached to a substrate. An infrared reflective membrane (e.g., 1 micron gold) can be supported by the array of microsupports to provide radiation shielding. The micro heat barrier can be evacuated to eliminate gas phase heat conduction and convection. Semi-isotropic, reactive ion plasma etching can be used to create a microspike having a cusp-like shape with a sharp, pointed tip (<0.1 micron), to minimize the tip's contact area. A heat source can be placed directly on the microspikes. The micro heat barrier can have an apparent thermal conductivity in the range of 10.sup.-6 to 10.sup.-7 W/m-K. Multiple layers of reflective membranes can be used to increase thermal resistance.

Overcoming psychosocial and developmental barriers to blood and marrow transplantation (BMT) in an adolescent/young adult (AYA) transgender patient with chronic myelogenous leukemia.

PubMed

Khazal, Sajad; Abdel-Azim, Hisham; Kapoor, Neena; Mahadeo, Kris M

2014-11-01

Adolescents/young adults (AYAs) afflicted with cancer face unique barriers to potentially standard curative therapies, such as blood and marrow transplantation (BMT). Transgender AYAs face additional barriers and there is a dearth of published literature regarding their oncology-related experience. We present the case of an AYA male-to-female (MTF) transgender patient on cross-sex hormone therapy, with a history of Chronic Myelogenous Leukemia (CML) and significant psychosocial barriers, which initially served as a barrier to BMT at two different centers; we modified our standard consent and education process and was able to successfully proceed with BMT and subsequently cure her CML. Despite unique challenges, AYA and transgender patients with significant psychosocial barriers may achieve successful outcomes with BMT. Research is needed regarding guidelines for cross-sex hormone therapy administration for patients undergoing BMT and other issues, which may be unique to the transgender experience.

Apparatus and method for in Situ installation of underground containment barriers under contaminated lands

DOEpatents

Carter, Jr., Ernest E.; Sanford, Frank L.; Saugier, R. Kent

1999-09-28

An apparatus for constructing a subsurface containment barrier under a waste site disposed in soil is provided. The apparatus uses a reciprocating cutting and barrier forming device which forms a continuous elongate panel through the soil having a defined width. The reciprocating cutting and barrier forming device has multiple jets which eject a high pressure slurry mixture through an arcuate path or transversely across the panel being formed. A horizontal barrier can be formed by overlapping a plurality of such panels. The cutting device and barrier forming device is pulled through the soil by two substantially parallel pulling pipes which are directionally drilled under the waste site. A tractor or other pulling device is attached to the pulling pipes at one end and the cutting and barrier forming device is attached at the other. The tractor pulls the cutting and barrier forming device through the soil under the waste site without intersecting the waste site. A trailing pipe, attached to the cutting and barrier forming device, travels behind one of the pulling pipes. In the formation of an adjacent panel the trailing pipe becomes one of the next pulling pipes. This assures the formation of a continuous barrier.

Apparatus for in situ installation of underground containment barriers under contaminated lands

DOEpatents

Carter, Jr., Ernest E.; Sanford, Frank L.; Saugier, R. Kent

1998-06-16

An apparatus for constructing a subsurface containment barrier under a waste site disposed in soil is provided. The apparatus uses a reciprocating cutting and barrier forming device which forms a continuous elongate panel through the soil having a defined width. The reciprocating cutting and barrier forming device has multiple jets which eject a high pressure slurry mixture through an arcuate path or transversely across the panel being formed. A horizontal barrier can be formed by overlapping a plurality of such panels. The cutting device and barrier forming device is pulled through the soil by two substantially parallel pulling pipes which are directionally drilled under the waste site. A tractor or other pulling device is attached to the pulling pipes at one end and the cutting and barrier forming device is attached at the other. The tractor pulls the cutting and barrier forming device through the soil under the waste site without intersecting the waste site. A trailing pipe, attached to the cutting and barrier forming device, travels behind one of the pulling pipes. In the formation of an adjacent panel the trailing pipe becomes one of the next pulling pipes. This assures the formation of a continuous barrier.

Barriers to participation in global surgery academic collaborations, and possible solutions: a qualitative study.

PubMed

Fallah, Parisa Nicole; Bernstein, Mark

2018-04-06

OBJECTIVE There is a global lack of access to surgical care, and this issue disproportionately affects those in low- and middle-income countries. Global surgery academic collaborations (GSACs) between surgeons in high-income countries and those in low- and middle-income countries are one possible sustainable way to address the global surgical need. The objective of this study was to examine the barriers to participation in GSACs and to suggest ways to increase involvement. METHODS A convenience sample of 86 surgeons, anesthesiologists, other physicians, residents, fellows, and nurses from the US, Canada, and Norway was used. Participants were all health care providers from multiple specialties and multiple academic centers with varied involvement in GSACs. More than half of the participants were neurosurgeons. Participants were interviewed in person or over Skype in Toronto over the course of 2 months by using a predetermined set of open-ended questions. Thematic content analysis was used to evaluate the participants' responses. RESULTS Based on the data, 3 main themes arose that pointed to individual, community, and system barriers for involvement in GSACs. Individual barriers included loss of income, family commitments, young career, responsibility to local patients, skepticism of global surgery efforts, ethical concerns, and safety concerns. Community barriers included insufficient mentorship and lack of support from colleagues. System barriers included lack of time, minimal academic recognition, insufficient awareness, insufficient administrative support and organization, and low political and funding support. CONCLUSIONS Steps can be taken to address some of these barriers and to increase the involvement of surgeons from high-income countries in GSACs. This could lead to a necessary scale-up of global surgery efforts that may help increase worldwide access to surgical care.

The Path to Self-Management: A Qualitative Study Involving Older People with Multiple Sclerosis

PubMed Central

Austin, Mark W.; Murdoch, Michelle; Kearney, Anne; Godwin, Marshall; Stefanelli, Mark

2012-01-01

ABSTRACT Purpose: This qualitative study sought to explore older people's experience of ageing with multiple sclerosis (MS) and to describe the natural history of self-management from their points of view. Methods: Eighteen people over age 55 and living with MS for at least 20 years were recruited from an MS clinic and rehabilitation outpatient records. Interviews (60–80 min), using open-ended questions, explored participants' lifelong experiences of MS. Following interview transcription, data were coded and analyzed; themes, subthemes, and their relationships were described based on consensus. Results: Participants recounted their diagnosis process, their life experience with MS, and how they eventually accepted their disease, adapted, and moved toward self-management. The findings included vivid descriptions of social relationships, health care interactions, overcoming barriers, and the emotions associated with living with MS. A conceptual model of phases of self-management, from diagnosis to integration of MS into a sense of self, was developed. Conclusions: Study participants valued self-management and described its phases, facilitators, and inhibitors from their points of view. Over years and decades, learning from life experiences, trial and error, and interactions with health care professionals, participants seemed to consolidate MS into their sense of self. Self-determination, social support, strong problem-solving abilities, and collaborative relationships with health professionals aided adaptation and coping. Findings from this study make initial steps toward understanding how MS self-management evolves over the life course and how self-management programmes can help people with MS begin to manage wellness earlier in their lives. PMID:23277680

Developing a Framework to Help Bedside Nurses Bring About Change.

PubMed

Porter, Jordan S; Strout, Kelley A

2016-12-01

: Nurses across all care settings and experience levels are being called upon to lead. In a 2011 report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine examined the ways nurses could more fully apply their knowledge of direct patient care to address the increasing demands placed on the health care system since the passage of the Affordable Care Act. The report asked: "What roles can nursing assume to address the increasing demand for safe, high-quality, and effective health care services?"Multiple variables influence a nurse's ability to assume a leadership role, and multiple barriers to these roles continue to exist. This article uses the first-person voice to share the experience of a new graduate nurse in a formal nurse residency program who found himself in a position to identify the need for, advocate for, and ultimately influence a policy change in the staffing practice of floating as it was applied to new RNs on his unit. In a retrospective analysis of the process, the new graduate RN and his former professor acting as a writing mentor developed a leadership framework for nurses called RN LEADER, which they hope will empower and guide other nurses to lead evidence-based change in their workplaces.

Small is big: Interactive Trumps passive information in breaking information barriers and impacting behavioral antecedents

DOE PAGES

Beck, Ariane L.; Lakkaraju, Kiran; Rai, Varun; ...

2017-01-18

The wealth of information available on seemingly every topic creates a considerable challenge both for information providers trying to rise above the noise and discerning individuals trying to find relevant, trustworthy information. We approach this information problem by investigating how passive versus interactive information interventions can impact the antecedents of behavior change using the context of solar energy adoption, where persistent information gaps are known to reduce market potential. We use two experiments to investigate the impact of both passive and interactive approaches to information delivery on the antecedents (attitudes, subjective norms, and perceived behavioral control in the Theory ofmore » Planned Behavior) of intentions and behavior, as well as their effect on intentions and behavior directly. The passive information randomized control trial delivered via Amazon Mechanical Turk tests the effectiveness of delivering the same content in a single message versus multiple shorter messages. The interactive information delivery uses an online (mobile and PC) trivia-style gamification platform. Both experiments use the same content and are carried out over a two-week time period. Lastly, our findings suggest that interactive, gamified information has greater impact than passive information, and that shorter multiple messages of passive information are more effective than a single passive message.« less

Small is big: Interactive Trumps passive information in breaking information barriers and impacting behavioral antecedents

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

Beck, Ariane L.; Lakkaraju, Kiran; Rai, Varun

The wealth of information available on seemingly every topic creates a considerable challenge both for information providers trying to rise above the noise and discerning individuals trying to find relevant, trustworthy information. We approach this information problem by investigating how passive versus interactive information interventions can impact the antecedents of behavior change using the context of solar energy adoption, where persistent information gaps are known to reduce market potential. We use two experiments to investigate the impact of both passive and interactive approaches to information delivery on the antecedents (attitudes, subjective norms, and perceived behavioral control in the Theory ofmore » Planned Behavior) of intentions and behavior, as well as their effect on intentions and behavior directly. The passive information randomized control trial delivered via Amazon Mechanical Turk tests the effectiveness of delivering the same content in a single message versus multiple shorter messages. The interactive information delivery uses an online (mobile and PC) trivia-style gamification platform. Both experiments use the same content and are carried out over a two-week time period. Lastly, our findings suggest that interactive, gamified information has greater impact than passive information, and that shorter multiple messages of passive information are more effective than a single passive message.« less

Small Is Big: Interactive Trumps Passive Information in Breaking Information Barriers and Impacting Behavioral Antecedents.

PubMed

Beck, Ariane L; Lakkaraju, Kiran; Rai, Varun

2017-01-01

The wealth of information available on seemingly every topic creates a considerable challenge both for information providers trying to rise above the noise and discerning individuals trying to find relevant, trustworthy information. We approach this information problem by investigating how passive versus interactive information interventions can impact the antecedents of behavior change using the context of solar energy adoption, where persistent information gaps are known to reduce market potential. We use two experiments to investigate the impact of both passive and interactive approaches to information delivery on the antecedents (attitudes, subjective norms, and perceived behavioral control in the Theory of Planned Behavior) of intentions and behavior, as well as their effect on intentions and behavior directly. The passive information randomized control trial delivered via Amazon Mechanical Turk tests the effectiveness of delivering the same content in a single message versus multiple shorter messages. The interactive information delivery uses an online (mobile and PC) trivia-style gamification platform. Both experiments use the same content and are carried out over a two-week time period. Our findings suggest that interactive, gamified information has greater impact than passive information, and that shorter multiple messages of passive information are more effective than a single passive message.

Translating Current Science into Materials for High School via a Scientist-Teacher Partnership

NASA Astrophysics Data System (ADS)

Brown, Julie C.; Bokor, Julie R.; Crippen, Kent J.; Koroly, Mary Jo

2014-04-01

Scientist-teacher partnerships are a unique form of professional development that can assist teachers in translating current science into classroom instruction by involving them in meaningful collaborations with university researchers. However, few reported models aim to directly alter science teachers' practices by supporting them in the development of curriculum materials. This article reports on a multiple case study of seven high school science teachers who attended an ongoing scientist-teacher partnership professional development program at a major Southeastern research university. Our interest was to understand the capacity of this professional development program for supporting teachers in the transfer of personal learning experiences with advanced science content and skills into curriculum materials for high school students. Findings indicate that, regardless of their ultimate success constructing curriculum materials, all cases considered the research grounded professional development supports beneficial to their professional growth with the exception of collective participation. Additionally, the cases also described how supports such as professional recognition and transferability served as affordances to the process of constructing these materials. However, teachers identified multiple constraints, including personal learning barriers, their classroom context, and the cost associated with implementing some of their curriculum ideas. Results have direct implications for future research and the purposeful design of professional development experiences through scientist-teacher partnerships.

The AGING Initiative experience: a call for sustained support for team science networks.

PubMed

Garg, Tullika; Anzuoni, Kathryn; Landyn, Valentina; Hajduk, Alexandra; Waring, Stephen; Hanson, Leah R; Whitson, Heather E

2018-05-18

Team science, defined as collaborative research efforts that leverage the expertise of diverse disciplines, is recognised as a critical means to address complex healthcare challenges, but the practical implementation of team science can be difficult. Our objective is to describe the barriers, solutions and lessons learned from our team science experience as applied to the complex and growing challenge of multiple chronic conditions (MCC). MCC is the presence of two or more chronic conditions that have a collective adverse effect on health status, function or quality of life, and that require complex healthcare management, decision-making or coordination. Due to the increasing impact on the United States society, MCC research has been identified as a high priority research area by multiple federal agencies. In response to this need, two national research entities, the Healthcare Systems Research Network (HCSRN) and the Claude D. Pepper Older Americans Independence Centers (OAIC), formed the Advancing Geriatrics Infrastructure and Network Growth (AGING) Initiative to build nationwide capacity for MCC team science. This article describes the structure, lessons learned and initial outcomes of the AGING Initiative. We call for funding mechanisms to sustain infrastructures that have demonstrated success in fostering team science and innovation in translating findings to policy change necessary to solve complex problems in healthcare.

Small Is Big: Interactive Trumps Passive Information in Breaking Information Barriers and Impacting Behavioral Antecedents

PubMed Central

2017-01-01

The wealth of information available on seemingly every topic creates a considerable challenge both for information providers trying to rise above the noise and discerning individuals trying to find relevant, trustworthy information. We approach this information problem by investigating how passive versus interactive information interventions can impact the antecedents of behavior change using the context of solar energy adoption, where persistent information gaps are known to reduce market potential. We use two experiments to investigate the impact of both passive and interactive approaches to information delivery on the antecedents (attitudes, subjective norms, and perceived behavioral control in the Theory of Planned Behavior) of intentions and behavior, as well as their effect on intentions and behavior directly. The passive information randomized control trial delivered via Amazon Mechanical Turk tests the effectiveness of delivering the same content in a single message versus multiple shorter messages. The interactive information delivery uses an online (mobile and PC) trivia-style gamification platform. Both experiments use the same content and are carried out over a two-week time period. Our findings suggest that interactive, gamified information has greater impact than passive information, and that shorter multiple messages of passive information are more effective than a single passive message. PMID:28099478

Refining Measurement of Social Cognitive Theory Factors Associated with Exercise Adherence in Head and Neck Cancer Patients.

PubMed

Rogers, Laura Q; Fogleman, Amanda; Verhulst, Steven; Bhugra, Mudita; Rao, Krishna; Malone, James; Robbs, Randall; Robbins, K Thomas

2015-01-01

Social cognitive theory (SCT) measures related to exercise adherence in head and neck cancer (HNCa) patients were developed. Enrolling 101 HNCa patients, psychometric properties and associations with exercise behavior were examined for barriers self-efficacy, perceived barriers interference, outcome expectations, enjoyment, and goal setting. Cronbach's alpha ranged from.84 to.95; only enjoyment demonstrated limited test-retest reliability. Subscales for barriers self-efficacy (motivational, physical health) and barriers interference (motivational, physical health, time, environment) were identified. Multiple SCT constructs were cross-sectional correlates and prospective predictors of exercise behavior. These measures can improve the application of the SCT to exercise adherence in HNCa patients.

A grounded theory of bisexual individuals' experiences of help seeking.

PubMed

MacKay, Jenna; Robinson, Margaret; Pinder, Sarah; Ross, Lori E

2017-01-01

Bisexual people constitute the largest sexual minority group in North America and experience significant mental health disparities in relation to heterosexuals, gays, and lesbians. In this article, we will examine the process and experience of help seeking among bisexuals. This was a community-based study that collected qualitative interview data from 41 diverse bisexual people from across Ontario, Canada. We analyzed the interview data using grounded theory and constructed an understanding of bisexuals' experiences of help seeking. We have conceptualized an overarching model that illustrates 4 interrelated stages: (a) the consideration of services, (b) the process of finding services, (c) barriers and facilitators to accessing services, and (d) experience of service utilization. This model is nonlinear, in that participants do not necessarily move through stages in sequence. Although many stages are experienced at the individual level, they are simultaneously informed by multiple factors at interpersonal and system levels. Our findings suggest a need for interventions at the policy, service and provider levels to improve accessibility of culturally competent services for this population. Understanding the mental health experiences of bisexual people will allow mental health professionals to build competencies working with this population and thereby contribute to a reduction in mental health disparities. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Stifled Voices: Barriers to Help-Seeking Behavior for South African Childhood Sexual Assault Survivors

ERIC Educational Resources Information Center

Smith, Kimberly; Bryant-Davis, Thema; Tillman, Shaquita; Marks, Alison

2010-01-01

In South Africa, females under the age of 18 comprise approximately 40% of the rapes and other forms of sexual assault that occur. However, South African girls face multiple barriers to seeking help in the aftermath of sexual assault. This literature review provides an overview of childhood sexual assault in South African girls and addresses…

Understanding the free energy barrier and multiple timescale dynamics of charge separation in organic photovoltaic cells.

PubMed

Yan, Yaming; Song, Linze; Shi, Qiang

2018-02-28

By employing several lattice model systems, we investigate the free energy barrier and real-time dynamics of charge separation in organic photovoltaic (OPV) cells. It is found that the combined effects of the external electric field, entropy, and charge delocalization reduce the free energy barrier significantly. The dynamic disorder reduces charge carrier delocalization and results in the increased charge separation barrier, while the effect of static disorder is more complicated. Simulation of the real-time dynamics indicates that the free charge generation process involves multiple time scales, including an ultrafast component within hundreds of femtoseconds, an intermediate component related to the relaxation of the hot charge transfer (CT) state, and a slow component on the time scale of tens of picoseconds from the thermally equilibrated CT state. Effects of hot exciton dissociation as well as its dependence on the energy offset between the Frenkel exciton and the CT state are also analyzed. The current results indicate that only a small energy offset between the band gap and the lowest energy CT state is needed to achieve efficient free charge generation in OPV devices, which agrees with recent experimental findings.

Understanding the free energy barrier and multiple timescale dynamics of charge separation in organic photovoltaic cells

NASA Astrophysics Data System (ADS)

Yan, Yaming; Song, Linze; Shi, Qiang

2018-02-01

By employing several lattice model systems, we investigate the free energy barrier and real-time dynamics of charge separation in organic photovoltaic (OPV) cells. It is found that the combined effects of the external electric field, entropy, and charge delocalization reduce the free energy barrier significantly. The dynamic disorder reduces charge carrier delocalization and results in the increased charge separation barrier, while the effect of static disorder is more complicated. Simulation of the real-time dynamics indicates that the free charge generation process involves multiple time scales, including an ultrafast component within hundreds of femtoseconds, an intermediate component related to the relaxation of the hot charge transfer (CT) state, and a slow component on the time scale of tens of picoseconds from the thermally equilibrated CT state. Effects of hot exciton dissociation as well as its dependence on the energy offset between the Frenkel exciton and the CT state are also analyzed. The current results indicate that only a small energy offset between the band gap and the lowest energy CT state is needed to achieve efficient free charge generation in OPV devices, which agrees with recent experimental findings.

National survey of perspectives of palliative radiation therapy: role, barriers, and needs.

PubMed

McCloskey, Susan A; Tao, May Lin; Rose, Christopher M; Fink, Arlene; Amadeo, Alessandra M

2007-01-01

Despite growth of palliative care programs and evidence on the effectiveness of radiotherapy in palliating cancer symptoms, radiotherapy is probably underused in this setting. Radiation and medical oncologists and palliative medicine specialists were surveyed regarding the perceived role of palliative radiotherapy and barriers to its use. The survey was sent electronically to all physician members of the American Society for Therapeutic Radiology and Oncology (ASTRO) and the American Academy of Hospice and Palliative Medicine (AAHPM) and a random sample of American Society of Clinical Oncology (ASCO) members, with known e-mail addresses. Response rates were 27%, 14% and 26% for ASTRO, ASCO, and AAHPM respondents, respectively. Although most felt radiotherapy is an effective and important option for palliation of some common cancer symptoms, referrals for such therapy may be declining. Most agreed that radiation oncologists should be more involved in palliative care; however, multiple barriers were identified, such as poor reimbursement, emotional burden of care, insufficient training/knowledge, and the sense of unwillingness of others to share delivery of such services. Although multiple barriers limit optimal integration, most agree that there should be greater national and professional society efforts to promote the advancement of radiation oncology in the area of palliative care.

Multiple Family Groups: An Engaging Intervention for Child Welfare-Involved Families

ERIC Educational Resources Information Center

Gopalan, Geetha; Bannon, William; Dean-Assael, Kara; Fuss, Ashley; Gardner, Lauren; LaBarbera, Brooke; McKay, Mary

2011-01-01

Differences between child welfare- and nonchild welfare-involved families regarding barriers to child mental health care, attendance, program satisfaction, and relationship with facilitators are examined for a multiple family group service delivery model aimed at reducing childhood disruptive behaviors. Although child welfare-involved caregivers…

Blood-brain barrier-on-a-chip: Microphysiological systems that capture the complexity of the blood-central nervous system interface.

PubMed

Phan, Duc Tt; Bender, R Hugh F; Andrejecsk, Jillian W; Sobrino, Agua; Hachey, Stephanie J; George, Steven C; Hughes, Christopher Cw

2017-11-01

The blood-brain barrier is a dynamic and highly organized structure that strictly regulates the molecules allowed to cross the brain vasculature into the central nervous system. The blood-brain barrier pathology has been associated with a number of central nervous system diseases, including vascular malformations, stroke/vascular dementia, Alzheimer's disease, multiple sclerosis, and various neurological tumors including glioblastoma multiforme. There is a compelling need for representative models of this critical interface. Current research relies heavily on animal models (mostly mice) or on two-dimensional (2D) in vitro models, neither of which fully capture the complexities of the human blood-brain barrier. Physiological differences between humans and mice make translation to the clinic problematic, while monolayer cultures cannot capture the inherently three-dimensional (3D) nature of the blood-brain barrier, which includes close association of the abluminal side of the endothelium with astrocyte foot-processes and pericytes. Here we discuss the central nervous system diseases associated with blood-brain barrier pathology, recent advances in the development of novel 3D blood-brain barrier -on-a-chip systems that better mimic the physiological complexity and structure of human blood-brain barrier, and provide an outlook on how these blood-brain barrier-on-a-chip systems can be used for central nervous system disease modeling. Impact statement The field of microphysiological systems is rapidly evolving as new technologies are introduced and our understanding of organ physiology develops. In this review, we focus on Blood-Brain Barrier (BBB) models, with a particular emphasis on how they relate to neurological disorders such as Alzheimer's disease, multiple sclerosis, stroke, cancer, and vascular malformations. We emphasize the importance of capturing the three-dimensional nature of the brain and the unique architecture of the BBB - something that until recently had not been well modeled by in vitro systems. Our hope is that this review will provide a launch pad for new ideas and methodologies that can provide us with truly physiological BBB models capable of yielding new insights into the function of this critical interface.

A qualitative analysis of multi-level barriers to HIV testing among women in Lebanon.

PubMed

Clark, Kirsty A; Keene, Danya E; Pachankis, John E; Fattal, Omar; Rizk, Nesrine; Khoshnood, Kaveh

2017-09-01

While the number of HIV cases in the Middle East and North Africa region is low compared to other regions, recent studies show that incidence is increasing especially among high-risk populations; in particular, little is known about women and HIV in the region. Through semi-structured interviews with sexual healthcare providers and staff at non-governmental organisations, we sought to understand barriers to HIV testing among women in Lebanon. Using snowball sampling, key informants were recruited from greater Beirut (12 physicians, 9 non-governmental organisation staff). Data were analysed using a grounded theory framework. Findings identified barriers to HIV testing among women at each level of an adapted social-ecological model (i.e. social-cultural barriers, policy barriers, interpersonal healthcare provider barriers and intrapersonal barriers). Primary findings include the culture of sex as taboo; lack of sexual health education among women; fear of disclosing HIV testing and diagnosis; financial barriers linked to stigmatising insurance policies; and provider attitudes towards women. Findings can be used to inform HIV-related sexual health interventions at multiple levels for women in Lebanon and the greater region.

Reducing occupational sitting: Workers' perspectives on participation in a multi-component intervention.

PubMed

Hadgraft, Nyssa T; Willenberg, Lisa; LaMontagne, Anthony D; Malkoski, Keti; Dunstan, David W; Healy, Genevieve N; Moodie, Marj; Eakin, Elizabeth G; Owen, Neville; Lawler, Sheleigh P

2017-05-30

Office workers spend much of their time sitting, which is now understood to be a risk factor for several chronic diseases. This qualitative study examined participants' perspectives following their involvement in a cluster randomised controlled trial of a multi-component intervention targeting prolonged workplace sitting (Stand Up Victoria). The intervention incorporated a sit-stand workstation, individual health coaching and organisational support strategies. The aim of the study was to explore the acceptability of the intervention, barriers and facilitators to reducing workplace sitting, and perceived effects of the intervention on workplace culture, productivity and health-related outcomes. Semi-structured interviews (n = 21 participants) and two focus groups (n = 7) were conducted with intervention participants at the conclusion of the 12 month trial and thematic analysis was used to analyse the data. Questions covered intervention acceptability, overall impact, barriers and facilitators to reducing workplace sitting, and perceived impact on productivity and workplace culture. Overall, participants had positive intervention experiences, perceiving that reductions in workplace sitting were associated with improved health and well-being with limited negative impact on work performance. While sit-stand workstations appeared to be the primary drivers of change, workstation design and limited suitability of standing for some job tasks and situations were perceived as barriers to their use. Social support from team leaders and other participants was perceived to facilitate behavioural changes and a shift in norms towards increased acceptance of standing in the workplace. Multi-component interventions to reduce workplace sitting, incorporating sit-stand workstations, are acceptable and feasible; however, supportive social and environmental conditions are required to support participant engagement. Best practice approaches to reduce workplace sitting should address the multiple levels of influence on behaviour, including factors that may act as barriers to behavioural change.

Multi-Level Factors Affecting Entry into and Engagement in the HIV Continuum of Care in Iringa, Tanzania

PubMed Central

Layer, Erica H.; Kennedy, Caitlin E.; Beckham, Sarah W.; Mbwambo, Jessie K.; Likindikoki, Samuel; Davis, Wendy W.; Kerrigan, Deanna L.; Brahmbhatt, Heena

2014-01-01

Progression through the HIV continuum of care, from HIV testing to lifelong retention in antiretroviral therapy (ART) care and treatment programs, is critical to the success of HIV treatment and prevention efforts. However, significant losses occur at each stage of the continuum and little is known about contextual factors contributing to disengagement at these stages. This study sought to explore multi-level barriers and facilitators influencing entry into and engagement in the continuum of care in Iringa, Tanzania. We used a mixed-methods study design including facility-based assessments and interviews with providers and clients of HIV testing and treatment services; interviews, focus group discussions and observations with community-based providers and clients of HIV care and support services; and longitudinal interviews with men and women living with HIV to understand their trajectories in care. Data were analyzed using narrative analysis to identify key themes across levels and stages in the continuum of care. Participants identified multiple compounding barriers to progression through the continuum of care at the individual, facility, community and structural levels. Key barriers included the reluctance to engage in HIV services while healthy, rigid clinic policies, disrespectful treatment from service providers, stock-outs of supplies, stigma and discrimination, alternate healing systems, distance to health facilities and poverty. Social support from family, friends or support groups, home-based care providers, income generating opportunities and community mobilization activities facilitated engagement throughout the HIV continuum. Findings highlight the complex, multi-dimensional dynamics that individuals experience throughout the continuum of care and underscore the importance of a holistic and multi-level perspective to understand this process. Addressing barriers at each level is important to promoting increased engagement throughout the continuum. PMID:25119665

How community environment shapes physical activity: perceptions revealed through the PhotoVoice method.

PubMed

Belon, Ana Paula; Nieuwendyk, Laura M; Vallianatos, Helen; Nykiforuk, Candace I J

2014-09-01

A growing body of evidence shows that community environment plays an important role in individuals' physical activity engagement. However, while attributes of the physical environment are widely investigated, sociocultural, political, and economic aspects of the environment are often neglected. This article helps to fill these knowledge gaps by providing a more comprehensive understanding of multiple dimensions of the community environment relative to physical activity. The purpose of this study was to qualitatively explore how people's experiences and perceptions of their community environments affect their abilities to engage in physical activity. A PhotoVoice method was used to identify barriers to and opportunities for physical activity among residents in four communities in the province of Alberta, Canada, in 2009. After taking pictures, the thirty-five participants shared their perceptions of those opportunities and barriers in their community environments during individual interviews. Using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, themes emerging from these photo-elicited interviews were organized in four environment types: physical, sociocultural, economic, and political. The data show that themes linked to the physical (56.6%) and sociocultural (31.4%) environments were discussed more frequently than the themes of the economic (5.9%) and political (6.1%) environments. Participants identified nuanced barriers and opportunities for physical activity, which are illustrated by their quotes and photographs. The findings suggest that a myriad of factors from physical, sociocultural, economic, and political environments influence people's abilities to be physically active in their communities. Therefore, adoption of a broad, ecological perspective is needed to address the barriers and build upon the opportunities described by participants to make communities more healthy and active. Copyright © 2014 Elsevier Ltd. All rights reserved.

Teacher-Perceived Barriers to Integrating Instructional Technology in a Bermuda Senior High School

ERIC Educational Resources Information Center

Henry-Young, Marcia

2013-01-01

The purpose of this qualitative phenomenological study was to identify, classify, and interpret, through the lived experiences of teachers, the subjective barriers to the use of new communications technology in the classroom. Three questions guided this study: (a) What in the teacher's experience prevented him or her in the adoption and active use…

Creating the Global Graduate: A Cross-Cultural Videoconferencing Case Study

ERIC Educational Resources Information Center

Ferry, Diane L.; Kydd, Christine T.; Boyles, Corinne

2012-01-01

Business people in multinational environments must deal with a variety of situational barriers and cultural differences, such as time zones, languages, and common practice differences. Learning to accommodate these barriers and differences effectively often takes years of practice. Students who experience some of these barriers and become aware of…

Investigation on transmission and reflection characteristics of plasma array to 6 GHz high-power microwave

NASA Astrophysics Data System (ADS)

Yang, Liu; Yang, Zhongcun; Wan, Jianing; Liu, Hao

2016-10-01

For the safety of electronic equipment, a double-layer barrier of cylindrical plasma array was designed, and its protective performance to high-power microwave (HPM) were analyzed and the protective performance experiment was conducted. Combining the density distribution characteristic of the discharge plasma, the shielding effectiveness of the double-layer plasma on 6GHz HPM pulse was studied. The experiment results indicate that the protective effectiveness of two layers plasma array is better than that of one layer. Two layers plasma array can make the peak electric field of transmission waveform less than interference threshold of electronic equipment to achieve better protection effectiveness. Transmission attenuation of one layer and two layers plasma array to HPM can reach -6.6066dB and -24.9357dB. The results also show that for the existence of multiple reflection, even the plasma electron density is not high enough, it can realize a strong attenuation. The experiment results in this paper are of great significance in protecting against HPM and electromagnetic pulse.

Physics education: Understanding the barriers for young women in Ontario

NASA Astrophysics Data System (ADS)

Mainhood, Lindsay Ann

In nearly all countries of the world, at every level of education, physics as a field of science is failing to recruit and retain women. This phenomenon is believed to relate to girls' educational experiences from K-12, but the reasons for the gender gap in physics are not fully understood. The purpose of this phenomenological research is to explore and understand the barriers encountered by Ontario female high school students during their physics education and the meanings attributed to those barriers by these young women. This research is guided by social cognitive career theory (SCCT) and uses the concept of physics identity as a lens through which the influence of contextual barriers can be understood. Nine participants, selected via snowball sampling from an Eastern Ontario university, together participated in four semi-structured focus group meetings and individually participated in a single in-depth, one-on-one interview. Audio data was transcribed verbatim and analyzed using a general inductive approach. Emergent themes are descriptively presented as the findings of the research study: perceiving the high school physics experience, experiencing high school physics education, and identity and gender in the high school physics experience. Sub-themes presented include limited prior experiences, negative perceptions of physics, images of physics learners, decision-making, reactions to pedagogy, learning needs, physics identity, gender-dependent influences, and making meaning of the experiences in high school physics. The shared experience of high school physics education for young women is understood as both a richly challenging and rewarding experience. Based on the findings of this research, recommendations are made for practical and research settings, and for future work in this area. Drawing on literature on underrepresentation of women in physics, this research contributes to the physics education research community and beyond; it offers voices of Ontario female high school students, and an understanding of the barriers and the meanings associated with their experiences in high school physics.

Gay-Straight Alliance Advisors: Negotiating Multiple Ecological Systems when Advocating for LGBTQ Youth

ERIC Educational Resources Information Center

Watson, Laurel B.; Varjas, Kris; Meyers, Joel; Graybill, Emily C.

2010-01-01

This qualitative study investigated the barriers and facilitators that advisors of gay-straight alliances encounter when advocating for LGBTQ (lesbian, gay, bisexual, transgender, and queer) youth within schools. Twenty-two advisors were interviewed, and data revealed that multiple ecological systems (e.g., sociocultural, school, and individual…

Noncredit and Credit Divisions in Community Colleges: The Dilemma of Multiple Organizational Identities

ERIC Educational Resources Information Center

Palter Gill, Dianne

2012-01-01

Despite the importance of effective linkages between credit and noncredit divisions, significant barriers interfere with and detract from these units working well together. Community college leaders are challenged to manage these multiple and sometimes competing organizational identities in a complex and rapidly-changing educational landscape.…

SOMOS: Evaluation of an HIV Prevention Intervention for Latino Gay Men

ERIC Educational Resources Information Center

Vega, Miriam Y.; Spieldenner, Andrew R.; DeLeon, Dennis; Nieto, Bolivar X.; Stroman, Carolyn A.

2011-01-01

Latino gay men face multiple barriers to human immunodeficiency virus (HIV) prevention, in particular a lack of intervention programs that integrate prevention messages with cultural norms and address issues of social marginalization from multiple communities (gay community and Latino community), homophobia and racism. In order to address these…

Loading, Release, Biodegradation, and Biocompatibility of a Nanovector Delivery System

NASA Technical Reports Server (NTRS)

Ferrai, Mauro; Tasciotti, Ennio

2012-01-01

A nanovector multistage system has been created to overcome or bypass sequential barriers within the human body, in order to deliver a therapeutic or imaging agent to a specific location. This innovation consists of a composition that includes two or more stages of particles, such that smaller, later-stage particles are contained in the larger, early-stage particles. An active agent, such as a therapeutic agent or imaging agent, is preferentially delivered and/or localized to a particular target site in the body of a subject. The multistage composition overcomes multiple biological barriers in the body. The multistage composition also allows for simultaneous delivery and localization at the same or different target sites of multiple active agents.

Fertilisation and early developmental barriers to hybridisation in field crickets.

PubMed

Tyler, Frances; Rodríguez-Muñoz, Rolando; Tregenza, Tom

2013-02-15

Post-mating interactions between the reproductive traits and gametes of mating individuals and among their genes within zygotes are invariably complex, providing multiple opportunities for reproduction to go awry. These interactions have the potential to act as barriers to gene flow between species, and may be important in the process of speciation. There are multiple post-mating barriers to interbreeding between the hybridising field crickets Gryllus bimaculatus and G. campestris. Female G. bimaculatus preferentially store sperm from conspecific males when mated to both conspecific and heterospecific partners. Additionally, conspecific males sire an even greater proportion of offspring than would be predicted from their sperm's representation in the spermatheca. The nature of these post-sperm-storage barriers to hybridisation are unknown. We use a fluorescent staining technique to determine whether barriers occur prior to, or during embryo development. We show that eggs laid by G. bimaculatus females mated to G. campestris males are less likely to begin embryogenesis than eggs from conspecific mating pairs. Of the eggs that are successfully fertilised and start to develop, those from heterospecific mating pairs are more likely to arrest early, prior to blastoderm formation. We find evidence for bimodal variation among egg clutches in the number of developing embryos that subsequently arrest, indicating that there is genetic variation for incompatibility between mating individuals. In contrast to the pattern of early embryonic mortality, those hybrids reaching advanced stages of embryogenesis have survival rates equal to that of embryos from conspecific mating pairs. Post-sperm-storage barriers to hybridisation show evidence of genetic polymorphism. They are sufficiently large, that if the species interbreed where they are sympatric, these barriers could play a role in the maintenance of reproductive isolation between them. The number of eggs that fail to develop represents a substantial cost of hybridization to G. bimaculatus females, and this cost could reinforce the evolution of barriers occurring earlier in the reproductive process.

Interrupted: The roles of distributed effort and incubation in preventing fixation and generating problem solutions.

PubMed

Sio, Ut Na; Kotovsky, Kenneth; Cagan, Jonathan

2017-05-01

Fixation on inappropriate concepts is a key barrier to problem solving. Previous research has shown that continuous work is likely to cause repeated retrieval of those concepts, resulting in increased fixation. Accordingly, distributing effort across problems through multiple, brief, and interlaced sessions (distributed effort) should prevent such fixation and in turn enhance problem solving. This study examined whether distributed effort can provide an advantage for problem solving, particularly for problems that can induce fixation (Experiment 1), and whether and how incubation can be combined with distributed effort to further enhance performance (Experiment 2). Remote Associates Test (RAT) problems were used as the problem-solving tasks. Half of them (i.e., misleading RAT) were more likely to mislead individuals to fixate on incorrect associates than the other half. Experiments revealed a superiority of distributed over massed effort on misleading RAT performance and a differing time course of incubation for the massed and distributed groups. We conclude that distributed effort facilitates problem solving, most likely via overcoming fixation. Cognitive mechanisms other than the commonly posited forgetting of inappropriate ideas may occur during incubation to facilitate problem solving. The experiments in this article offer support for the occurrence of spreading activation during incubation.

Improving interprofessional competence in undergraduate students using a novel blended learning approach.

PubMed

Riesen, Eleanor; Morley, Michelle; Clendinneng, Debra; Ogilvie, Susan; Ann Murray, Mary

2012-07-01

Interprofessional simulation interventions, especially when face-to-face, involve considerable resources and require that all participants convene in a single location at a specific time. Scheduling multiple people across different programs is an important barrier to implementing interprofessional education interventions. This study explored a novel way to overcome the challenges associated with scheduling interprofessional learning experiences through the use of simulations in a virtual environment (Web.Alive™) where learners interact as avatars. In this study, 60 recent graduates from nursing, paramedic, police, and child and youth service programs participated in a 2-day workshop designed to improve interprofessional competencies through a blend of learning environments that included virtual face-to-face experiences, traditional face-to-face experiences and online experiences. Changes in learners' interprofessional competence were assessed through three outcomes: change in interprofessional attitudes pre- to post-workshop, self-perceived changes in interprofessional competence and observer ratings of performance across three clinical simulations. Results from the study indicate that from baseline to post-intervention, there was significant improvement in learners' interprofessional competence across all outcomes, and that the blended learning environment provided an acceptable way to develop these competencies.

Leadership and followership in the healthcare workplace: exploring medical trainees' experiences through narrative inquiry.

PubMed

Gordon, Lisi J; Rees, Charlotte E; Ker, Jean S; Cleland, Jennifer

2015-12-01

To explore medical trainees' experiences of leadership and followership in the interprofessional healthcare workplace. A qualitative approach using narrative interviewing techniques in 11 group and 19 individual interviews with UK medical trainees. Multisite study across four UK health boards. Through maximum variation sampling, 65 medical trainees were recruited from a range of specialties and at various stages of training. Participants shared stories about their experiences of leadership and followership in the healthcare workplace. Data were analysed using thematic and narrative analysis. We identified 171 personal incident narratives about leadership and followership. Participants most often narrated experiences from the position of follower. Their narratives illustrated many factors that facilitate or inhibit developing leadership identities; that traditional medical and interprofessional hierarchies persist within the healthcare workplace; and that wider healthcare systems can act as barriers to distributed leadership practices. This paper provides new understandings of the multiple ways in which leadership and followership is experienced in the healthcare workplace and sets out recommendations for future leadership educational practices and research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Retention in HIV care depends on patients' perceptions of the clinic experience.

PubMed

Wessinger, Matthew H; Hennink, Monique M; Kaiser, Bonnie N; Mangal, Jed P; Gokhale, Runa H; Ruchin, Lauren; Moanna, Abeer; Rimland, David; Farber, Eugene W; Marconi, Vincent C

2017-10-01

Institutional barriers in HIV primary care settings can contribute substantially to disparities in retention in HIV treatment and HIV-related outcomes. This qualitative study compared the perceptions of clinic experiences of persons living with HIV (PLWH) in a Veterans Affairs HIV primary care clinic setting who were retained in care with the experiences of those who were not retained in care. Qualitative data from 25 in-depth interviews were analyzed to identify facilitators and barriers to retention in HIV care. Results showed that participants not retained in care experienced barriers to retention involving dissatisfaction with clinic wait times, low confidence in clinicians, and customer service concerns. For participants retained in care, patience with procedural issues, confidence in clinicians, and interpersonal connections were factors that enhanced retention despite the fact that these participants recognized the same barriers as those who were not retained in care. These findings can inform interventions aimed at improving retention in HIV care.

Barriers to continuity in the pathway toward occupational engagement among ethnic minorities with mental illness.

PubMed

Pooremamali, Parvin; Morville, Anne-Le; Eklund, Mona

2017-07-01

Ethnic minorities have particular needs and difficulties in terms of support for meaningful occupations, lack of access to and use of occupation-based rehabilitation services. They are not established in the labour market and are seldom in paid employment. This study aimed to investigate how mentally ill ethnic minority clients experience, feel and think about participation in occupation-based rehabilitation, and potential barriers they might encounter. Nine participants experiencing mental illness and receiving occupation-based rehabilitation were interviewed. Grounded theory methods were used in order to collect and analyze data. One core category, "barriers for a continuous path towards enriched and meaningful occupation" described the participants' experiences of a variety of barriers related to personal, occupational and system factors that hindered participation in occupation-based rehabilitation and influenced their need for occupational development and growth. The core category was composed of; personal-related barriers, occupational-related barriers, and system-related barriers as well as six related sub-categories. These barriers interacted continually across time and space in ways that increased the participants' sense of occupational deprivation and alienation. The findings also suggested that the issues of paid employment for ethnic minorities with mental illness should feature on the agenda of local, regional and state politicians and professionals involved in occupational rehabilitation.

Adeno-associated virus serotype 8 efficiently delivers genes to muscle and heart.

PubMed

Wang, Zhong; Zhu, Tong; Qiao, Chunping; Zhou, Liqiao; Wang, Bing; Zhang, Jian; Chen, Chunlian; Li, Juan; Xiao, Xiao

2005-03-01

Systemic gene delivery into muscle has been a major challenge for muscular dystrophy gene therapy, with capillary blood vessels posing the principle barrier and limiting vector dissemination. Previous efforts to deliver genes into multiple muscles have relied on isolated vessel perfusion or pharmacological interventions to enforce broad vector distribution. We compared the efficiency of multiple adeno-associated virus (AAV) vectors after a single injection via intraperitoneal or intravenous routes without additional intervention. We show that AAV8 is the most efficient vector for crossing the blood vessel barrier to attain systemic gene transfer in both skeletal and cardiac muscles of mice and hamsters. Serotypes such as AAV1 and AAV6, which demonstrate robust infection in skeletal muscle cells, were less effective in crossing the blood vessel barrier. Gene expression persisted in muscle and heart, but diminished in tissues undergoing rapid cell division, such as neonatal liver. This technology should prove useful for muscle-directed systemic gene therapy.

An internet survey of the characteristics and physical activity of community-dwelling Australian adults with acquired brain injury: Exploring interest in an internet-delivered self-management program focused on physical activity.

PubMed

Jones, Taryn M; Dean, Catherine M; Dear, Blake F; Hush, Julia M; Titov, Nickolai

2016-01-01

Individuals with acquired brain injury (ABI) are more likely to be physically inactive and experience barriers to accessing services to address inactivity. This study was designed to guide the development of an internet-delivered self-management program to increase physical activity after ABI. The aims of this study were to examine the current physical activity status of community-dwelling Australian adults with ABI, the barriers to physical activity they experience and to explore interest an internet-delivered self-management program aimed at increasing physical activity. An online survey of Australian adults with ABI was used to collect information about demographic characteristics; general health; emotional well-being; mobility and physical activity status, and satisfaction; barriers to physical activity; confidence in overcoming barriers, and; interest in an internet self-management program. Data were analyzed descriptively and correlational analyses examined relationships between variables. Data were analyzed from 59 respondents. Over half were not satisfied with their current physical activity status. The most frequently reported barriers were pain/discomfort, fatigue and fear, and confidence to overcome these barriers was very low. Interest in an internet-delivered self-management program was high (74%) and not related to the amount of physical activity, satisfaction with physical activity and mobility status or total number of barriers. Australian adults with ABI are not satisfied with their activity levels and experience barriers in maintaining their physical activity levels. Participants were interested in accessing an internet-delivered self-management program aimed at improving physical activity levels. Therefore such a program warrants development and evaluation. Copyright © 2016 Elsevier Inc. All rights reserved.

Caring for pregnant refugee women in a turbulent policy landscape: perspectives of health care professionals in Calgary, Alberta.

PubMed

Winn, Anika; Hetherington, Erin; Tough, Suzanne

2018-06-26

Female refugees can be a vulnerable population, often having suffered through traumatic events that pose risks to their health, especially during pregnancy. Pregnancy can be an entry point into the health care system, providing health care professionals the opportunity to gain women's trust, connect refugees with resources, and optimize the health of mother and child. Policies surrounding the provision and funding of health care services to refugees can impact access to and quality of care. The aim of our study was to understand the experiences of health care professionals caring for pregnant refugee women in Calgary, AB, taking into consideration recent contextual changes to the refugee landscape in Canada. We conducted ten semi-structured interviews with health care professionals who provided regular care for pregnant refugee women at a refugee health clinic and major hospital in Calgary, Alberta. Interviews were recorded, transcribed, and analyzed using an interpretive description methodology. Health care providers described several barriers when caring for pregnant refugees, including language barriers, difficulty navigating the health care system, and cultural barriers such as managing traditional gender dynamics, only wanting a female provider and differences in medical practices. Providers managed these barriers through strategies including using a team-based approach to care, coordinating the patient's care with other services, and addressing both the medical and social needs of the patient. The federal funding cuts added additional challenges, as many refugees were left without adequate health coverage and the system was complicated to understand. Health care providers developed creative strategies to maximize coverage for their patients including paying out of pocket or relying on donations to care for uninsured refugees. Finally, the recent Syrian refugee influx has increased the demand on service providers and further strained already limited resources. Health care providers caring for pregnant refugee women faced complex cultural and system-level barriers, and used multiple strategies to address these barriers. Additional system strains add extra pressure on health care professionals, requiring them to quickly adjust and accommodate for new demands.

Views and Experiences of Malaysian Family Medicine Trainees of Female Sexual Dysfunction.

PubMed

Lai, Pauline Siew Mei; Tan, Sing Yee; Liew, Su May

2016-11-01

Sociocultural factors have been shown to be important influencers of sexual health and sexuality. Hence, the aim of our study was to explore the views and experiences of family medicine trainees regarding female sexual dysfunction (FSD) with a focus on the barriers and facilitators towards the initiation of conversation on this topic. A qualitative study design involving semi-structured focus group discussions (FGDs) was conducted with 19 family medicine trainees in Malaysia. The conceptual framework used was based on the Theory of Planned Behavior. Thematic approach was used to analyze the data. Participants perceived FSD as being uncommon and unimportant. According to our participants, patients often presented with indirect complaints, and doctors were not proactive in asking about FSD. Three main barriers were identified: doctor factors, perceived patient factors, and system factors. Lack of confidence, knowledge, experience, time, and embarrassment were the key barriers identified at the doctors' level. Lack of awareness, among patients regarding FSD, and local cultural and religious norms were the perceived patient barriers. System barriers were lack of time and privacy. Various facilitators, such as continuous medical education and public forums, were suggested as means to encourage family medicine trainees to initiate discussion on sexual matters during consultations. In conclusion, family medicine trainees found it difficult to initiate conversation on FSD with patients. Interventions to encourage conversation on FSD should target this and other identified barriers.

Barriers to development: pushing the boundaries

PubMed Central

Neirotti, Rodolfo A.

2015-01-01

Why some countries have failed to create democracy, wealth and happiness for their people is one of the great questions of our time. This essay encompasses a description of the multiple barriers to development that may have different characteristics, according to the context and the social structures that maintain these conditions. It would be arrogant to pretend to have all the solutions for these problems. PMID:25859874

Stacked Metal Silicide/Silicon Far-Infrared Detectors

NASA Technical Reports Server (NTRS)

Maserjian, Joseph

1988-01-01

Selective doping of silicon in proposed metal silicide/silicon Schottky-barrier infrared photodetector increases maximum detectable wavelength. Stacking layers to form multiple Schottky barriers increases quantum efficiency of detector. Detectors of new type enhance capabilities of far-infrared imaging arrays. Grows by molecular-beam epitaxy on silicon waferscontaining very-large-scale integrated circuits. Imaging arrays of detectors made in monolithic units with image-preprocessing circuitry.

Evaluation of Gastrointestinal Leakage in Multiple Enteric Inflammation Models in Chickens

PubMed Central

Kuttappan, Vivek A.; Vicuña, Eduardo A.; Latorre, Juan D.; Wolfenden, Amanda D.; Téllez, Guillermo I.; Hargis, Billy M.; Bielke, Lisa R.

2015-01-01

Enteric inflammation models can help researchers’ study methods to improve health and performance and evaluate various growth promoters and dietary formulations targeted to improve performance in poultry. Oral administration of fluorescein isothiocyanate-dextran (FITC-d; 3–5 kDa) and its pericellular mucosal epithelial leakage are an established marker to evaluate enteric inflammation in multiple species. The present study evaluated different methods to induce gut inflammation in poultry based on FITC-d leakage. Four independent experiments were completed with different inflammation treatment groups, and serum FITC-d and/or retention of FITC-d in GI tract were determined. In experiment 1 (n = 10 birds/treatment, broilers, processed at 14 days), groups included control (CON), dextran sodium sulfate (DSS; drinking water at 0.75%) and feed restriction (FRS; 24 h before processing). Experiment 2 (n = 14 birds/treatment, leghorns, processed at 7 days) included CON, DSS, FRS, and rye-based diet (RBD). In experiments 3 and 4 (n = 15 birds/treatment, broilers, processed at 7 days), groups were CON, DSS, high fat diet (HFD), FRS, and RBD. In all experiments, FRS and RBD treatments showed significantly higher serum FITC-d levels compared to the respective CON. This indicates that FRS and RBD results in disruption of the intact barrier of the gastrointestinal tract (GIT), resulting in increased gut permeability. DSS and HFD groups showed elevation of serum FITC-d levels although the magnitude of difference from respective CON was inconsistent between experiments. FRS was the only treatment which consistently showed elevated retention of FITC-d in GIT in all experiments. The results from present studies showed that FRS and RBD, based on serum FITC-d levels, can be robust models to induce gut leakage in birds in different age and species/strains. PMID:26697435

Healthcare professionals' perceptions of psychological treatment for chronic pain in Singapore: challenges, barriers, and the way forward.

PubMed

Yang, Su-Yin; Bogosian, Angeliki; Moss-Morris, Rona; McCracken, Lance M

2016-08-01

There are very few studies on healthcare providers' experiences of delivering treatment for chronic pain in a Southeast Asian setting. The aims of this study are to understand the experiences of professionals delivering treatment for people with chronic pain in Singapore and identify possible barriers to psychological treatment for this condition within the broader experiences of these professionals. Healthcare professionals with at least 1-year experience treating chronic pain were recruited and purposefully sampled. Fifteen inductive semi-structured interviews were conducted to explore healthcare professionals' experiences of treating people with chronic pain. Interviews were transcribed verbatim and analysed using thematic analysis. Four main themes were identified: 'System Barriers', 'Core Beliefs and management of Chronic Pain', 'Engaging Patients in treatment' and 'Creating Awareness for Chronic Pain Management'. Professionals trained in a multidisciplinary approach to pain management were seen as rare. Professionals who could refer patients for psychological treatment do not refer due to costs, and their perception that patients may lack understanding of such a treatment. Reducing barriers in the access to psychological treatment in settings like Singapore will require a multifaceted approach. Implications for Rehabilitation A multifaceted approach is required to reduce barriers to psychological treatment for chronic pain in settings like Singapore. Educating healthcare professionals on the need for a multidisciplinary approach to chronic pain could help in reducing misconceptions and increase understanding of the benefits of psychological approaches. Utilizing both media and technological platforms as a means to facilitate psychological treatment uptake for chronic pain may be a way forward for a technological savvy generation.

The experience of Patient Aligned Care Team (PACT) members.

PubMed

Ladebue, Amy C; Helfrich, Christian D; Gerdes, Zachary T; Fihn, Stephan D; Nelson, Karin M; Sayre, George G

2016-01-01

In April 2010, the Veterans Health Administration (VHA) launched the Patient Aligned Care Team (PACT) initiative to implement a patient-centered medical home (PCMH) model. Few evaluations have addressed the effects of PCMH on health care professionals' experiences. The aim of this study was to contribute to evaluation of the PACT initiative and the broader literature on PCMH by assessing respondents' experiences of implementing a PCMH model and becoming a teamlet. A retrospective qualitative analysis of open-text responses in a survey fielded to all VHA Primary Care personnel (VHA Primary Care physicians, nurse practitioners, physician assistants, nurse care managers, clinical associates, and administrative clerks) in May and June 2012 (approximately 2 years into the 5-year planned implementation of PACT) using deductive and inductive content analysis. The main measures were two open-response fields: "Is there anything else you would like us to relay to the VA leadership in Central Office?" and "Do you have any other comments or feedback on PACT?" The data consisted of free text responses of 3,868 survey participants who provided text for one or both of the open-response fields. Although respondents viewed PACT positively as a model and reported it improved relationships with patients and increased patient satisfaction, they described multiple barriers to achieving functioning teamlets and unintended consequences, including reduced time with patients, increased participant burnout, and decreased team efficacy because of low-performing team members. A central theme related to staffing being insufficient for the new model. Insufficient staffing of PCMH teams is a critical barrier to realizing the benefits of the new model. Frontline staff have concrete recommendations for other problems, such as using back-up teams to cover during absences, but that will require providing more opportunities for feedback from staff to be heard.

Exploring physiotherapists' experiences of implementing a cognitive behavioural approach for managing low back pain and identifying barriers to long-term implementation.

PubMed

Richmond, Helen; Hall, Amanda M; Hansen, Zara; Williamson, Esther; Davies, David; Lamb, Sarah E

2018-03-01

Our objectives were two-fold: (i) to describe physiotherapists' experiences of implementing a cognitive behavioural approach (CBA) for managing low back pain (LBP) after completing an extensive online training course (iBeST), and (ii) to identify how iBeST could be enhanced to support long-term implementation before scale up for widespread use. We conducted semi-structured interviews with 11 physiotherapists from six National Health Service departments in the Midlands, Oxfordshire and Derbyshire. Questions centred on (i) using iBeST to support implementation, (ii) what barriers they encountered to implementation and (iii) what of information or resources they required to support sustained implementation. Interviews were transcribed and thematically analysed using NVivo. Themes were categorised using the Theoretical Domains Framework (TDF). Evidence-based techniques were identified using the behaviour change technique taxonomy to target relevant TDF domains. Three themes emerged from interviews: anxieties about using a CBA, experiences of implementing a CBA, and sustainability for future implementation of a CBA. Themes crossed multiple TDF domains and indicated concerns with knowledge, beliefs about capabilities and consequences, social and professional roles, social influences, emotion, and environmental context and resources. We identified evidence-based strategies that may support sustainable implementation of a CBA for LBP in a physiotherapy setting. This study highlighted potential challenges for physiotherapists in the provision of evidence-based LBP care within the current UK NHS. Using the TDF provided the foundation to develop a tailored, evidence-based, implementation intervention to support long term use of a CBA by physiotherapists managing LBP within UK NHS outpatient departments. Copyright © 2017 Chartered Society of Physiotherapy. All rights reserved.

'There were more wires than him': the potential for wireless patient monitoring in neonatal intensive care.

PubMed

Bonner, Oliver; Beardsall, Kathryn; Crilly, Nathan; Lasenby, Joan

2017-02-01

The neonatal intensive care unit (NICU) can be one of the most stressful hospital environments. Alongside providing intensive clinical care, it is important that parents have the opportunity for regular physical contact with their babies because the neonatal period is critical for parent-child bonding. At present, monitoring technology in the NICU requires multiple wired sensors to track each baby's vital signs. This study describes the experiences that parents and nurses have with the current monitoring methods, and reports on their responses to the concept of a wireless monitoring system. Semistructured interviews were conducted with six parents, each of whom had babies on the unit, and seven nurses who cared for those babies. The interviews initially focused on the participants' experiences of the current wired system and then on their responses to the concept of a wireless system. The transcripts were analysed using a general inductive approach to identify relevant themes. Participants reported on physical and psychological barriers to parental care, the ways in which the current system obstructed the efficient delivery of clinical care and the perceived benefits and risks of a wireless system. The parents and nurses identified that the wires impeded baby-parent bonding; physically and psychologically. While a wireless system was viewed as potentially enabling greater interaction, staff and parents highlighted potential concerns, including the size, weight and battery life of any new device. The many wires required to safely monitor babies within the NICU creates a negative environment for parents at a critical developmental period, in terms of physical and psychological interactions. Nurses also experience challenges with the existing system, which could negatively impact the clinical care delivery. Developing a wireless system could overcome these barriers, but there remain challenges in designing a device suitable for this unique environment.

Developing a national dental education research strategy: priorities, barriers and enablers.

PubMed

Ajjawi, Rola; Barton, Karen L; Dennis, Ashley A; Rees, Charlotte E

2017-03-29

This study aimed to identify national dental education research (DER) priorities for the next 3-5 years and to identify barriers and enablers to DER. Scotland. In this two-stage online questionnaire study, we collected data with multiple dental professions (eg, dentistry, dental nursing and dental hygiene) and stakeholder groups (eg, learners, clinicians, educators, managers, researchers and academics). Eighty-five participants completed the Stage 1 qualitative questionnaire and 649 participants the Stage 2 quantitative questionnaire. Eight themes were identified at Stage 1. Of the 24 DER priorities identified, the top three were: role of assessments in identifying competence; undergraduate curriculum prepares for practice and promoting teamwork. Following exploratory factor analysis, the 24 items loaded onto four factors: teamwork and professionalism, measuring and enhancing performance, dental workforce issues and curriculum integration and innovation. Barriers and enablers existed at multiple levels: individual, interpersonal, institutional structures and cultures and technology. This priority setting exercise provides a necessary first step to developing a national DER strategy capturing multiple perspectives. Promoting DER requires improved resourcing alongside efforts to overcome peer stigma and lack of valuing and motivation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Factors Associated with Suicidal Ideation and Quality of Life in Adolescents from Puerto Rico with Type 1 Diabetes.

PubMed

Guerrero-Ramírez, Grace; Cumba-Avilés, Eduardo

2018-03-01

People with type 1 diabetes (T1D) may experience significant changes in their daily routines due to this condition, which frequently results in depressive symptoms and the deterioration of their quality of life. We examined the factors associated with suicidal ideation (SI) and diabetes-related quality of life (DRQOL) in adolescents (aged 12 to 17) with T1D. The sample consisted of 51 youths (29 girls) recruited during a treatment study for depression. They completed the Diabetes Quality of Life for Youth questionnaire, the Suicidal Ideation Questionnaire Junior, and other measures that explore emotional, cognitive, somatic, behavioral, and relational aspects. Their caregivers completed the Barriers to Adherence Questionnaire and the Somatic Complaints subscale of the Child Behavior Checklist, among other measures. We used correlation and multiple linear regression analyses to identify the factors associated with the dependent variables. The variables associated with SI were depression, somatic complaints, perceived family emotional support, self care for diabetes, self-deprecation, helplessness, and hopelessness, among others. In a multiple regression analysis, the first 3 accounted for 46% of the variance. Those related to DRQOL included cognitive alterations, barriers to adherence, perceived family emotional support, self-efficacy for diabetes and for depression, helplessness, anxiety, and self-deprecation, among others. The first 4 accounted for 61% of the variance. Our findings highlight the impact of emotional, cognitive, somatic, behavioral, and relational aspects on the quality of mental health and the DRQOL of youth with T1D, as well as their pertinence for the development of psychosocial interventions for this population.

[On Atomic Nuclear Fusion Processes at Low-Temperatures. An Enhancement of the Probability of Transition through a Potential Barrier Due to the So-Called Barrier Anti-Zeno Effect].

PubMed

Namiot, V A

2016-01-01

It is known that in quantum mechanics the act of observing the experiment can affect the experimental findings in some cases. In particular, it happens under the so-called Zeno effect. In this work it is shown that in contrast to the "standard" Zeno-effect where the act of observing a process reduces the probability of its reality, an inverse situation when a particle transmits through a potential barrier (a so-called barrier anti-Zeno effect) can be observed, the observation of the particle essentially increases the probability of its transmission through the barrier. The possibility of using the barrier anti-Zeno effect is discussed to explain paradoxical results of experiments on "cold nuclear fusion" observed in various systems including biological ones. (According to the observers who performed the observations, the energy generation, which could not be explained by any chemical processes, as well as the change in the isotope and even element composition of the studied object may occur in these systems.

Exploring barriers to primary care for migrants in Greece in times of austerity: Perspectives of service providers.

PubMed

Papadakaki, Maria; Lionis, Christos; Saridaki, Aristoula; Dowrick, Christopher; de Brún, Tomas; O'Reilly-de Brún, Mary; O'Donnell, Catherine A; Burns, Nicola; van Weel-Baumgarten, Evelyn; van den Muijsenbergh, Maria; Spiegel, Wolfgang; MacFarlane, Anne

2017-12-01

Migration in Europe is increasing at an unprecedented rate. There is an urgent need to develop 'migrant-sensitive healthcare systems'. However, there are many barriers to healthcare for migrants. Despite Greece's recent, significant experiences of inward migration during a period of economic austerity, little is known about Greek primary care service providers' experiences of delivering care to migrants. To identify service providers' views on the barriers to migrant healthcare. Qualitative study involving six participatory learning and action (PLA) focus group sessions with nine service providers. Data generation was informed by normalization process theory (NPT). Thematic analysis was applied to identify barriers to efficient migrant healthcare. Three main provider and system-related barriers emerged: (a) emphasis on major challenges in healthcare provision, (b) low perceived control and effectiveness to support migrant healthcare, and (c) attention to impoverished local population. The study identified major provider and system-related barriers in the provision of primary healthcare to migrants. It is important for the healthcare system in Greece to provide appropriate supports for communication in cross-cultural consultations for its diversifying population.

LGBT Populations' Barriers to Cancer Care.

PubMed

Boehmer, Ulrike

2018-02-01

To describe lesbian, gay, bisexual, and transgender (LGBT) individuals' barriers to accessing and receiving quality cancer care. Published data on cancer care and studies of LGBT individuals. There is a clustering of barriers among LGBT individuals, which suggests multiple inequities exist in LGBT individuals' cancer care, although data on disparities along the cancer control continuum are not consistently available. Nurses can make a difference in LGBT individuals' cancer care by obtaining training on LGBT health and their cancer-related needs and by providing a welcoming and respectful relationship with LGBT patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Self-employment as a solution for attitudinal barriers: a case study.

PubMed

Quinton, Melanie C

2014-01-01

This paper uses a case study to examine attitudinal barriers to employment and underemployment. We follow the career path of PR, a woman with multiple physical impairments, as she seeks financial independence through several employment strategies. In these, she faced attitudinal barriers and employment situations without opportunity for advancement. Eventually, PR opens her own business, turning to an alternative loan program to acquire the funds necessary to purchase a ready-made vehicle that matches her needs for accessible transportation. Use of this vehicle to provide delivery services for her business has more than doubled her income.

[Involvement of doctors' assistants in primary care for patients with long-term conditions. General practitioners' (GPs) perception of barriers and opportunities--a qualitative study].

PubMed

Bölter, Regine; Ose, Dominik; Götz, Katja; Miksch, Antje; Szecsenyi, Joachim; Freund, Tobias

2010-01-01

Care for patients with multiple and chronic diseases is an increasing challenge. The particular demands of chronically ill patients increase the complexity of primary care. Involvement of doctors' assistants is discussed as part of comprehensive frameworks for structured care like the Chronic Care Model (CCM). The aim of this qualitative study was to reveal perceived barriers and opportunities among German general practitioners (GPs) according to the involvement of their assistants in patient care. 14 GPs were interviewed. The documents were evaluated analytically according to their content. Most GPs have a positive point of view with regard to the integration of their assistants. They claim a task-oriented training for the assistants as a precondition. Their working experience, an established patient-assistant relationship and the preparedness to take own responsibility in patient care are stated as supporting factors for the involvement of doctors' assistants in patient care. Main barrier seems to be a lack of time for additional work of their employees. There is a need for task-oriented training, in order to professionalize practice teams. Remarkably, this new approach to chronic care is already integrated into routine care. However, it seems to suit only for some distinct diseases, selected patients and a limited number of doctors' assistants. As part of further professionalization an evaluation of a new job profile for doctors' assistants should be discussed.

Interprofessional communication between community pharmacists and general practitioners: a qualitative study.

PubMed

Weissenborn, Marina; Haefeli, Walter E; Peters-Klimm, Frank; Seidling, Hanna M

2017-06-01

Background While collaboration between community pharmacists (CPs) and general practitioners (GPs) is essential to provide comprehensive patient care, their communication often is scarce and hampered by multiple barriers. Objective We aimed to assess both professions' perceptions of interprofessional communication with regard to content and methods of communication as a basis to subsequently develop best-practice recommendations for information exchange. Setting Ambulatory care setting in Germany. Method CPs and GPs shared their experience in focus groups and in-depth interviews which were conducted using a semi-structured interview guideline. Transcribed recordings were assessed using qualitative content analysis according to Mayring. Main outcome measure Specification of existing barriers, CPs'/GPs' general perceptions of interprofessional communication and similarities and differences regarding prioritization of specific information items and how to best communicate with each other. Results Four focus groups and fourteen interviews were conducted. Seven internal (e.g. professions were not personally known to one another) and nine external barriers (e.g. mutual accessibility) were identified. Ten organizational, eight medication-related, and four patient-related information items were identified requiring interprofessional communication. Their relevance varied between the professions, e.g. CPs rated organizational issues higher than GPs. Both professions indicated communication via phone to be the most frequently used method of communication. Conclusion CPs and GPs opinions often differ. However, communication between CPs and GPs is perceived as crucial suggesting that a future concept has to offer standardized recommendations, while leaving CPs and GPs room to adjust it to their individual needs.

Access to primary care for socio-economically disadvantaged older people in rural areas: A qualitative study.

PubMed

Ford, John A; Turley, Rachel; Porter, Tom; Shakespeare, Tom; Wong, Geoff; Jones, Andy P; Steel, Nick

2018-01-01

We aim to explore the barriers to accessing primary care for socio-economically disadvantaged older people in rural areas. Using a community recruitment strategy, fifteen people over 65 years, living in a rural area, and receiving financial support were recruited for semi-structured interviews. Four focus groups were held with rural health professionals. Interviews and focus groups were audio-recorded and transcribed. Thematic analysis was used to identify barriers to primary care access. Older people's experience can be understood within the context of a patient perceived set of unwritten rules or social contract-an individual is careful not to bother the doctor in return for additional goodwill when they become unwell. However, most found it difficult to access primary care due to engaged telephone lines, availability of appointments, interactions with receptionists; breaching their perceived social contract. This left some feeling unwelcome, worthless or marginalised, especially those with high expectations of the social contract or limited resources, skills and/or desire to adapt to service changes. Health professionals' described how rising demands and expectations coupled with service constraints had necessitated service development, such as fewer home visits, more telephone consultations, triaging calls and modifying the appointment system. Multiple barriers to accessing primary care exist for this group. As primary care is re-organised to reduce costs, commissioners and practitioners must not lose sight of the perceived social contract and models of care that form the basis of how many older people interact with the service.

Embryonic blood-cerebrospinal fluid barrier formation and function

PubMed Central

Bueno, David; Parvas, Maryam; Hermelo, Ismaïl; Garcia-Fernàndez, Jordi

2014-01-01

During embryonic development and adult life, brain cavities and ventricles are filled with cerebrospinal fluid (CSF). CSF has attracted interest as an active signaling medium that regulates brain development, homeostasis and disease. CSF is a complex protein-rich fluid containing growth factors and signaling molecules that regulate multiple cell functions in the central nervous system (CNS). The composition and substance concentrations of CSF are tightly controlled. In recent years, it has been demonstrated that embryonic CSF (eCSF) has a key function as a fluid pathway for delivering diffusible signals to the developing brain, thus contributing to the proliferation, differentiation and survival of neural progenitor cells, and to the expansion and patterning of the brain. From fetal stages through to adult life, CSF is primarily produced by the choroid plexus. The development and functional activities of the choroid plexus and other blood–brain barrier (BBB) systems in adults and fetuses have been extensively analyzed. However, eCSF production and control of its homeostasis in embryos, from the closure of the anterior neuropore when the brain cavities become physiologically sealed, to the formation of the functional fetal choroid plexus, has not been studied in as much depth and remains open to debate. This review brings together the existing literature, some of which is based on experiments conducted by our research group, concerning the formation and function of a temporary embryonic blood–CSF barrier in the context of the crucial roles played by the molecules in eCSF. PMID:25389383

Barriers to providing maternity care to women with physical disabilities: Perspectives from health care practitioners.

PubMed

Mitra, Monika; Smith, Lauren D; Smeltzer, Suzanne C; Long-Bellil, Linda M; Sammet Moring, Nechama; Iezzoni, Lisa I

2017-07-01

Women with physical disabilities are known to experience disparities in maternity care access and quality, and communication gaps with maternity care providers, however there is little research exploring the maternity care experiences of women with physical disabilities from the perspective of their health care practitioners. This study explored health care practitioners' experiences and needs around providing perinatal care to women with physical disabilities in order to identify potential drivers of these disparities. We conducted semi-structured telephone interviews with 14 health care practitioners in the United States who provide maternity care to women with physical disabilities, as identified by affiliation with disability-related organizations, publications and snowball sampling. Descriptive coding and content analysis techniques were used to develop an iterative code book related to barriers to caring for this population. Public health theory regarding levels of barriers was applied to generate broad barrier categories, which were then analyzed using content analysis. Participant-reported barriers to providing optimal maternity care to women with physical disabilities were grouped into four levels: practitioner level (e.g., unwillingness to provide care), clinical practice level (e.g., accessible office equipment like adjustable exam tables), system level (e.g., time limits, reimbursement policies), and barriers relating to lack of scientific evidence (e.g., lack of disability-specific clinical data). Participants endorsed barriers to providing optimal maternity care to women with physical disabilities. Our findings highlight the needs for maternity care practice guidelines for women with physical disabilities, and for training and education regarding the maternity care needs of this population. Copyright © 2016 Elsevier Inc. All rights reserved.

School Teachers' Experiences of Science Curriculum Reform

NASA Astrophysics Data System (ADS)

Ryder, Jim; Banner, Indira

2013-02-01

We examine teachers' experiences of a major reform of the school science curriculum for 14-16-year olds in England. This statutory reform enhances the range of available science courses and emphasises the teaching of socio-scientific issues and the nature of science, alongside the teaching of canonical science knowledge. This paper examines teachers' experiences of the reform and the factors that condition these experiences. A designed sample of 22 teachers discussed their experiences of the reform within a semi-structured interview. Our analysis considers how the external and internal structures within which teachers work interact with the personal characteristics of teachers to condition their experiences of the curriculum reform. In many cases, personal/internal/external contexts of teachers' work align, resulting in an overall working context that is supportive of teacher change. However, in other cases, tensions within these contexts result in barriers to change. We also explore cases in which external curriculum reform has stimulated the development of new contexts for teachers' work. We argue that curriculum reformers need to recognise the inevitability of multiple teaching goals within a highly differentiated department and school workplace. We also show how experiences of curriculum reform can extend beyond the learning of new knowledge and associated pedagogies to involve challenges to teachers' professional identities. We argue for the extended use of teacher role models within local communities of practice to support such 'identity work'.

Barriers to front propagation in laminar, three-dimensional fluid flows

NASA Astrophysics Data System (ADS)

Doan, Minh; Simons, J. J.; Lilienthal, Katherine; Solomon, Tom; Mitchell, Kevin A.

2018-03-01

We present experiments on one-way barriers that block reaction fronts in a fully three-dimensional (3D) fluid flow. Fluorescent Belousov-Zhabotinsky reaction fronts are imaged with laser-scanning in a laminar, overlapping vortex flow. The barriers are analyzed with a 3D extension to burning invariant manifold (BIM) theory that was previously applied to two-dimensional advection-reaction-diffusion processes. We discover tube and sheet barriers that guide the front evolution. The experimentally determined barriers are explained by BIMs calculated from a model of the flow.

Minimizing Barriers in Learning for On-Call Radiology Residents-End-to-End Web-Based Resident Feedback System.

PubMed

Choi, Hailey H; Clark, Jennifer; Jay, Ann K; Filice, Ross W

2018-02-01

Feedback is an essential part of medical training, where trainees are provided with information regarding their performance and further directions for improvement. In diagnostic radiology, feedback entails a detailed review of the differences between the residents' preliminary interpretation and the attendings' final interpretation of imaging studies. While the on-call experience of independently interpreting complex cases is important to resident education, the more traditional synchronous "read-out" or joint review is impossible due to multiple constraints. Without an efficient method to compare reports, grade discrepancies, convey salient teaching points, and view images, valuable lessons in image interpretation and report construction are lost. We developed a streamlined web-based system, including report comparison and image viewing, to minimize barriers in asynchronous communication between attending radiologists and on-call residents. Our system provides real-time, end-to-end delivery of case-specific and user-specific feedback in a streamlined, easy-to-view format. We assessed quality improvement subjectively through surveys and objectively through participation metrics. Our web-based feedback system improved user satisfaction for both attending and resident radiologists, and increased attending participation, particularly with regards to cases where substantive discrepancies were identified.

Interdisciplinary collaboration between social workers and dieticians in nutrition education programs for children-at-risk.

PubMed

Shor, Ron

2010-01-01

Bio-psycho-social risk factors may lead to situations of poor nutrition of children. However, despite the multiple risk factors involved in such situations, interdisciplinary collaboration between experts in the psycho-social dimensions and experts in the bio-dimension of poor nutrition has not been a common model of practice. An evaluation was conducted in Israel of the experience of collaboration between social workers and dieticians in leading nutrition-education programs. A qualitative methodology was implemented with 22 participants. The findings illuminate the potential that interdisciplinary collaboration has to enhance the response of each of the professions to the risks for poor nutrition. The barriers affecting collaboration are: (a) role ambiguity about the non-administrative functions of social workers; (b) the dieticians' lack of sufficient familiarity with the life circumstances of low-income families and how to adjust the nutrition-related contents to their circumstances; and (c) difficulties to achieve a balance between the structured methods of knowledge delivery of the dieticians and the less structured methods of intervention of social workers. The findings illuminate the significance of incorporating suitable approaches into the collaboration for reducing these barriers.

American Thoracic Society and National Heart, Lung, and Blood Institute Implementation Research Workshop Report.

PubMed

Bender, Bruce G; Krishnan, Jerry A; Chambers, David A; Cloutier, Michelle M; Riekert, Kristin A; Rand, Cynthia S; Schatz, Michael; Thomson, Carey C; Wilson, Sandra R; Apter, Andrea; Carson, Shannon S; George, Maureen; Gerald, Joe K; Gerald, Lynn; Goss, Christopher H; Okelo, Sande O; Mularski, Richard A; Nguyen, Huong Q; Patel, Minal R; Szefler, Stanley J; Weiss, Curtis H; Wilson, Kevin C; Freemer, Michelle

2015-12-01

To advance implementation research (IR) in respiratory, sleep, and critical care medicine, the American Thoracic Society and the Division of Lung Diseases from the NHLBI cosponsored an Implementation Research Workshop on May 17, 2014. The goals of IR are to understand the barriers and facilitators of integrating new evidence into healthcare practices and to develop and test strategies that systematically target these factors to accelerate the adoption of evidence-based care. Throughout the workshop, presenters provided examples of IR that focused on the rate of adoption of evidence-based practices, the feasibility and acceptability of interventions to patients and other stakeholders who make healthcare decisions, the fidelity with which practitioners use specific interventions, the effects of specific barriers on the sustainability of an intervention, and the implications of their research to inform policies to improve patients' access to high-quality care. During the discussions that ensued, investigators' experience led to recommendations underscoring the importance of identifying and involving key stakeholders throughout the research process, ensuring that those who serve as reviewers understand the tenets of IR, managing staff motivation and turnover, and tackling the challenges of scaling up interventions across multiple settings.

The role of comorbidities in patients' hypertension self-management.

PubMed

Fix, Gemmae M; Cohn, Ellen S; Solomon, Jeffrey L; Cortés, Dharma E; Mueller, Nora; Kressin, Nancy R; Borzecki, Ann; Katz, Lois A; Bokhour, Barbara G

2014-06-01

We sought to understand barriers to hypertension self-management in patients with hypertension and comorbidities. We conducted semi-structured, qualitative interviews with 48 patients with uncontrolled hypertension and at least one comorbidity to learn about beliefs and behaviors that might affect hypertension self-management. Using a grounded theory strategy, we analyzed interview transcripts detailing patients' hypertension self-management behaviors vis-à-vis a framework including Explanatory Models-a patient's understanding of the pathophysiology, cause, course, treatment, and severity of an illness, such as hypertension. We identified four factors that interfered with hypertension self-management. (1) Interdependence: Participants saw hypertension as interconnected to their comorbidities and subsequently had difficulty separating information about their illnesses. (2) Low priority: Compared to other conditions, participants assigned hypertension a lower priority. (3) Conflicts: Participants struggled with conflicts between hypertension self-management practices and those for comorbidities. (4) Managing multiple medications: Polypharmacy led to patients' confusion and concern about taking medications as prescribed. Participants did not experience hypertension as a discreet clinical condition; rather, they self-managed hypertension concurrently with other conditions, leading to a breakdown in hypertension self-management. We provide strategies to address each of the four barriers to better equip providers in addressing their clinically salient concerns.

Experiencing 'pathologized presence and normalized absence'; understanding health related experiences and access to health care among Iraqi and Somali asylum seekers, refugees and persons without legal status.

PubMed

Fang, Mei Lan; Sixsmith, Judith; Lawthom, Rebecca; Mountian, Ilana; Shahrin, Afifa

2015-09-19

Asylum seekers, refugees and persons without legal status have been reported to experience a range of difficulties when accessing public services and supports in the UK. While research has identified health care barriers to equitable access such as language difficulties, it has not considered the broader social contexts of marginalization experienced through the dynamics of 'othering'. The current study explores health and health care experiences of Somali and Iraqi asylum seekers, refugees and persons without legal status, highlighting 'minoritization' processes and the 'pathologization' of difference as analytical lenses to understand the multiple layers of oppression that contribute to health inequities. For the study, qualitative methods were used to document the lived experiences of asylum seekers, refugees and persons without legal status. Thirty-five in-depth interviews and five focus groups were used to explore personal accounts, reveal shared understandings and enable social, cognitive and emotional understandings of on-going health problems and challenges when seeking treatment and care. A participatory framework was undertaken which inspired collaborative workings with local organizations that worked directly with asylum seekers, refugees and persons without legal status. The analysis revealed four key themes: 1) pre-departure histories and post-arrival challenges; 2) legal status; 3) health knowledges and procedural barriers as well as 4) language and cultural competence. Confidentiality, trust, wait times and short doctor-patient consultations were emphasized as being insufficient for culturally specific communications and often translating into inadequate treatment and care. Barriers to accessing health care was associated with social disadvantage and restrictions of the broader welfare system suggesting that a re-evaluation of the asylum seeking process is required to improve the situation. Macro- and micro-level intersections of accustomed societal beliefs, practices and norms, broad-level legislation and policy decisions, and health care and social services delivery methods have affected the health and health care experiences of forced migrants that reside in the UK. Research highlights how 'minoritization processes,' influencing the intersections between social identities, can hinder access to and delivery of health and social services to vulnerable groups. Similar findings were reported here; and the most influential mechanism directly impacting health and access to health and social services was legal status. Equitable health care provision requires systemic change that incorporate understandings of marginalization, 'othering' processes and the intersections between the past histories and everyday realities of asylum seekers, refugees and persons without legal status.

Parent-identified barriers to pediatric health care: a process-oriented model.

PubMed

Sobo, Elisa J; Seid, Michael; Reyes Gelhard, Leticia

2006-02-01

To further understand barriers to care as experienced by health care consumers, and to demonstrate the importance of conjoining qualitative and quantitative health services research. Transcripts from focus groups conducted in San Diego with English- and Spanish-speaking parents of children with special health care needs. Participants were asked about the barriers to care they had experienced or perceived, and their strategies for overcoming these barriers. Using elementary anthropological discourse analysis techniques, a process-based conceptual model of the parent experience was devised. The analysis revealed a parent-motivated model of barriers to care that enriched our understanding of quantitative findings regarding the population from which the focus group sample was drawn. Parent-identified barriers were grouped into the following six temporally and spatially sequenced categories: necessary skills and prerequisites for gaining access to the system; realizing access once it is gained; front office experiences; interactions with physicians; system arbitrariness and fragmentation; outcomes that affect future interaction with the system. Key to the successful navigation of the system was parents' functional biomedical acculturation; this construct likens the biomedical health services system to a cultural system within which all parents/patients must learn to function competently. Qualitative analysis of focus group data enabled a deeper understanding of barriers to care--one that went beyond the traditional association of marker variables with poor outcomes ("what") to reveal an understanding of the processes by which parents experience the health care system ("how,"why") and by which disparities may arise. Development of such process-oriented models furthers the provision of patient-centered care and the creation of interventions, programs, and curricula to enhance such care. Qualitative discourse analysis, for example using this project's widely applicable protocol for generating experientially based models, can enhance our knowledge of the parent/patient experience and aid in the development of more powerful conceptualizations of key health care constructs.

Experimental testing of flexible barriers for containment of debris flows

USGS Publications Warehouse

DeNatale, Jay S.; Iverson, Richard M.; Major, Jon J.; LaHusen, Richard G.; Fliegel, Gregg L.; Duffy, John D.

1999-01-01

In June 1996, six experiments conducted at the U.S. Geological Survey Debris Flow Flume demonstrated that flexible, vertical barriers constructed of wire rope netting can stop small debris flows. All experimental debris flows consisted of water-saturated gravelly sand with less than two percent finer sediment by weight. All debris flows had volumes of about 10 cubic meters, masses of about 20 metre tons, and impact velocities of 5 to 9 meters per second. In four experiments, the debris flow impacted pristine, unreformed barriers of varying design; in the other two experiments, the debris flow impacted barriers already loaded with sediment from a previous flow. Differences in barrier design led to differences in barrier performance. Experiments were conducted with barriers constructed of square-mesh wire-rope netting with 30centimeter, 20centimeter, and 15 centimeter mesh openings as well as 30centimeter diameter interlocking steel rings. In all cases, sediment cascading downslope at the leading edge of the debris flows tended to spray through the nets. Nets fitted with finer-mesh chain link or chicken wire liners contained more sediment than did unlined nets, and a ring net fitted with a synthetic silt screen liner contained nearly 100 percent of the sediment. Irreversible net displacements of up to 2 meters and friction brake engagement on the support and anchor cables dissipated some of the impact energy. However, substantial forces developed in the steel support columns and the lateral and tie-back anchor cables attached to these columns. As predicted by elementary mechanics, the anchor cables experienced larger tensile forces when the support columns were hinged at the base rather than bolted rigidly to the foundation. Measured loads in the lateral anchor cables exceeded those in the tie-back anchor cables and the load cell capacity of 45 kilo-Newtons. Measurements also indicated that the peak loads in the tie- back anchors were highly transient and occurred at the points of maximum momentum impulse to the net.

Computational Investigation of the Interplay of Substrate Positioning and Reactivity in Catechol O-Methyltransferase

PubMed Central

Patra, Niladri; Ioannidis, Efthymios I.

2016-01-01

Catechol O-methyltransferase (COMT) is a SAM- and Mg2+-dependent methyltransferase that regulates neurotransmitters through methylation. Simulations and experiments have identified divergent catecholamine substrate orientations in the COMT active site: molecular dynamics simulations have favored a monodentate coordination of catecholate substrates to the active site Mg2+, and crystal structures instead preserve bidentate coordination along with short (2.65 Å) methyl donor-acceptor distances. We carry out longer dynamics (up to 350 ns) to quantify interconversion between bidentate and monodentate binding poses. We provide a systematic determination of the relative free energy of the monodentate and bidentate structures in order to identify whether structural differences alter the nature of the methyl transfer mechanism and source of enzymatic rate enhancement. We demonstrate that the bidentate and monodentate binding modes are close in energy but separated by a 7 kcal/mol free energy barrier. Analysis of interactions in the two binding modes reveals that the driving force for monodentate catecholate orientations in classical molecular dynamics simulations is derived from stronger electrostatic stabilization afforded by alternate Mg2+ coordination with strongly charged active site carboxylates. Mixed semi-empirical-classical (SQM/MM) substrate C-O distances (2.7 Å) for the bidentate case are in excellent agreement with COMT X-ray crystal structures, as long as charge transfer between the substrates, Mg2+, and surrounding ligands is permitted. SQM/MM free energy barriers for methyl transfer from bidentate and monodentate catecholate configurations are comparable at around 21–22 kcal/mol, in good agreement with experiment (18–19 kcal/mol). Overall, the work suggests that both binding poses are viable for methyl transfer, and accurate descriptions of charge transfer and electrostatics are needed to provide balanced relative barriers when multiple binding poses are accessible, for example in other transferases. PMID:27564542

Overview and Experiences of a Nursing e-Mentorship Program

PubMed Central

Faiman, Beth

2012-01-01

Little is known regarding the feasibility and efficacy of an online continuing education program for oncology nurses. The Multiple Myeloma Mentorship Program, a quality improvement project for the Institute for Medical Education and Research, was designed to meet the educational needs of oncology nurses caring for patients with multiple myeloma. Twenty-five expert nurses with expertise in multiple myeloma from 23 cancer centers in the United States partnered with 50 oncology nurses in an electronic format from July 2009 to January 2010. The purpose of the program was to educate oncology nurses about the latest treatments and strategies for optimal side-effect management for patients with multiple myeloma. Nurse mentees selected their preferred form of learning—webcast, in-person speaker, or monograph. Two live webcasts allowed for didactic discussion between mentors and mentees. During and after the program, mentors conducted informal, unscripted interviews with nurse participants to determine preferred learning format, challenges, and implications for practice. Twelve nurses preferred Web-based learning to in-person presentations, citing flexibility and convenience as reasons for that choice. Time constraints with Web-based and in-person learning were a barrier to nurse mentees completing assigned modules. Several nurses implemented practice changes as a result of the program. Nurses who participated in the mentorship program were satisfied with the content. Learning styles and format should be considered in future mentorship programs. PMID:21810575

The use of video conferencing to develop a community of practice for preceptors located in rural and non traditional placement settings: an evaluation study.

PubMed

Zournazis, Helen E; Marlow, Annette H

2015-03-01

Support for nursing students in rural and non-traditional health environments within Tasmania is predominately undertaken by preceptors. It is recognised that preceptors who work within these environments, require support in their role and opportunities to communicate with academic staff within universities. Multiple methods of information distribution support and networking opportunities provide preceptors with flexible options to keep them abreast of the student learning process. This paper presents survey findings from preceptors in rural and non-traditional professional experience placement environments taken from a pilot project regarding the implementation of video conferencing forums for education and peer networking in Tasmania. The purpose of the evaluation was to establish whether video conferencing met the requirements of preceptors' understanding of learning and teaching requirements during students' professional experience placement. The findings reveal preceptors' workload pressures and the need for organisational support were key barriers that prevented preceptor participation. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

Meeting Health and Psychological Needs of Women In Drug Treatment Court

PubMed Central

Morse, Diane S.; Cerulli, Catherine; Bedell, Precious; Wilson, John L.; Thomas, Katherine; Mittal, Mona; Lamberti, J. Steven; Williams, Geoffrey; Silverstein, Jennifer; Mukherjee, Aninda; Walck, Donna; Chin, Nancy

2013-01-01

We explored healthcare-related experiences of women drug court participants through combining context from the Socio-Ecological Model with motivation needs for health behavior as indicated by self-determination theory. Five focus groups with 8 women drug court participants, 8 court staff, and 9 community service providers were examined using qualitative framework analysis. Themes emerged across the Socio-Ecological Model and were cross-mapped with self-determination theory-defined motivation needs for autonomy, relatedness, and competence. Socio-Ecological levels contained experiences either supporting or eroding women’s motivation needs: 1) intrapersonal challenges participants termed an “evil cycle” of relapse, recidivism, trauma, and life challenges; 2) interpersonal context of parenting and stigma involving features of this “evil cycle”; 3) institutions with logistical barriers to legal and medical assistance; 4) community resources inadequate to support living and employment needs. Self-determination theory helps explain motivation required to address the women’s healthcare needs and multiple demands at all levels of the Socio-Ecological Model. PMID:24074850

Meeting health and psychological needs of women in drug treatment court.

PubMed

Morse, Diane S; Cerulli, Catherine; Bedell, Precious; Wilson, John L; Thomas, Katherine; Mittal, Mona; Lamberti, J Steven; Williams, Geoffrey; Silverstein, Jennifer; Mukherjee, Aninda; Walck, Donna; Chin, Nancy

2014-02-01

We explored healthcare-related experiences of women drug court participants through combining context from the socio-ecological model with motivation needs for health behavior as indicated by self-determination theory. Five focus groups with 8 women drug court participants, 8 court staff, and 9 community service providers were examined using qualitative framework analysis. Themes emerged across the socio-ecological model and were cross-mapped with self-determination theory-defined motivation needs for autonomy, relatedness, and competence. Socio-ecological levels contained experiences either supporting or eroding women's motivation needs: (1) intrapersonal challenges participants termed an "evil cycle" of relapse, recidivism, trauma, and life challenges; (2) interpersonal context of parenting and stigma involving features of this "evil cycle"; (3) institutions with logistical barriers to legal and medical assistance; (4) community resources inadequate to support living and employment needs. Self-determination theory helps explain motivation required to address the women's healthcare needs and multiple demands at all levels of the socio-ecological model. © 2013.

Competitive testing of health behavior theories: how do benefits, barriers, subjective norm, and intention influence mammography behavior?

PubMed Central

Murphy, Caitlin C.; Vernon, Sally W.; Diamond, Pamela M.; Tiro, Jasmin A.

2013-01-01

Background Competitive hypothesis testing may explain differences in predictive power across multiple health behavior theories. Purpose We tested competing hypotheses of the Health Belief Model (HBM) and Theory of Reasoned Action (TRA) to quantify pathways linking subjective norm, benefits, barriers, intention, and mammography behavior. Methods We analyzed longitudinal surveys of women veterans randomized to the control group of a mammography intervention trial (n=704). We compared direct, partial mediation, and full mediation models with Satorra-Bentler χ2 difference testing. Results Barriers had a direct and indirect negative effect on mammography behavior; intention only partially mediated barriers. Benefits had little to no effect on behavior and intention; however, it was negatively correlated with barriers. Subjective norm directly affected behavior and indirectly affected intention through barriers. Conclusions Our results provide empiric support for different assertions of HBM and TRA. Future interventions should test whether building subjective norm and reducing negative attitudes increases regular mammography. PMID:23868613

Barriers to physical activity and restorative care for residents in long-term care: a review of the literature.

PubMed

Benjamin, Kathleen; Edwards, Nancy; Ploeg, Jenny; Legault, Frances

2014-01-01

Despite the benefits of physical activity, residents living in long-term care (LTC) are relatively sedentary. Designing successful physical activity and restorative care programs requires a good understanding of implementation barriers. A database search (2002-2013) yielded seven studies (nine articles) that met our inclusion criteria. We also reviewed 31 randomized controlled trials (RCTs) to determine if the authors explicitly discussed the barriers encountered while implementing their interventions. Eleven RCTs (13 articles) included a discussion of the barriers. Hence, a total of 18 studies (22 articles) were included in this review. Barriers occurred at resident (e.g., health status), environmental (e.g., lack of space for physical activity), and organizational (e.g., staffing and funding constraints) levels. These barriers intersect to adversely affect the physical activity of older people living in LTC. Future studies targeting physical activity interventions for residents living in LTC are needed to address these multiple levels of influence.

Methods for fabricating a micro heat barrier

DOEpatents

Marshall, Albert C.; Kravitz, Stanley H.; Tigges, Chris P.; Vawter, Gregory A.

2004-01-06

Methods for fabricating a highly effective, micron-scale micro heat barrier structure and process for manufacturing a micro heat barrier based on semiconductor and/or MEMS fabrication techniques. The micro heat barrier has an array of non-metallic, freestanding microsupports with a height less than 100 microns, attached to a substrate. An infrared reflective membrane (e.g., 1 micron gold) can be supported by the array of microsupports to provide radiation shielding. The micro heat barrier can be evacuated to eliminate gas phase heat conduction and convection. Semi-isotropic, reactive ion plasma etching can be used to create a microspike having a cusp-like shape with a sharp, pointed tip (<0.1 micron), to minimize the tip's contact area. A heat source can be placed directly on the microspikes. The micro heat barrier can have an apparent thermal conductivity in the range of 10.sup.-6 to 10.sup.-7 W/m-K. Multiple layers of reflective membranes can be used to increase thermal resistance.

Multifactorial skin barrier deficiency and atopic dermatitis: Essential topics to prevent the atopic march.

PubMed

Egawa, Gyohei; Kabashima, Kenji

2016-08-01

Atopic dermatitis (AD) is the most common inflammatory skin disease in the industrialized world and has multiple causes. Over the past decade, data from both experimental models and patients have highlighted the primary pathogenic role of skin barrier deficiency in patients with AD. Increased access of environmental agents into the skin results in chronic inflammation and contributes to the systemic "atopic (allergic) march." In addition, persistent skin inflammation further attenuates skin barrier function, resulting in a positive feedback loop between the skin epithelium and the immune system that drives pathology. Understanding the mechanisms of skin barrier maintenance is essential for improving management of AD and limiting downstream atopic manifestations. In this article we review the latest developments in our understanding of the pathomechanisms of skin barrier deficiency, with a particular focus on the formation of the stratum corneum, the outermost layer of the skin, which contributes significantly to skin barrier function. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Multiple Personality and the Pathological Dissociation of Self.

ERIC Educational Resources Information Center

Price, Reese E.

This paper considers the condition of Multiple Personality Disorder (MPD), which is defined as a separation of alternating personalities by rigid boundaries and amnestic barriers. It is proposed that MPD represents the end of a continuum of a defensive dissociation of the self that can result when a child employs a dissociative splitting of self…

Active Learning in the Middle Grades Classroom: Overcoming the Barriers to Implementation

ERIC Educational Resources Information Center

Edwards, Susan

2015-01-01

The Association for Middle Level Education advocates for instruction that incorporates active learning and multiple learning approaches in middle grades classrooms. The aim of this qualitative study was to examine middle level teachers who are able to implement active learning and multiple learning approaches within the standardized testing and…

Use of NASA Satellite Data in Aiding Mississippi Barrier Island Restoration Projects

NASA Technical Reports Server (NTRS)

Giardino, Marco; Spruce, Joseph; Kalcic, Maria; Fletcher, Rose

2009-01-01

This presentation discusses a NASA Stennis Space Center project in which NASA-supported satellite and aerial data is being used to aid state and federal agencies in restoring the Mississippi barrier islands. Led by the Applied Science and Technology Project Office (ASTPO), this project will produce geospatial information products from multiple NASA-supported data sources, including Landsat, ASTER, and MODIS satellite data as well as ATLAS multispectral, CAMS multispectral, AVIRIS hyperspectral, EAARL, and other aerial data. Project objectives include the development and testing of a regional sediment transport model and the monitoring of barrier island restoration efforts through remote sensing. Barrier islands provide invaluable benefits to the State of Mississippi, including buffering the mainland from storm surge impacts, providing habitats for valuable wildlife and fisheries habitat, offering accessible recreational opportunities, and preserving natural environments for educating the public about coastal ecosystems and cultural resources. Unfortunately, these highly valued natural areas are prone to damage from hurricanes. For example, Hurricane Camille in 1969 split Ship Island into East and West Ship Island. Hurricane Georges in 1998 caused additional land loss for the two Ship Islands. More recently, Hurricanes Ivan, Katrina, Rita, Gustav, and Ike impacted the Mississippi barrier islands. In particular, Hurricane Katrina caused major damage to island vegetation and landforms, killing island forest overstories, overwashing entire islands, and causing widespread erosion. In response, multiple state and federal agencies are working to restore damaged components of these barrier islands. Much of this work is being implemented through federally funded Coastal Impact Assessment and Mississippi Coastal Improvement programs. One restoration component involves the reestablishment of the island footprints to that in 1969. Our project will employ NASA remote sensing data and products to support these federally funded efforts on multiple fronts. Landsat and ASTER data is being analyzed to assess changes in barrier island land cover over the last 35 years. ASTER, SRTM, and EAARL terrain products and other NASA airborne imagery are being applied in assessing changes in barrier island geomorphology and geospatial extent. MODIS data is being examined as a tool for sediment transport modeling by supplying geospatial data that quantifies in-water sediment concentrations. MODIS satellite data is being assessed for monitoring changes in the spatial extent of individual barrier islands. Results thus far indicate that NASA data products are useful in assessing barrier island conditions and changes. This value is enhanced with additional historical geospatial data, commercial high resolution satellite data, other non-NASA aerial imagery, and field survey data. The project s products are relevant to the Gulf of Mexico Alliance priority issues, including coastal habitat conservation, restoration and coastal community resilience. Such products will be available to state and federal agencies involved with coastal restoration. Potential end-users of these products include the National Park Service, U.S. Geological Survey, U.S. Army Corps of Engineers, Environmental Protection Agency, Mississippi Department of Environmental Quality, and Mississippi Department of Marine Resources.

The Changing Role of Data Stewardship in Creating Trustworthy, Interdisciplinary High Performance Data Platforms for the Future.

NASA Astrophysics Data System (ADS)

Richards, C. J.; Evans, B. J. K.; Wyborn, L. A.; Wang, J.; Trenham, C. E.; Druken, K. A.

2016-12-01

The Australian National Computational Infrastructure (NCI) has ingested over 10PB of national and international environmental, Earth systems science and geophysics reference data onto a single platform to advance high performance data (HPD) techniques that enable interdisciplinary Data-intensive Science. Improved Data Stewardship is critical to evolve both data and data services that support the increasing need for programmatic usability and that prioritises interoperability rather than just traditional data download or portal access. A data platform designed for programmatic access requires quality checked collections that better utilise interoperable data formats and standards. Achieving this involves strategies to meet both the technical and `social' challenges. Aggregating datasets used by different communities and organisations requires satisfying multiple use cases for the broader research community, whilst addressing existing BAU requirements. For NCI, this requires working with data stewards to manage the process of replicating data to the common platform, community representatives and developers to confirm their requirements, and with international peers to better enable globally integrated data communities. It is particularly important to engage with representatives from each community who can work collaboratively to a common goal, as well as capture their community needs, apply quality assurance, determine any barriers to change and to understand priorities. This is critical when managing the aggregation of data collections from multiple producers with different levels of stewardship maturity, technologies and standards, and where organisational barriers can impact the transformation to interoperable and performant data access. To facilitate the management, development and operation of the HPD platform, NCI coordinates technical and domain committees made up of user representatives, data stewards and informatics experts to provide a forum to discuss, learn and advise NCI's management. This experience has been a useful collaboration and suggests that in the age of interdisciplinary HPD research, Data Stewardship is evolving from a focus on the needs of a single community to one which helps balance priorities and navigates change for multiple communities.

Using a Bayesian network to predict barrier island geomorphologic characteristics

USGS Publications Warehouse

Gutierrez, Ben; Plant, Nathaniel G.; Thieler, E. Robert; Turecek, Aaron

2015-01-01

Quantifying geomorphic variability of coastal environments is important for understanding and describing the vulnerability of coastal topography, infrastructure, and ecosystems to future storms and sea level rise. Here we use a Bayesian network (BN) to test the importance of multiple interactions between barrier island geomorphic variables. This approach models complex interactions and handles uncertainty, which is intrinsic to future sea level rise, storminess, or anthropogenic processes (e.g., beach nourishment and other forms of coastal management). The BN was developed and tested at Assateague Island, Maryland/Virginia, USA, a barrier island with sufficient geomorphic and temporal variability to evaluate our approach. We tested the ability to predict dune height, beach width, and beach height variables using inputs that included longer-term, larger-scale, or external variables (historical shoreline change rates, distances to inlets, barrier width, mean barrier elevation, and anthropogenic modification). Data sets from three different years spanning nearly a decade sampled substantial temporal variability and serve as a proxy for analysis of future conditions. We show that distinct geomorphic conditions are associated with different long-term shoreline change rates and that the most skillful predictions of dune height, beach width, and beach height depend on including multiple input variables simultaneously. The predictive relationships are robust to variations in the amount of input data and to variations in model complexity. The resulting model can be used to evaluate scenarios related to coastal management plans and/or future scenarios where shoreline change rates may differ from those observed historically.

Barriers to Asthma Management for School Nurses: An Integrative Review.

PubMed

Hanley Nadeau, Ellen; Toronto, Coleen E

2016-04-01

Childhood asthma is a growing health concern. Asthma is the most common chronic illness of childhood and a leading cause of emergency room visits, hospitalizations, and school absenteeism. School nurses play a valuable role in asthma management. The purpose of this integrative review is to examine barriers to asthma management for school nurses in the school setting. Findings revealed multiple barriers school nurses encounter in managing asthma. Six themes emerged that included lack of resources and support, insufficient time, communication challenges, limited knowledge, and lack of awareness of school nurses' expertise. Students, parents, primary care physicians, school administration, staff, and school nurses themselves all play a role in constructing barriers to asthma management. There is a need for school nurses and school nurse leaders to focus efforts to develop strategies to overcome barriers to ensure evidence-based, best practice management of asthma in the school setting. © The Author(s) 2015.

Ocular Drug Delivery Barriers-Role of Nanocarriers in the Treatment of Anterior Segment Ocular Diseases.

PubMed

Bachu, Rinda Devi; Chowdhury, Pallabitha; Al-Saedi, Zahraa H F; Karla, Pradeep K; Boddu, Sai H S

2018-02-27

Ocular drug delivery is challenging due to the presence of anatomical and physiological barriers. These barriers can affect drug entry into the eye following multiple routes of administration (e.g., topical, systemic, and injectable). Topical administration in the form of eye drops is preferred for treating anterior segment diseases, as it is convenient and provides local delivery of drugs. Major concerns with topical delivery include poor drug absorption and low bioavailability. To improve the bioavailability of topically administered drugs, novel drug delivery systems are being investigated. Nanocarrier delivery systems demonstrate enhanced drug permeation and prolonged drug release. This review provides an overview of ocular barriers to anterior segment delivery, along with ways to overcome these barriers using nanocarrier systems. The disposition of nanocarriers following topical administration, their safety, toxicity and clinical trials involving nanocarrier systems are also discussed.

The Role of Structural Barriers in Risky Sexual Behavior, Victimization and Readiness to Change HIV/STI-Related Risk Behavior Among Transgender Women.

PubMed

Raiford, Jerris L; Hall, Grace J; Taylor, Raekiela D; Bimbi, David S; Parsons, Jeffrey T

2016-10-01

This study examines the role of structural barriers experienced by a community-based sample of 63 HIV-positive and negative transgender women that may elevate HIV infection and transmission risks. Separate hierarchical linear multiple regression analyses tested the association between structural barriers (e.g., unemployment, lack of food, shelter) and condomless anal sex acts, abuse, and readiness to change risk behavior, while controlling for other related factors. Among this primarily Hispanic and African-American sample, HIV-positive and negative transgender women experienced a similar number of structural barriers and experiencing structural barriers was significantly associated with an increased number of condomless anal sex acts (p = .002), victimization (p = .000) and a decreased readiness to change HIV-related risk behavior (p = .014). Structural-level interventions are needed to address this elevated risk among this underserved and hard-to-reach population.

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

Does self-compassion mitigate the relationship between burnout and barriers to compassion? A cross-sectional quantitative study of 799 nurses.

PubMed

Dev, Vinayak; Fernando, Antonio T; Lim, Anecita Gigi; Consedine, Nathan S

2018-05-01

Burnout has numerous negative consequences for nurses, potentially impairing their ability to deliver compassionate patient care. However, the association between burnout and compassion and, more specifically, barriers to compassion in medicine is unclear. This article evaluates the associations between burnout and barriers to compassion and examines whether dispositional self-compassion might mitigate this association. Consistent with prior work, the authors expected greater burnout to predict greater barriers to compassion. We also expected self-compassion - the ability to be kind to the self during times of distress - to weaken the association between burnout and barriers to compassion among nurses. Registered nurses working in New Zealand medical contexts were recruited using non-random convenience sampling. Following consent, 799 valid participants completed a cross-sectional survey including the Copenhagen Burnout Inventory, the Barriers to Physician Compassion scale, and a measure of dispositional self-compassion. As expected, greater burnout predicted greater barriers to compassion while self-compassion predicted fewer barriers. However, self-compassion mitigated the association between burnout and burnout related barriers to compassion (but not other barriers). The interaction suggested that suggested that the association was stronger (rather than weaker) among those with greater self-compassion. Understanding the lack of compassion and the effects of burnout in patient care are priorities in health. This report extends evidence on the association between burnout and compassion-fatigue to show that burnout also predicts the experience of specific barriers to compassion. While self-compassion predicted lower burnout and barriers, it may not necessarily reduce the extent to which burnout contributes to the experience of barriers to compassion in medicine. Implications for understanding how burnout manifests in barriers to clinical compassion, interventions and professional training, and future directions in nursing are discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

Immigrant women's experiences of maternity-care services in Canada: a systematic review using a narrative synthesis.

PubMed

Higginbottom, Gina M A; Morgan, Myfanwy; Alexandre, Mirande; Chiu, Yvonne; Forgeron, Joan; Kocay, Deb; Barolia, Rubina

2015-02-11

Canada's diverse society and its statutory commitment to multiculturalism means that a synthesis of knowledge related to the healthcare experiences of immigrants is essential to realise the health potential for future Canadians. Although concerns about the maternity experiences of immigrants in Canada are relatively new, recent national guidelines explicitly call for the tailoring of services to user needs. We therefore assessed the experiences of immigrant women accessing maternity-care services in Canada. In particular, we investigated the experiences of immigrant women in Canada in accessing and navigating maternity and related healthcare services from conception to 6 months postpartum in Canada. Our focus was on (a) the accessibility and acceptability of maternity-care services for immigrant women and (b) the effects of the perceptions and experiences of these women on their birth and postnatal outcomes. We conducted a systematic review using a systematic search and narrative synthesis of peer-reviewed and non-peer-reviewed reports of empirical research, with the aim of providing stakeholders with perspectives on maternity-care services as experienced by immigrant women. We partnered with key stakeholders ('integrated knowledge users') to ensure the relevancy of topics and to tailor recommendations for effective translation into future policy, practice and programming. Two search phases and a three-stage selection process for published and grey literature were conducted prior to appraisal of literature quality and narrative synthesis of the findings. Our knowledge synthesis of maternity care among immigrants to Canada provided a coherent evidence base for (a) eliciting a better understanding of the factors that generate disparities in accessibility, acceptability and outcomes during maternity care; and (b) improving culturally based competency in maternity care. Our synthesis also identified pertinent issues in multiple sectors that should be addressed to configure maternity services and programs appropriately. Although immigrant women in Canada are generally given the opportunity to obtain necessary services, they face many barriers in accessing and utilising these services. These barriers include lack of information about or awareness of the services, insufficient supports to access these services and discordant expectations between the women and their service providers. PROSPERO registration number: CRD42012002185 .

Differences between men and women in condom use, attitudes, and skills in substance abuse treatment seekers

PubMed Central

Calsyn, Donald A.; Peavy, K. Michelle; Wells, Elizabeth A.; Campbell, Aimee N. C.; Hatch-Maillette, Mary A; Greenfield, Shelly F.; Tross, Susan

2012-01-01

Examining attitudes and skills regarding condom use by men and women in substance abuse treatment who engage in high risk sexual behavior may help to explain their inconsistent condom use. Men and women enrolled in two multi-site HIV risk reduction studies were administered the Condom Barriers Scale, Condom Use Skills and an audio computer-assisted structured interview assessing sexual risk behavior. Men endorsed more barriers to condom use than women, especially in the Effects on Sexual Experience factor. For both men and women, stronger endorsement of barriers to condom use was associated with less use of condoms. However, the difference between condom users and condom non-users in endorsement of condom barriers in general is greater for men than women, especially for those who report having casual partners. Findings support the need to focus on gender-specific barriers to condom use in HIV/STI prevention interventions, especially risk behavior intervention techniques that address sexual experience with condoms. PMID:23414501

Containment of a silicone fluid free surface in reduced gravity using barrier coatings

NASA Technical Reports Server (NTRS)

Pline, Alexander D.; Jacobson, Thomas P.

1988-01-01

In support of the Surface Tension Driven Convection Experiment planned for flight aboard the Space Shuttle, tests were conducted under reduced gravity in the 2.2-sec Drop Tower and the 5.0-sec Zero-G facility at the NASA Lewis Research Center. The dynamics of controlling the test fluid, a 10-cSt viscosity silicone fluid in a low gravity environment were investigated using different container designs and barrier coatings. Three container edge designs were tested without a barrier coating; a square edge, a sharp edge with a 45-deg slope, and a sawtooth edge. All three edge designs were successful in containing the fluid below the edge. G-jitter experiments were made in scaled down containers subjected to horizontal accelerations. The data showed that a barrier coating is effective in containing silicone fluid under g-levels up to 10 sup -1 sub g sub 0. In addition, a second barrier coating was found which has similar anti-wetting characteristics and is also more durable.

Solitary wave runup and force on a vertical barrier

NASA Astrophysics Data System (ADS)

Liu, Philip L.-F.; Al-Banaa, Khaled

2004-04-01

In this paper we investigate the interaction between a solitary wave and a thin vertical barrier. A set of laboratory experiments was performed with different values of incident wave height to water depth ratio, H/h, and the draught of the barrier to water depth ratio, D/h. While wave gauges were used to measure the reflected and transmitted waves, pressure transducers were installed on both sides of the barrier, enabling the calculation of wave force. The particle image velocimetry (PIV) technique is also employed to measure the velocity field in the vicinity of the barrier. A numerical model, based on the Reynolds-averaged Navier Stokes (RANS) equations and the k - epsilon turbulence closure model, was first checked with experimental data and then employed to obtain additional results for the range of parameters where the laboratory experiments were not performed. Using both experimental data and numerical results, formulae for the maximum runup height, and the maximum wave force are derived in terms of H/h and D/h.

Worlds apart? A scoping review addressing different stakeholder perspectives on barriers to family involvement in the care for persons with severe mental illness.

PubMed

Landeweer, Elleke; Molewijk, Bert; Hem, Marit Helene; Pedersen, Reidar

2017-05-15

Empirical evidence shows that family involvement (FI) can play a pivotal role in the coping and recovery of persons with severe mental illness (SMI). Nevertheless, various studies demonstrate that FI in mental healthcare services is often not (sufficiently) realized. In order to develop more insights, this scoping review gives an overview of how various stakeholders conceptualize, perceive and experience barriers to FI. Central questions are: 1) What are the main barriers to FI reported by the different key stakeholders (i.e. the persons with SMI, their families and the professionals, and 2) What are the differences and similarities between the various stakeholders' perspectives on these barriers. A systematic search into primary studies regarding FI was conducted in four databases: Medline/Pubmed, Cinahl, PsychInfo and Web of Knowledge with the use of a PICO scheme. Thematic analysis focused on stakeholder perspectives (i.e. which stakeholder group reports the barrier) and types of barriers (i.e. which types of barriers are addressed). Thirty three studies were included. The main barriers reported by the stakeholder groups reveal important similarities and differences between the stakeholder groups and were related to: 1) the person with SMI, 2) the family, 3) the professionals, 4) the organization of care and 5) the culture-paradigm. Our stakeholder approach elicits the different stakeholders' concepts, presuppositions and experiences of barriers to FI, and gives fundamental insights on how to deal with barriers to FI. The stakeholders differing interpretations and perceptions of the barriers related to FI is closely related to the inherent complexity involved in FI in itself. In order to deal better with these barriers, openly discussing and reflecting upon each other's normative understandings of barriers is needed. Differences in perceptions of barriers to FI can itself be a barrier. To deal with barriers to FI, a dialogical approach on how the different stakeholders perceive and value FI and its barriers is required. Methods such as moral case deliberation or systematic ethics reflections can be useful.

Shock wave attenuation by grids and orifice plates

NASA Astrophysics Data System (ADS)

Britan, A.; Igra, O.; Ben-Dor, G.; Shapiro, H.

2006-11-01

The interaction of weak shock waves with porous barriers of different geometries and porosities is examined. Installing a barrier inside the shock tube test section will cause the development of the following wave pattern upon a head-on collision between the incident shock wave and the barrier: a reflected shock from the barrier and a transmitted shock propagating towards the shock tube end wall. Once the transmitted shock wave reaches the end wall it is reflected back towards the barrier. This is the beginning of multiple reflections between the barrier and the end wall. This full cycle of shock reflections/interactions resulting from the incident shock wave collision with the barrier can be studied in a single shock tube test. A one-dimensional (1D), inviscid flow model was proposed for simulating the flow resulting from the initial collision of the incident shock wave with the barrier. Fairly good agreement is found between experimental findings and simulations based on a 1D flow model. Based on obtained numerical and experimental findings an optimal design procedure for shock wave attenuator is suggested. The suggested attenuator may ensure the safety of the shelter’s ventilation systems.

Only Above Barrier Energy Components Contribute to Barrier Traversal Time

NASA Astrophysics Data System (ADS)

Galapon, Eric A.

2012-04-01

A time of arrival operator across a square potential barrier is constructed. The expectation value of the barrier time of arrival operator for a sufficiently localized incident wave packet is compared with the expectation value of the free particle time of arrival operator for the same wave packet. The comparison yields an expression for the expected traversal time across the barrier. It is shown that only the above barrier components of the momentum distribution of the incident wave packet contribute to the barrier traversal time, implying that below the barrier components are transmitted without delay. This is consistent with the recent experiment in attosecond ionization in helium indicating that there is no real tunneling delay time [P. Eckle , Science 322, 1525 (2008)SCIEAS0036-807510.1126/science.1163439].

Comparing barrier algorithms

NASA Technical Reports Server (NTRS)

Arenstorf, Norbert S.; Jordan, Harry F.

1987-01-01

A barrier is a method for synchronizing a large number of concurrent computer processes. After considering some basic synchronization mechanisms, a collection of barrier algorithms with either linear or logarithmic depth are presented. A graphical model is described that profiles the execution of the barriers and other parallel programming constructs. This model shows how the interaction between the barrier algorithms and the work that they synchronize can impact their performance. One result is that logarithmic tree structured barriers show good performance when synchronizing fixed length work, while linear self-scheduled barriers show better performance when synchronizing fixed length work with an imbedded critical section. The linear barriers are better able to exploit the process skew associated with critical sections. Timing experiments, performed on an eighteen processor Flex/32 shared memory multiprocessor, that support these conclusions are detailed.

Patients' Perspectives on Factors that Influence Diabetes Self-Care.

PubMed

Shakibazadeh, E; Larijani, B; Shojaeezadeh, D; Rashidian, A; Forouzanfar, Mh; Bartholomew, Lk

2011-12-01

Although diabetes mellitus is of high concern in Iran, and the level of control is unacceptable, few qualitative studies have been carried out to reflect the experiences of patients on the barriers and motivators to self-care. This study aimed to explore a culturally based experience of Iranian diabetic patients regarding the personal and environmental barriers to and facilitating factors for diabetes self-care. Six focus groups were conducted among type 2 diabetic patients in the Charity Foundation for Special Diseases' diabetes clinic. Purposeful sampling was used. Newly diagnosed patients (less than six months) and all type 1 diabetic patients were excluded. Three focus groups were held on for each sex. A total of 43 patients participated in the study. Frame-work analysis was used to extract the themes from the data. DATA ANALYSIS SHOWED FIVE MAIN BARRIERS: physical barriers (such as physical effects of diabetes); psychological barriers (such as health beliefs); educational barriers (such as lack of knowledge about diabetes); social barriers (such as group pressure); and care system barriers (such as service availability). Along with the barriers, there were some motivators that the participants mentioned as a stimuli to control their diabetes. They include beliefs about diabetes, perceived responsibility for family, religious beliefs, and the views of significant others. Culturally based interventions are needed to improve diabetes care management in Iran. In addition to personal factors, diabetes health educators should pay attention to the environmental factors when they develop programs.

Infrastructure-Based Sensors Augmenting Efficient Autonomous Vehicle Operations: Preprint

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

Jun, Myungsoo; Markel, Anthony J

Autonomous vehicle technology development relies on an on-board network of fused sensor inputs for safe and efficient operation. The fused sensors offer multiple perspectives of similar information aiding in system decision robustness. The high cost of full systems on individual vehicles is seen as a potential barrier to broad adoption and achieving system energy efficiency gains. Since traffic in autonomous vehicle technology development relies on an on-board network of fused sensor inputs for safe and efficient operation. The fused sensors offer multiple perspectives of similar information aiding in system decision robustness. The high cost of full systems on individual vehiclesmore » is seen as a potential barrier to broad adoption and achieving system energy efficiency gains.« less

Identifying real and perceived barriers to therapeutic education programs for individuals with inflammatory arthritis.

PubMed

Bain, Lorna; Sangrar, Ruheena; Bornstein, Carolyn; Lukmanji, Sara; Hapuhennedige, Sandani; Thorne, Carter; Beattie, Karen A

2016-09-01

Therapeutic Education Programs (TEPs) grounded in self-management principles have been shown to improve quality of life of patients with chronic conditions and reduce patient-related healthcare costs. Though these programs are becoming more readily available, patients often experience barriers in participating. This study sought to identify barriers faced by inflammatory arthritis (IA) patients in attending a TEP and understand how patients overcame perceived barriers. A mixed-method study design was used. Questionnaires were distributed to individuals with IA who were invited to attend a TEP between 2010 and 2013. Respondents were those that chose not to attend (group A), individuals who attended ≤4 of 10 sessions (group B), individuals who attended ≥5 of 10 sessions prior to May 2013 (group C), and individuals who attended ≥5 of 10 sessions from June 2013 to November 2013 (group D). Individuals in group D were also invited to participate in focus groups to discuss how they had overcome perceived barriers. Real barriers identified by individuals in groups A and B included time, distance, and cost associated with attendance. Individuals who overcame perceived barriers (groups C and D) discussed strategies they used to do so. Aspects of the overall program experience and access to clinic and program also contributed to patients being able to overcome barriers. Time, distance, and cost are external barriers that prevented individuals from utilizing self-management education opportunities. These barriers were overcome if and when individuals had resources available to them. Readiness for behavior change also influenced commitment to participate in the program.

Barriers to Breastfeeding in Female Physicians.

PubMed

Cantu, Rebecca M; Gowen, Marie S; Tang, Xinyu; Mitchell, Kristin

2018-06-01

Breast milk is considered the normative nutrition for human infants, and exclusive breastfeeding for the first 6 months of life is recommended by several national and global societies. Female physicians are a high-risk group for early unintended weaning. We aimed to assess and compare the most common barriers to successful breastfeeding perceived by female physicians in various stages of training and practice. Female faculty physicians and trainees (medical students, resident physicians, and fellows) affiliated with a large medical university in 2016 were surveyed via an anonymous web-based survey distributed through institutional e-mail lists. The three-item survey assessed role, breastfeeding experience, and perceived barriers to successful breastfeeding. Comparisons between groups were performed using Wilcoxon rank-sum tests or Fisher's exact tests. The survey was distributed to 1,301 women with 223 responses included in analysis. The majority (57%) of respondents had never breastfed; of those, 87% reported plans to breastfeed in the future. Ninety-seven percent of women with breastfeeding experience reported at least one perceived barrier to successful breastfeeding. Trainees identified more barriers compared with faculty physicians (median count 5 versus 3, p = 0.014). No individual barrier reached statistical significance when comparing between faculty and trainees. The most frequently identified barriers to breastfeeding were lack of time and appropriate place to pump breast milk, unpredictable schedule, short maternity leave, and long working hours. Physicians and medical students who breastfeed face occupation-related barriers that could lead to early unintended weaning. Trainees and faculty report similar barriers. Institutional support may help improve some barriers to successful breastfeeding in female physicians.

Qualitative Investigation of Exercise Perceptions and Experiences in People With Multiple Sclerosis Before, During, and After Participation in a Personally Tailored Exercise Program.

PubMed

Crank, Helen; Carter, Anouska; Humphreys, Liam; Snowdon, Nicky; Daley, Amanda; Woodroofe, Nicola; Sharrack, Basil; Petty, Jane; Saxton, John M

2017-12-01

To undertake a qualitative investigation of exercise perceptions and experiences in people with multiple sclerosis (PwMS) before, during, and after participation in a personally tailored program designed to promote long-term maintenance of self-directed exercise. Focus groups and semistructured telephone interviews. University exercise science department close to the recruiting hospital. PwMS (N=33; mean age ± SD, 47.6±7.9y). Participants were recruited after participation in a randomized controlled exercise trial; all had been allocated to a 12-week exercise program comprising supervised and self-directed exercise sessions. Exercise perceptions and experiences before, during, and after participation in the program. Four themes emerged from the analysis: (1) the transition to inactivity; (2) lack of knowledge and confidence; (3) positive exercise experiences; and (4) perspectives on exercise adherence. Lack of confidence and exercise knowledge, coupled with negative perceptions about physical capabilities after an MS diagnosis, are clear barriers to exercise participation in PwMS. These issues are not being adequately addressed as part of the health care pathway or in community settings. Perceptions of improved posture, ability to overcome everyday difficulties, acute mood enhancements during and after exercise, and increased opportunities for social interaction were among the reported benefits of exercise participation. Despite the provision of a personally tailored exercise plan and use of cognitive behavioral strategies, self-directed exercise continued to present challenges to PwMS, and the importance of seeking cost-effective ways to maintain motivational support was implicit in participant responses. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Mentoring Undergraduate Students in Estuarine Research Experiences: Different Strokes for Different Folks

NASA Astrophysics Data System (ADS)

Moser, F. C.; Allen, M. R.; Montoya-Ospina, R. A.; Maldonado, P.; Barberena-Arias, M.; Olivo-Delgado, C.; Harris, L.; Pierson, J. J.; Alvarez, J. P.

2015-12-01

Here we consider how mentoring, both traditional and peer based, contributes to successful student outcomes in undergraduate research programs and we present several approaches to encourage positive mentor-mentee relationships. From several different research mentoring programs with undergraduates in Maryland and in Puerto Rico, we find that some mentoring techniques are universally useful, while others need to be tailored to a specific program and mentee population. Our programs differ in length, student composition, and student expectations, we find that success occurs across-the-board when mentors quickly establish rapport with their students and reach an early joint understanding of the program's requirements and the students' capabilities and needs through immersive orientations early in the program. Alternatively, mentors have to customize their approaches (e.g. simplify presentations of concepts, increase time for questions) when they encounter differences in student knowledge levels and cultural disconnects (e.g. language barriers, unfamiliarity with research labs and academia). Our current approach to improving and evaluating mentoring includes using a system of multiple mentor tiers (peer, near-peer, faculty, and program leaders), multiple qualitative and quantitative evaluations during the program, and post-research experience student outreach, all of which we believe improve student outcomes. Although we have measures of mentee success (e.g., presenting at national meetings, pursuing additional research experiences, applying to graduate school in marine science-related fields, etc.), we continue to look for additional short and long-term evaluation techniques that may help us to distinguish between the influence of mentoring and that of other program attributes (e.g. lab and field experiences, professional development seminars, ethics training, etc.) on student achievement.

Detour Behavior of Mice Trained with Transparent, Semitransparent and Opaque Barriers

PubMed Central

Juszczak, Grzegorz R.; Miller, Michal

2016-01-01

Detour tasks are commonly used to study problem solving skills and inhibitory control in canids and primates. However, there is no comparable detour test designed for rodents despite its significance for studying the development of executive skills. Furthermore, mice offer research opportunities that are not currently possible to achieve when primates are used. Therefore, the aim of the study was to translate the classic detour task to mice and to compare obtained data with key findings obtained previously in other mammals. The experiment was performed with V-shaped barriers and was based on the water escape paradigm. The study showed that an apparently simple task requiring mice to move around a small barrier constituted in fact a challenge that was strongly affected by the visibility of the target. The most difficult task involved a completely transparent barrier, which forced the mice to resolve a conflict between vision and tactile perception. The performance depended both on the inhibitory skills and on previous experiences. Additionally, all mice displayed a preference for one side of the barrier and most of them relied on the egocentric strategy. Obtained results show for the first time that the behavior of mice subjected to the detour task is comparable to the behavior of other mammals tested previously with free-standing barriers. This detailed characterization of the detour behavior of mice constitutes the first step toward the substitution of rodents for primates in laboratory experiments employing the detour task. PMID:27588753

The impact of financial barriers on access to care, quality of care and vascular morbidity among patients with diabetes and coronary heart disease.

PubMed

Parikh, Puja B; Yang, Jie; Leigh, Steven; Dorjee, Kunchok; Parikh, Roopali; Sakellarios, Nicholas; Meng, Hongdao; Brown, David L

2014-01-01

The prevalence and consequences of financial barriers to health care among patients with multiple chronic diseases are poorly understood. We sought to assess the prevalence of self-reported financial barriers to health care among individuals with diabetes and coronary heart disease (CHD) and to determine their association with access to care, quality of care and clinical outcomes. The 2007 Centers for Disease Control Behavioral Risk Factor Surveillance Survey. Diabetic patients with CHD. Financial barriers to health care were defined by a self-reported time in the past 12 months when the respondent needed to see a doctor but could not because of cost. The primary clinical outcome was vascular morbidity—a composite of stroke, retinopathy, nonhealing foot sores or bilateral foot amputations. Among the 11,274 diabetics with CHD, 1,541 (13.7 %) reported financial barriers to health care. Compared to individuals without financial barriers, those with financial barriers had significantly reduced rates of medical assessments within the past 2 years, hemoglobin (Hgb) A1C measurements in the past year, cholesterol measurements at any time, eye and foot examinations within the past year, diabetic education, antihypertensive treatment, aspirin use and a higher prevalence of vascular morbidity. In multivariable analyses, financial barriers to health care were independently associated with reduced odds of medical checkups (Odds Ratio [OR], 0.61; 95 % Confidence Intervals [CI], 0.55–0.67), Hgb A1C measurement (OR, 0.85; 95 % CI, 0.77–0.94), cholesterol measurement (OR, 0.76; 95 % CI, 0.67–0.86), eye (OR, 0.85; 95 % CI, 0.79–0.92) and foot (OR, 0.92; 95 % CI, 0.84–1.00) examinations, diabetic education (OR, 0.93; 95 % CI, 0.87–0.99), aspirin use (OR, 0.88; 95 % CI, 0.81–0.96) and increased odds of vascular morbidity (OR, 1.23; 95 % CI, 1.14–1.33). In diabetic adults with CHD, financial barriers to health care were associated with impaired access to medical care, inferior quality of care and greater vascular morbidity. Eliminating financial barriers and adherence to guideline-based recommendations may improve the health of individuals with multiple chronic diseases.

Thermal dissociation and relaxation in vinyl fluoride, 1,1-difluoroethane and 1,3,5-triazine

NASA Astrophysics Data System (ADS)

Xu, Hui

This study reports measurements of the thermal dissociation of 1,1-difluoroethane in the shock tube. The experiments employ laser schlieren measurements of rate for the dominant HF elimination using 10% 1,1-difluoroethane in Kr over 1500--2000 K and 43 < P < 424 torr. The product vinyl then dissociates affecting the late density gradient. We include a laser schlieren study (1717--2332 K, 75 < P < 482 torr in 10% and 4% vinyl fluoride in Kr) of this dissociation. This latter work also includes a set of experiments using shock-tube time-of-flight mass-spectrometry (4% vinyl fluoride in neon, 1500--1980 K, 500 < P < 1300 torr), which confirm the theoretical expectation that the only reaction in vinyl fluoride is HF elimination. The relaxation experiments (1--20% C2H3F in Kr, 415--1975 K, 5 < P < 50 torr, and 2% and 5% C2H4F2 in Kr, 700--1350 K, 6 < P < 22 torr) exhibit very rapid relaxation, and incubation delays should be negligible in dissociation. A RRKM model of dissociation in 1,1-difluoroethane based on a G3B3 calculation of barrier and other properties fits the experiments but requires a very large down of 1600cm-1 . Dissociation of vinyl fluoride has two parallel HF eliminations both three-center and four-center with nearly equal barriers. An RRKM fit to the observed falloff again requires an unusually large down and the experiments actually support a slightly reduced barrier. Both 1,3,5-triazine and pyrazine relax extremely rapidly with energy transfer in a few collisions, any incubation delay can be confidently discounted in dissociation. 1,3,5-triazine dissociation experiments show fall-off with a clear pressure dependence. The three body product dissociation mechanism models this dissociation perfectly. Experimental data agree well with an RRKM calculation using a down of 1200cm-1 and a barrier E0 = 84.66 kcal/mol. Dyakov et al. suggested lower barrier of E0 = 81 kcal/mole. The new RRKM calculation using this barrier seems a better fit to the experiments. The falloff is now fit well with a down of the more usual form 126(T/298) 0-9 cm-1.

Barriers and Solutions to Fieldwork Education in Hand Therapy.

PubMed

Short, Nathan; Sample, Shelby; Murphy, Malachi; Austin, Brittany; Glass, Jillian

2017-08-09

Survey. Fieldwork education is a vital component of training the next generation of CHTs. Barriers and solutions to fieldwork rotations in hand therapy are examined, as well as proposed solutions, including recommendations for student preparation. This descriptive study examined barriers for certified hand therapist clinicians to accept students for clinical rotations and clinicians' preferences for student preparation before a rotation in a hand setting. A survey was developed, peer reviewed, and distributed using the electronic mailing list of the Hand Therapy Certification Commission via SurveyMonkey. Aggregate responses were analyzed to identify trends including barriers to student clinical rotations and recommendations for students to prepare for hand rotations. A total of 2080 participants responded to the survey, representing a 37% response rate. Common logistical barriers were identified for accepting students such as limited clinical time and space. Many clinicians (32% agree and 8% strongly agree) also felt that the students lack the clinical knowledge to be successful. Areas of knowledge, skill set, and experience were surveyed for development before a clinical rotation in a hand setting. Most respondents (74%) reported increased likelihood of accepting a student with the recommended preparation. Novel qualitative responses to improve clinical experiences are presented as well. Student preparation before a clinical rotation in a hand setting appears to be a significant barrier based on the survey results. Areas of recommended knowledge, skill set, and experience may serve to guide both formal and informal methods of student preparation before a hand-specific clinical rotation to facilitate knowledge translation from experienced certified hand therapists to the next generation. Although logistical barriers may be difficult to overcome, hand-specific preparation based on clinician' recommendations may facilitate student acceptance and success in hand specialty clinical rotations. N/A. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

[Barriers and motivations of nurses for conducting research in Intensive Care Units and Emergency Medical Service].

PubMed

Llauradó-Serra, M; Güell-Baró, R; Castanera-Duro, A; Sandalinas, I; Argilaga, E; Fortes-Del Valle, M L; Jiménez-Herrera, M F; Bordonado-Pérez, L; Fuentes-Pumarola, C

The implementation of evidence based practice is essential in clinical practice. However, it is still a challenge in critical care patients. To identify the barriers for conducting research that nursing professionals perceive in intensive care and medical emergency departments, as well as to investigate the areas of interest and motivations to carry out research projects. Cross-sectional and multicentre study carried out in 4 intensive care units and in one Medical Emergency Department emergency pre-hospital carein Catalonia on 2014. The instrument used was The Barriers to Research Utilization Scale which had been previously validated into Spanish. A descriptive and bivariate analysis was performed. A statistical significance of P<.05 was assumed. One hundred seventy-two questionnaires were obtained (69.9% response). Of the total, 135 were from critical care, 27 to pre-hospital care, and 10 from both. Just over half (57.3%) had research experience, although 44.4% had related training. The questionnaire dimension considered most relevant was organisational characteristics. The most important barriers were: there is not enough time at work [3.11 (SD 1.21)], physicians do not collaborate in its implementation [2.99 (SD 1.22)], and nurses are isolated with respect to other professionals [2.86 (SD 1.32)]. Significant differences were observed in the barriers according to research experience and work place. The main motivation was to be updated in critical patient care. The main barriers perceived are related to the organisation. There are differences in the barriers according to research experience and work place. Copyright © 2016 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

Strategies for Disseminating Information on Biomedical Research on Autism to Hispanic Parents

PubMed Central

Lajonchere, Clara M.; Wheeler, Barbara Y.; Valente, Thomas W.; Kreutzer, Cary; Munson, Aron; Narayanan, Shrikanth; Kazemzadeh, Abe; Cruz, Roxana; Martinez, Irene; Schrager, Sheree M.; Schweitzer, Lisa; Chklovski, Tara; Hwang, Darryl

2015-01-01

Low income Hispanic families experience multiple barriers to accessing evidence-based information on Autism Spectrum Disorders (ASD). This study utilized a mixed-strategy intervention to create access to information in published bio-medical research articles on ASD by distilling the content into parent-friendly English- and Spanish-language ASD Science Briefs and presenting them to participants using two socially-oriented dissemination methods. There was a main effect for short-term knowledge gains associated with the Science Briefs but no effect for the dissemination method. After 5 months, participants reported utilizing the information learned and 90% wanted to read more Science Briefs. These preliminary findings highlight the potential benefits of distilling biomedical research articles on ASD into parent-friendly educational products for currently underserved Hispanic parents. PMID:26563948

Thermal barrier coating experience in the gas turbine engine

NASA Technical Reports Server (NTRS)

Bose, S.; Demasi-Marcin, J.

1995-01-01

Thermal Barrier Coatings (TBC), provide thermal insulation and oxidation resistance in an environment consisting of hot combustion gases. TBC's consist of a two layer system. The outer ceramic layer provides good thermal insulation due to the low thermal conductivity of the ceramic coatings used, while the inner metallic bond coat layer provides needed oxidation resistance to the underlying superalloy. Pratt & Whitney has over a decade of experience with several generations of TBC systems on turbine airfoils. This paper will focus on the latest TBC field experience along with a proposed durability model.

Safety-relevant hydrogeological properties of the claystone barrier of a Swiss radioactive waste repository: An evaluation using multiple lines of evidence

NASA Astrophysics Data System (ADS)

Gautschi, Andreas

2017-09-01

In Switzerland, the Opalinus Clay - a Jurassic (Aalenian) claystone formation - has been proposed as the first-priority host rock for a deep geological repository for both low- and intermediate-level and high-level radioactive wastes. An extensive site and host rock investigation programme has been carried out during the past 30 years in Northern Switzerland, comprising extensive 2D and 3D seismic surveys, a series of deep boreholes within and around potential geological siting regions, experiments in the international Mont Terri Rock Laboratory, compilations of data from Opalinus Clay in railway and motorway tunnels and comparisons with similar rocks. The hydrogeological properties of the Opalinus Clay that are relevant from the viewpoint of long-term safety are described and illustrated. The main conclusions are supported by multiple lines of evidence, demonstrating consistency of conclusions based on hydraulic properties, porewater chemistry, distribution of natural tracers across the Opalinus Clay as well as small- and large-scale diffusion models and the derived conceptual understanding of solute transport.

Relationships, Being-ness, and Voice: Exploring Multiple Dimensions of Humanizing Work with Black Girls

ERIC Educational Resources Information Center

Edwards, Erica; McArthur, Sherell A.; Russell-Owens, LaToya

2016-01-01

This work argues for an approach to research and education practices that considers the historically deficit-based research practices and views on Black girls and develops humanizing research methods that consider the multiple oppressions that act as barriers for this group. Research must acknowledge the precarious position of Black girls in order…

Epstein Barr Virus and Blood Brain Barrier in Multiple Sclerosis

DTIC Science & Technology

2014-01-01

ABSTRACT Multiple sclerosis (MS) is a chronic, autoimmune neurodegenerative disease . Epstein - Barr virus (EBV) infection is associated with MS...factors such as Epstein - Barr virus (EBV) infections. EBV is a herpesvirus that infects many cell types and associated with other autoimmune diseases . The...AD_________________ Award Number: W81XWH-12-1-0225 TITLE: Epstein Barr virus and

Managing in the Contemporary World: Rape Victims' and Supporters' Experiences of Barriers within the Police and the Health Care System in Tanzania

ERIC Educational Resources Information Center

Muganyizi, Projestine S.; Nystrom, Lennarth; Axemo, Pia; Emmelin, Maria

2011-01-01

Grounded theory guided the analysis of 30 in-depth interviews with raped women and community members who had supported raped women in their contact with the police and health care services in Tanzania. The aim of this study was to understand and conceptualize the experiences of the informants by creating a theoretical model focusing on barriers,…

Determination of the Rotational Barrier for Kinetically Stable Conformational Isomers via NMR and 2D TLC: An Introductory Organic Chemistry Experiment

ERIC Educational Resources Information Center

Rushton, Gregory T.; Burns, William G.; Lavin, Judi M.; Chong, Yong S.; Pellechia, Perry; Shimizu, Ken D.

2007-01-01

An experiment to determine the rotational barrier about a C[subscript aryl]-N[subscript imide] single bond that is suitable for first-semester organic chemistry students is presented. The investigation begins with the one-step synthesis of a N,N'-diaryl naphthalene diimide, which exists as two room temperature-stable atropisomers (syn and anti).…

Conducting a Multisite Education Research Project: Strategies to Overcome the Barriers to Achieve the Benefits.

PubMed

Beischel, Kelly P; Hart, Julie; Turkelson, Sandra L

2016-01-01

Multisite education research projects have many benefits as well as perceived barriers. In this article, we share our experiences with a multisite education research project and the barriers we overcame to reap the benefits. The outcome of our research resulted in increased rigor, role-modeling professional collaboration, and promotion of future multisite education studies. The strategies presented in this article will help alleviate perceived barriers and ameliorate the process of conducting multisite education research studies.

Barriers to learning from reflection: a study of the use of groupwork with post-registration nurses.

PubMed

Platzer, H; Blake, D; Ashford, D

2000-05-01

There are few studies which describe the use of groups to facilitate reflection and even fewer which evaluate the effectiveness of such groups. Much of the literature discussing the techniques used to facilitate reflection suggests that learners willingly engage in such processes and find them enjoyable. This paper reports on a qualitative study of the use of groups to develop learning through reflection on a part-time post-registration diploma programme for nurses. The findings suggest that there are many barriers to learning which must be overcome before practitioners can use the opportunities to reflect on and learn from their experience. It is also contended that such learning may not necessarily be an enjoyable experience. The findings suggest that previous educational experience and the current culture in which nurses and midwives work, impose tremendous barriers to reflecting on, and learning from, experience. In particular these affect the willingness of learners to expose themselves to the judgement of others and their ability to be open to taking responsibility for their own learning. Other barriers to learning in groups are the effects of other group members, their commitment or resistance to shared learning, the ways in which group members interact with each other and facilitation styles.

Caution, Student Experience May Vary: Social Identities Impact a Student’s Experience in Peer Discussions

PubMed Central

Eddy, Sarah L.; Brownell, Sara E.; Thummaphan, Phonraphee; Lan, Ming-Chih; Wenderoth, Mary Pat

2015-01-01

In response to calls for implementing active learning in college-level science, technology, engineering, and mathematics courses, classrooms across the country are being transformed from instructor centered to student centered. In these active-learning classrooms, the dynamics among students becomes increasingly important for understanding student experiences. In this study, we focus on the role a student prefers to assume during peer discussions, and how this preferred role may vary given a student’s social identities. In addition we explore whether three hypothesized barriers to participation may help explain participation difference in the classroom. These barriers are 1) students are excluded from the discussion by actions of their groupmates; 2) students are anxious about participating in peer discussion; and 3) students do not see value in peer discussions. Our results indicate that self-reported preferred roles in peer discussions can be predicted by student gender, race/ethnicity, and nationality. In addition, we found evidence for all three barriers, although some barriers were more salient for certain students than others. We encourage instructors to consider structuring their in-class activities in ways that promote equity, which may require more purposeful attention to alleviating the current differential student experiences with peer discussions. PMID:26628561

'As many options as there are, there are just not enough for me': contraceptive use and barriers to access among Australian women.

PubMed

Dixon, Suzanne C; Herbert, Danielle L; Loxton, Deborah; Lucke, Jayne C

2014-10-01

A comprehensive life course perspective of women's experiences in obtaining and using contraception in Australia is lacking. This paper explores free-text comments about contraception provided by women born between 1973 and 1978 who participated in the Australian Longitudinal Study on Women's Health (ALSWH). The ALSWH is a national population-based cohort study involving over 40,000 women from three age groups, who are surveyed every three years. An initial search identified 1600 comments from 690 women across five surveys from 1996 (when they were aged 18-23 years) to 2009 (31-36 years). The analysis included 305 comments from 289 participants. Factors relating to experiences of barriers to access and optimal contraceptive use were identified and explored using thematic analysis. Five themes recurred across the five surveys as women aged: (i) side effects affecting physical and mental health; (ii) lack of information about contraception; (iii) negative experiences with health services; (iv) contraceptive failure; and (v) difficulty with accessing contraception. Side effects of hormonal contraception and concerns about contraceptive failure influence women's mental and physical health. Many barriers to effective contraception persist throughout women's reproductive lives. Further research is needed into reducing barriers and minimising negative experiences, to ensure optimal contraceptive access for Australian women.

Migration Experiences of Foreign Educated Nurses: A Systematic Review of the Literature.

PubMed

Moyce, Sally; Lash, Rebecca; de Leon Siantz, Mary Lou

2016-03-01

Global nurse migration has a recognized impact on host and source countries, but the lived experience of foreign educated nurses is an important aspect of the success of this migration. A systematic review of the literature was conducted to understand the lived migration and acculturation experiences of foreign educated nurses. A systematic review of the literature, based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was conducted. Primary research articles or secondary analyses were selected based on keyword and citation-based searches (n = 44). Nurses' experiences included migration and licensing barriers, difficulty with communication, racism and discrimination, skill underutilization, acculturation, and the role of the family. Barriers encountered in host countries may impede acculturation and successful nursing practice, resulting in circular migration and poor patient safety outcomes. Social support systems and cultural orientation programs can mitigate the impacts of social isolation and racism. Addressing common barriers can help minimize deskilling and allow safe and effective transitions to host countries. © The Author(s) 2015.

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

PubMed Central

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

2017-01-01

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

Two pathways through adversity: Predicting well-being and housing outcomes among homeless service users.

PubMed

Walter, Zoe C; Jetten, Jolanda; Dingle, Genevieve A; Parsell, Cameron; Johnstone, Melissa

2016-06-01

People who experience homelessness face many challenges and disadvantages that negatively impact health and well-being and form barriers to achieving stable housing. Further, people who are homeless often have limited social connections and support. Building on previous research that has shown the beneficial effect of group identification on health and well-being, the current study explores the relationship between two social identity processes - multiple group memberships and service identification - and well-being and positive housing outcomes. Measures were collected from 76 participants while they were residing in a homeless accommodation service (T1) and again 2-4 weeks after leaving the service (or 3 months after T1 if participants had not left the service). Mediation analyses revealed that multiple group memberships and service identification at T1 independently predicted well-being at T2 indirectly, via social support. Further, both social identity processes also indirectly predicted housing outcomes via social support. The implications of these findings are twofold. First, while belonging to multiple social groups may provide a pathway to gaining social support and well-being, group belonging may not necessarily be beneficial to achieve stable housing. Second, fostering identification with homeless services may be particularly important as a source of support that contributes to well-being. © 2015 The British Psychological Society.

An Integrative Review of Factors Associated with Patient Attrition from Community Health Worker Programs that Support Diabetes Self-Care.

PubMed

Merius, Heidy N; Rohan, Annie J

2017-01-01

An integrative review was conducted using PubMed and CINAHL databases to answer: What is known about adult attrition from community health worker (CHW) programs on diabetes self-care? The 14 articles described patients of multiple races who were mainly of lower socioeconomic status. CHW interventions were given in individual meetings and/or group sessions. Incentives to reduce attrition came in different forms. Barriers involved transportation, family obligations, and scheduling conflicts. Attrition from these programs is a multifactorial problem. Alleviating transportation barrier appears to be protective. Program planners should consider these barriers when planning CHW programs.

Work Barriers Experienced and Job Accommodations Used by Persons with Arthritis and Other Rheumatic Diseases.

ERIC Educational Resources Information Center

Allaire, Saralynn H.; Li, Wei; LaValley, Michael P.

2003-01-01

Many people with arthritis become work disabled, but little is known about the types of work barriers they experience and their use of job accommodations. This article describes work barriers and use of accommodations and examines factors associated with accommodation use in persons with arthritis at risk for work disability. (Contains 30…

Exploring barriers to primary care for migrants in Greece in times of austerity: Perspectives of service providers

PubMed Central

Papadakaki, Maria; Lionis, Christos; Saridaki, Aristoula; Dowrick, Christopher; de Brún, Tomas; O’Reilly-de Brún, Mary; O’Donnell, Catherine A; Burns, Nicola; van Weel-Baumgarten, Evelyn; van den Muijsenbergh, Maria; Spiegel, Wolfgang; MacFarlane, Anne

2017-01-01

Abstract Background: Migration in Europe is increasing at an unprecedented rate. There is an urgent need to develop ‘migrant-sensitive healthcare systems’. However, there are many barriers to healthcare for migrants. Despite Greece’s recent, significant experiences of inward migration during a period of economic austerity, little is known about Greek primary care service providers’ experiences of delivering care to migrants. Objectives: To identify service providers’ views on the barriers to migrant healthcare. Methods: Qualitative study involving six participatory learning and action (PLA) focus group sessions with nine service providers. Data generation was informed by normalization process theory (NPT). Thematic analysis was applied to identify barriers to efficient migrant healthcare. Results: Three main provider and system-related barriers emerged: (a) emphasis on major challenges in healthcare provision, (b) low perceived control and effectiveness to support migrant healthcare, and (c) attention to impoverished local population. Conclusion: The study identified major provider and system-related barriers in the provision of primary healthcare to migrants. It is important for the healthcare system in Greece to provide appropriate supports for communication in cross-cultural consultations for its diversifying population. PMID:28388310

Transition From Clinical to Educator Roles in Nursing: An Integrative Review.

PubMed

Fritz, Elizabeth

This review identified barriers to and facilitators of nurses' transition from clinical positions into nursing professional development and other nurse educator roles. The author conducted literature searches using multiple databases. Twenty-one articles met search criteria, representing a variety of practice settings. The findings, both barriers and facilitators, were remarkably consistent across practice settings. Four practice recommendations were drawn from the literature to promote nurses' successful transition to nursing professional development roles.

Photovoltaic driven multiple quantum well optical modulator

NASA Technical Reports Server (NTRS)

Maserjian, Joseph (Inventor)

1990-01-01

Multiple quantum well (MQW) structures (12) are utilized to provide real-time, reliable, high-performance, optically-addressed spatial-light modulators (SLM) (10). The optically-addressed SLM comprises a vertical stack of quantum well layers (12a) within the penetration depth of an optical write signal 18, a plurality of space charge barriers (12b) having predetermined tunneling times by control of doping and thickness. The material comprising the quantum well layers has a lower bandgap than that of the space charge barrier layers. The write signal modulates a read signal (20). The modulation sensitivity of the device is high and no external voltage source is required. In a preferred embodiment, the SLM having interleaved doped semiconductor layers for driving the MQW photovoltaically is characterized by the use of a shift analogous to the Moss-Burnstein shift caused by the filling of two-dimensional states in the multiple quantum wells, thus allowing high modulation sensitivity in very narrow wells. Arrays (30) may be formed with a plurality of the modulators.

Multiple capillary biochemical analyzer with barrier member

DOEpatents

Dovichi, N.J.; Zhang, J.Z.

1996-10-22

A multiple capillary biochemical analyzer is disclosed for sequencing DNA and performing other analyses, in which a set of capillaries extends from wells in a microtiter plate into a cuvette. In the cuvette the capillaries are held on fixed closely spaced centers by passing through a sandwich construction having a pair of metal shims which squeeze between them a rubber gasket, forming a leak proof seal for an interior chamber in which the capillary ends are positioned. Sheath fluid enters the chamber and entrains filament sample streams from the capillaries. The filament sample streams, and sheath fluid, flow through aligned holes in a barrier member spaced close to the capillary ends, into a collection chamber having a lower glass window. The filament streams are illuminated above the barrier member by a laser, causing them to fluoresce. The fluorescence is viewed end-on by a CCD camera chip located below the glass window. The arrangement ensures an equal optical path length from all fluorescing spots to the CCD chip and also blocks scattered fluorescence illumination, providing more uniform results and an improved signal-to-noise ratio. 12 figs.

Multiple capillary biochemical analyzer with barrier member

DOEpatents

Dovichi, Norman J.; Zhang, Jian Z.

1996-01-01

A multiple capillary biochemical analyzer for sequencing DNA and performing other analyses, in which a set of capillaries extends from wells in a microtiter plate into a cuvette. In the cuvette the capillaries are held on fixed closely spaced centers by passing through a sandwich construction having a pair of metal shims which squeeze between them a rubber gasket, forming a leak proof seal for an interior chamber in which the capillary ends are positioned. Sheath fluid enters the chamber and entrains filament sample streams from the capillaries. The filament sample streams, and sheath fluid, flow through aligned holes in a barrier member spaced close to the capillary ends, into a collection chamber having a lower glass window. The filament streams are illuminated above the barrier member by a laser, causing them to fluoresce. The fluorescence is viewed end-on by a CCD camera chip located below the glass window. The arrangement ensures an equal optical path length from all fluorescing spots to the CCD chip and also blocks scattered fluorescence illumination, providing more uniform results and an improved signal to noise ratio.

Reasons People Surrender Unowned and Owned Cats to Australian Animal Shelters and Barriers to Assuming Ownership of Unowned Cats.

PubMed

Zito, Sarah; Morton, John; Vankan, Dianne; Paterson, Mandy; Bennett, Pauleen C; Rand, Jacquie; Phillips, Clive J C

2016-01-01

Most cats surrendered to nonhuman animal shelters are identified as unowned, and the surrender reason for these cats is usually simply recorded as "stray." A cross-sectional study was conducted with people surrendering cats to 4 Australian animal shelters. Surrenderers of unowned cats commonly gave surrender reasons relating to concern for the cat and his/her welfare. Seventeen percent of noncaregivers had considered adopting the cat. Barriers to assuming ownership most commonly related to responsible ownership concerns. Unwanted kittens commonly contributed to the decision to surrender for both caregivers and noncaregivers. Nonowners gave more surrender reasons than owners, although many owners also gave multiple surrender reasons. These findings highlight the multifactorial nature of the decision-making process leading to surrender and demonstrate that recording only one reason for surrender does not capture the complexity of the surrender decision. Collecting information about multiple reasons for surrender, particularly reasons for surrender of unowned cats and barriers to assuming ownership, could help to develop strategies to reduce the number of cats surrendered.

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

Bridges or Barriers? Conceptualization of the Role of Multiple Identity Gateway Groups in Intergroup Relations.

PubMed

Levy, Aharon; Saguy, Tamar; Halperin, Eran; van Zomeren, Martijn

2017-01-01

The modern era of globalization has been accompanied by a massive growth in interconnections between groups, and has led to the sharing of multiple identities by individuals and groups. Following these developments, research has focused on the issue of multiple identities, and has shed important light on how individuals who hold these complex forms of identity feel and behave, and on the reactions they elicit from members of other groups. However, the potential of groups with such multiple identities (e.g., biracials, immigrants, etc.) to affect the intergroup relations between the groups that represent the respective sources of the different identities (e.g., Blacks and Whites, country of origin and country of residence, etc.) has not been examined to date. Accordingly, in this paper, we first systematically explore the potential of groups in which people identify with multiple social categories, or groups that are perceived as such by others, to play a role in intergroup dynamics. Next, we offer a theoretical framework outlining what functions groups of people with shared multiple identities may serve (as bridges or barriers ) by proposing how their presence may facilitate or deteriorate intergroup relations. Finally, we present recent empirical research examining how groups of people with shared multiple identities can act as gateways and bridge the cleft between two separate groups that represent the respective sources of their different identities, and discuss the theoretical and practical implications for the field of intergroup relations.

Bridges or Barriers? Conceptualization of the Role of Multiple Identity Gateway Groups in Intergroup Relations

PubMed Central

Levy, Aharon; Saguy, Tamar; Halperin, Eran; van Zomeren, Martijn

2017-01-01

The modern era of globalization has been accompanied by a massive growth in interconnections between groups, and has led to the sharing of multiple identities by individuals and groups. Following these developments, research has focused on the issue of multiple identities, and has shed important light on how individuals who hold these complex forms of identity feel and behave, and on the reactions they elicit from members of other groups. However, the potential of groups with such multiple identities (e.g., biracials, immigrants, etc.) to affect the intergroup relations between the groups that represent the respective sources of the different identities (e.g., Blacks and Whites, country of origin and country of residence, etc.) has not been examined to date. Accordingly, in this paper, we first systematically explore the potential of groups in which people identify with multiple social categories, or groups that are perceived as such by others, to play a role in intergroup dynamics. Next, we offer a theoretical framework outlining what functions groups of people with shared multiple identities may serve (as bridges or barriers) by proposing how their presence may facilitate or deteriorate intergroup relations. Finally, we present recent empirical research examining how groups of people with shared multiple identities can act as gateways and bridge the cleft between two separate groups that represent the respective sources of their different identities, and discuss the theoretical and practical implications for the field of intergroup relations. PMID:28706501

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

NASA Astrophysics Data System (ADS)

Atta, Debasis; Basu, D. N.

2014-12-01

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

Transcritical flow of a Bose-Einstein condensate through a penetrable barrier

NASA Astrophysics Data System (ADS)

Leszczyszyn, A. M.; El, G. A.; Gladush, Yu. G.; Kamchatnov, A. M.

2009-06-01

The problem of the transcritical flow of a Bose-Einstein condensate through a wide repulsive penetrable barrier is studied analytically using the combination of the locally steady “hydraulic” solution of the one-dimensional Gross-Pitaevskii equation and the solutions of the Whitham modulation equations describing the resolution of the upstream and downstream discontinuities through dispersive shocks. It is shown that within the physically reasonable range of parameters, the downstream dispersive shock is attached to the barrier and effectively represents the train of very slow dark solitons, which can be observed in experiments. The rate of the soliton emission, the amplitudes of the solitons in the train, and the drag force are determined in terms of the Bose-Einstein condensate oncoming flow velocity and the strength of the potential barrier. Good agreement with direct numerical solutions is demonstrated. Connection with recent experiments is discussed.

Exploring experiences, barriers, and enablers to home- and class-based exercise in rotator cuff tendinopathy: A qualitative study.

PubMed

Sandford, Fiona M; Sanders, Thomas A B; Lewis, Jeremy S

Qualitative study. Adherence is paramount to the successful outcome of exercise-based treatment. The barriers and enablers to adherence to a home- and class-based exercise program were explored in this qualitative study. Semi-structured interviews were carried out to establish common themes relating to the participants' experiences during a year-long randomized controlled trial. Twelve participants were interviewed. The main enablers to exercise were highlighted as equipment, perceived benefit from the exercises, and longer and more intensive monitoring. Barriers included the lack of motivation, lack of equipment, and pain. Implications for practice are incorporating enablers and addressing barriers including self-discharge from classes; the importance of longer term follow-up and the benefits of adopting exercise into a well-established routine may provide potential benefits. N/A. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Healthcare Experiences of Low-Income Women with Prior Gestational Diabetes.

PubMed

Oza-Frank, Reena; Conrey, Elizabeth; Bouchard, Jo; Shellhaas, Cynthia; Weber, Mary Beth

2018-07-01

Introduction An important yet understudied component of postpartum type 2 diabetes risk reduction among high risk women is experiences with the healthcare system. Our objective was to describe the healthcare experiences of a diverse, low-income sample of women with prior GDM, including their suggestions for improving care. Methods Focus groups were conducted among African American, Hispanic, and Appalachian women who were diagnosed with GDM within the past 10 years. Participants were recruited from community and medical resources. Twelve focus groups were conducted, four within each race-ethnic group. Results Three broad themes were identified around barriers to GDM care, management, and follow-up: (1) communication issues; (2) personal and environmental barriers; and (3) type and quality of healthcare. Many women felt communication with their provider could be improved, including more education on the severity of GDM, streamlining information to be less overwhelming, and providing additional support through referrals to community resources. Although women expressed interest in receiving more actionable advice for managing GDM during pregnancy and for preventing type 2 diabetes postpartum, few women reported changing behaviors. Barriers to behavior change were related to cost, transportation, and competing demands. Several opportunities for improved care were elucidated. Discussion Our findings suggest that across all racial and ethnic representations in our sample, low-income women with GDM experience similar communication, personal, and environmental barriers related to the healthcare they receive for their GDM. Considering the increased exposure to the health care system during a GDM-affected pregnancy, there are opportunities to address barriers among women with GDM across different race-ethnic groups.

Consequences, control and appraisal: cues and barriers to engaging in self-management among people affected by colorectal cancer - a secondary analysis of qualitative data.

PubMed

Kidd, Lisa A

2014-08-01

Little is known about peoples' self-management experiences and their desires or expectations to engage in self-management. As such, there is little understanding about individuals' perceived cues and barriers to engagement in self-management, particularly in people affected by cancer. To understand cues and barriers to people's engagement in self-management during chemotherapy treatment for colorectal cancer. Secondary analysis of qualitative data from mixed methods, longitudinal study. Eleven participants undergoing treatment for colorectal cancer. Semi-structured interviews were conducted twice with each participant, at the start and end of a 6-month course of chemotherapy treatment in a Scottish cancer centre. Cues and barriers to engagement in self-management appeared to stem from perceptions of the impact and associated severity of side effects experiences as well as the perceptions about the efficacy of chosen self-management activities and perceptions of control in minimizing the consequences of cancer treatment. Severe, episodic or unexpected side effects coupled with perceptions of uncertainty, lack of control and lack of adequate preparation to engage in self-management were identified as key barriers to engagement. Participants' reflection on, or appraisal of, their treatment-related experiences and personal abilities, confidence and preferences to manage the impact of these shaped their subsequent engagement in self-management. The findings highlight the importance of understanding individual's self-management experiences, perceptions, preferences, priorities and needs to help support, prepare and enable them to feel capable and confident to engage actively and effectively in self-management. © 2012 John Wiley & Sons Ltd.

Doing battle with "the monster:" how high-risk heterosexuals experience and successfully manage HIV stigma as a barrier to HIV testing.

PubMed

Gwadz, Marya; Leonard, Noelle R; Honig, Sylvie; Freeman, Robert; Kutnick, Alexandra; Ritchie, Amanda S

2018-04-20

Annual HIV testing is recommended for populations at-risk for HIV in the United States, including heterosexuals geographically connected to urban high-risk areas (HRA) with elevated rates of HIV prevalence and poverty, who are primarily African American/Black or Hispanic. Yet this subpopulation of "individuals residing in HRA" (IR-HRA) evidence low rates of regular HIV testing. HIV stigma is a recognized primary barrier to testing, in part due to its interaction with other stigmatized social identities. Guided by social-cognitive and intersectionality theories, this qualitative descriptive study explored stigma as a barrier to HIV testing and identified ways IR-HRA manage stigma. In 2012-2014, we conducted in-depth qualitative interviews with 31 adult IR-HRA (74% male, 84% African American/Black) with unknown or negative HIV status, purposively sampled from a larger study for maximum variation on HIV testing experiences. Interviews were audio-recorded and professionally transcribed verbatim. Data were analyzed using a systematic content analysis approach that was both theory-driven and inductive. Stigma was a primary barrier to HIV testing among IR-HRA. In the context of an under-resourced community, HIV stigma was experienced as emerging from, and being perpetuated by, health care organizations and educational institutions, as well as community members. Participants noted it was "better not to know" one's HIV status, to avoid experiencing HIV-related stigma, which could interact with other stigmatized social identities and threaten vital social relationships, life chances, and resources. Yet most had tested for HIV previously. Factors facilitating testing included health education to boost knowledge of effective treatments for HIV; understanding HIV does not necessitate ending social relationships; and tapping into altruism. In the context of economic and social inequality, HIV stigma operates on multiple, intersecting layers. IR-HRA struggle with an aversion to HIV testing, because adopting another stigmatized status is dangerous. They also find ways to manage stigma to engage in testing, even if not at recommended levels. Findings highlight strategies to reduce HIV stigma at the levels of communities, institutions, and individuals to improve rates of annual HIV testing necessary to eliminate HIV transmission and reduce HIV-related racial and ethnic health disparities among IR-HRA.

Mechanism for detecting NAPL using electrical resistivity imaging.

PubMed

Halihan, Todd; Sefa, Valina; Sale, Tom; Lyverse, Mark

2017-10-01

The detection of non-aqueous phase liquid (NAPL) related impacts in freshwater environments by electrical resistivity imaging (ERI) has been clearly demonstrated in field conditions, but the mechanism generating the resistive signature is poorly understood. An electrical barrier mechanism which allows for detecting NAPLs with ERI is tested by developing a theoretical basis for the mechanism, testing the mechanism in a two-dimensional sand tank with ERI, and performing forward modeling of the laboratory experiment. The NAPL barrier theory assumes at low bulk soil NAPL concentrations, thin saturated NAPL barriers can block pore throats and generate a detectable electrically resistive signal. The sand tank experiment utilized a photographic technique to quantify petroleum saturation, and to help determine whether ERI can detect and quantify NAPL across the water table. This experiment demonstrates electrical imaging methods can detect small quantities of NAPL of sufficient thickness in formations. The bulk volume of NAPL is not the controlling variable for the amount of resistivity signal generated. The resistivity signal is primarily due to a zone of high resistivity separate phase liquid blocking current flow through the fully NAPL saturated pores spaces. For the conditions in this tank experiment, NAPL thicknesses of 3.3cm and higher in the formation was the threshold for detectable changes in resistivity of 3% and greater. The maximum change in resistivity due to the presence of NAPL was an increase of 37%. Forward resistivity models of the experiment confirm the barrier mechanism theory for the tank experiment. Copyright © 2017 Elsevier B.V. All rights reserved.

'Just doing the best we can': health care providers' perceptions of barriers to providing care to Marshallese patients in Arkansas.

PubMed

McElfish, Pearl A; Chughtai, Almas; Low, Lisa K; Garner, Robert; Purvis, Rachel S

2018-05-04

Marshallese migrating to the United States encounter challenges in accessing health care. Previous literature has investigated Marshallese participants' perceptions of the barriers they face in accessing health care. For this study, health care providers managing the care of Marshallese patients were interviewed to understand the providers' perception of barriers that their Marshallese patients encounter. A qualitative research design was utilized to explore health care providers' perceptions of and experiences with the barriers faced by their Marshallese patients when accessing the US health care system. The primary barriers identified were: (1) economic barriers; (2) communication challenges; (3) difficulty understanding and navigating the western health care system; and (4) structural and system barriers. This study provides insight on the barriers Marshallese patients face in accessing health care as well as the barriers providers face in delivering care to Marshallese patients. A better understanding of these barriers can help health care providers and educators to begin initiating improvements in the delivery of care to Marshallese patients.

A home monitoring program including real-time wireless home spirometry in idiopathic pulmonary fibrosis: a pilot study on experiences and barriers.

PubMed

Moor, C C; Wapenaar, M; Miedema, J R; Geelhoed, J J M; Chandoesing, P P; Wijsenbeek, M S

2018-05-29

In idiopathic pulmonary fibrosis (IPF), home monitoring experiences are limited, not yet real-time available nor implemented in daily care. We evaluated feasibility and potential barriers of a new home monitoring program with real-time wireless home spirometry in IPF. Ten patients with IPF were asked to test this home monitoring program, including daily home spirometry, for four weeks. Measurements of home and hospital spirometry showed good agreement. All patients considered real-time wireless spirometry useful and highly feasible. Both patients and researchers suggested relatively easy solutions for the identified potential barriers regarding real-time home monitoring in IPF.

Experiences of facilitators or barriers in driving education from learner and novice drivers with ADHD or ASD and their driving instructors.

PubMed

Almberg, Maria; Selander, Helena; Falkmer, Marita; Vaz, Sharmila; Ciccarelli, Marina; Falkmer, Torbjörn

2017-02-01

Little is known about whether individuals with autism spectrum disorder (ASD) or attention deficit hyperactive disorder (ADHD) experience any specific facilitators or barriers to driving education. To explore the facilitators or barriers to driving education experienced by individuals with ASD or ADHD who obtained a learner's permit, from the perspective of the learner drivers and their driving instructors. Data were collected from 33 participants with ASD or ADHD, and nine of their driving instructors. Participants with ASD required twice as many driving lessons and more on-road tests than those with ADHD. Participants with ADHD repeated the written tests more than those with ASD. Driving license theory was more challenging for individuals with ADHD, whilst individuals with ASD found translating theory into practice and adjusting to "unfamiliar" driving situations to be the greatest challenges. Obtaining a driving license was associated with stressful training experience.

Experiences of Nigerian Internationally Educated Nurses Transitioning to United States Health Care Settings.

PubMed

Iheduru-Anderson, Kechinyere C; Wahi, Monika M

2018-04-01

Successful transition to practice of internationally educated nurses (IENs) can critically affect quality of care. The aim of this study was to characterize the facilitators and barriers to transition of Nigerian IENs (NIENs) to the United States health care setting. Using a descriptive phenomenology approach, 6 NIENs were interviewed about their transitional experiences in the United States. Thematic methods were used for data analysis. The three major themes identified from the participants' stories were "fear/anger and disappointment" (FAD), "road/journey to success/overcoming challenges" (RJO), and "moving forward" (MF). The FAD theme predominated, including experiences of racism, bullying, and inequality. The RJO theme included resilience, and the MF theme encompassed personal growth. NIENs face personal and organizational barriers to adaptation, especially fear, anger and disappointment. Future research should seek to develop a model for optimal adaptation that focuses on improving both personal and organizational facilitators and decreasing barriers.

Mental health assessment in rehabilitation: a descriptive study through an international internet survey.

PubMed

Juengst, Shannon; Nordvik, Jan E; Junttila, Ilkka S; Smith, Jason; Kew, Chung L; Laukkala, Tanja

2018-06-16

This cross-sectional study assessed international rehabilitation practitioners' views of mental health assessment (MHA), related specifically to assessment tools and needs in the field. We delivered an anonymous web-based survey capturing rehabilitation practioners' perspectives on MHA practices, assessment tools, and needs through the American Congress of Rehabilitation Medicine in the USA and through national rehabilitation networks in Finland and Norway. Altogether, 355 rehabilitation professionals answered the survey. Unmet MHA needs, most often attributed to insufficient time (112/269 responders), were recognized among rehabilitation professionals irrespective of the country of practice. When professional experience was weighed against barriers to conducting MHA, cost was statistically significantly linked to professional experience, with those with less experience viewing cost more as a barrier (P=0.019). Rehabilitation professionals from different professions, in different countries, and working with a variety of clinical populations recognize defined barriers to MHA in rehabilitation.

Exploring the Cervical Cancer Screening Experiences of Black Lesbian, Bisexual, and Queer Women: The Role of Patient-Provider Communication.

PubMed

Agénor, Madina; Bailey, Zinzi; Krieger, Nancy; Austin, S Bryn; Gottlieb, Barbara R

2015-01-01

Few studies have focused on the health and health care of U.S. black lesbian, bisexual, and queer (LBQ) women. To understand the facilitators of and barriers to cervical cancer screening in this population, focus group discussions were conducted in Boston and Cambridge, Massachusetts between November and December 2012. Using purposive sampling methods, the authors enrolled 18 black LBQ women who participated in one of four focus groups. Using thematic analysis, patient-provider communication was identified, which consisted of four sub-themes--health care provider communication style and demeanor; heteronormative provider assumptions; heterosexism, racism, and classism; and provider professional and sociodemographic background--as the most salient theme. Participants reported fears and experiences of multiple forms of discrimination and preferred receiving care from providers who were knowledgeable about same-sex sexual health and shared their life experiences at the intersection of gender, race/ethnicity, and sexual orientation. The cervical cancer screening experiences of black LBQ women would be improved by training all health care providers in same-sex sexual health, offering opportunities for clinicians to learn about the effects of various forms of discrimination on women's health care, and increasing the presence of LBQ women of color in health care settings.

Integration of depression and primary care: barriers to adoption.

PubMed

Grazier, Kyle L; Smith, Judith E; Song, Jean; Smiley, Mary L

2014-01-01

Despite the prevailing consensus as to its value, the adoption of integrated care models is not widespread. Thus, the objective of this article it to examine the barriers to the adoption of depression and primary care models in the United States. A literature search focused on peer-reviewed journal literature in Medline and PsycInfo. The search strategy focused on barriers to integrated mental health care services in primary care, and was based on previously existing searches. The search included: MeSH terms combined with targeted keywords; iterative citation searches in Scopus; searches for grey literature (literature not traditionally indexed by commercial publishers) in Google and organization websites, examination of reference lists, and discussions with researchers. Integration of depression care and primary care faces multiple barriers. Patients and families face numerous barriers, linked inextricably to create challenges not easily remedied by any one party, including the following: vulnerable populations with special needs, patient and family factors, medical and mental health comorbidities, provider supply and culture, financing and costs, and organizational issues. An analysis of barriers impeding integration of depression and primary care presents information for future implementation of services.

Barriers to HIV Medication Adherence as a Function of Regimen Simplification.

PubMed

Chen, Yiyun; Chen, Kun; Kalichman, Seth C

2017-02-01

Barriers to HIV medication adherence may differ by levels of dosing schedules. The current study examined adherence barriers associated with medication regimen complexity and simplification. A total of 755 people living with HIV currently taking anti-retroviral therapy were recruited from community services in Atlanta, Georgia. Participants completed audio-computer-assisted self-interviews that assessed demographic and behavioral characteristics, provided their HIV viral load obtained from their health care provider, and completed unannounced phone-based pill counts to monitor medication adherence over 1 month. Participants taking a single-tablet regimen (STR) were more likely to be adherent than those taking multi-tablets in a single-dose regimen (single-dose MTR) and those taking multi-tablets in a multi-dose regimen (multi-dose MTR), with no difference between the latter two. Regarding barriers to adherence, individuals taking STR were least likely to report scheduling issues and confusion as reasons for missing doses, but they were equally likely to report multiple lifestyle and logistical barriers to adherence. Adherence interventions may need tailoring to address barriers that are specific to dosing regimens.

Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients With Cancer

PubMed Central

Hamel, Lauren M.; Penner, Louis A.; Albrecht, Terrance L.; Heath, Elisabeth; Gwede, Clement K.; Eggly, Susan

2016-01-01

Background Clinical trials that study cancer are essential for testing the safety and effectiveness of promising treatments, but most people with cancer never enroll in a clinical trial — a challenge exemplified in racial and ethnic minorities. Underenrollment of racial and ethnic minorities reduces the generalizability of research findings and represents a disparity in access to high-quality health care. Methods Using a multilevel model as a framework, potential barriers to trial enrollment of racial and ethnic minorities were identified at system, individual, and interpersonal levels. Exactly how each level directly or indirectly contributes to doctor–patient communication was also reviewed. Selected examples of implemented interventions are included to help address these barriers. We then propose our own evidence-based intervention addressing barriers at the individual and interpersonal levels. Results Barriers to enrolling a diverse population of patients in clinical trials are complex and multilevel. Interventions focused at each level have been relatively successful, but multilevel interventions have the greatest potential for success. Conclusion To increase the enrollment of racial and ethnic minorities in clinical trials, future interventions should address barriers at multiple levels. PMID:27842322

Enabling Security, Stability, Transition, and Reconstruction Operations through Knowledge Management

DTIC Science & Technology

2009-03-18

strategy. Overall, the cultural barriers to knowledge sharing center on knowledge creation and capture. The primary barrier to knowledge sharing is lack ... Lacking a shared identity decreases the likelihood of knowledge sharing, which is essential to effective collaboration.84 Related to collaboration...to adapt, develop, and change based on experience-derived knowledge.90 A second cultural barrier to knowledge acquisition is the lack receptiveness

A Survey of Homework Use, Experience of Barriers to Homework, and Attitudes about the Barriers to Homework among Couples and Family Therapists

ERIC Educational Resources Information Center

Dattilio, Frank M.; Kazantzis, Nikolaos; Shinkfield, Gregg; Carr, Amanda G.

2011-01-01

Homework is a therapeutic process that has strong theoretical and empirical basis, but existing research has focused on "compliance" rather than considering the broader and more clinically meaningful construct of "engagement." Absent in the literature is empirical study of the barriers to engagement or study of homework use among couple and family…

Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study.

PubMed

Phillips, Cameron J; Marshall, Andrea P; Chaves, Nadia J; Jankelowitz, Stacey K; Lin, Ivan B; Loy, Clement T; Rees, Gwyneth; Sakzewski, Leanne; Thomas, Susie; To, The-Phung; Wilkinson, Shelley A; Michie, Susan

2015-01-01

The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF.

Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study

PubMed Central

Phillips, Cameron J; Marshall, Andrea P; Chaves, Nadia J; Jankelowitz, Stacey K; Lin, Ivan B; Loy, Clement T; Rees, Gwyneth; Sakzewski, Leanne; Thomas, Susie; To, The-Phung; Wilkinson, Shelley A; Michie, Susan

2015-01-01

Background The Theoretical Domains Framework (TDF) is an integrative framework developed from a synthesis of psychological theories as a vehicle to help apply theoretical approaches to interventions aimed at behavior change. Purpose This study explores experiences of TDF use by professionals from multiple disciplines across diverse clinical settings. Methods Mixed methods were used to examine experiences, attitudes, and perspectives of health professionals in using the TDF in health care implementation projects. Individual interviews were conducted with ten health care professionals from six disciplines who used the TDF in implementation projects. Deductive content and thematic analysis were used. Results Three main themes and associated subthemes were identified including: 1) reasons for use of the TDF (increased confidence, broader perspective, and theoretical underpinnings); 2) challenges using the TDF (time and resources, operationalization of the TDF) and; 3) future use of the TDF. Conclusion The TDF provided a useful, flexible framework for a diverse group of health professionals working across different clinical settings for the assessment of barriers and targeting resources to influence behavior change for implementation projects. The development of practical tools and training or support is likely to aid the utility of TDF. PMID:25834455

How do Dutch primary care providers overcome barriers to advance care planning with older people? A qualitative study.

PubMed

Glaudemans, Jolien J; de Jong, Anja E; Onwuteaka Philipsen, Bregje D; Wind, Jan; Willems, Dick L

2018-06-11

Few older people benefit from advance care planning (ACP), due to several barriers related to primary care professionals, such as insufficient knowledge, negative beliefs and a lack of time. Information on overcoming these barriers is limited. We assumed primary care professionals experienced in ACP with older patients are likely to have learned how to overcome these barriers. To investigate how Dutch primary care professionals experienced in ACP with older patients overcome these barriers. A qualitative study, based on semi-structured interviews, among a purposive sample of 14 Dutch primary care professionals experienced in ACP with older people. Transcripts were thematically analysed. We interviewed eight general practitioners (GPs), three nurses and three elderly care physicians, experienced in ACP with older people. Respondents overcame their own insufficient knowledge and skills, as well as their negative attitudes and beliefs by gaining experience through practicing ACP in their daily practices, exchanging and reflecting on those experiences with peers, pursuing continuing education, teaching and participating in research. To overcome patients' and families' lack of initiative and openness to ACP, respondents prepared them for further steps in ACP. To overcome a lack of time, respondents used tools and information communication technology, delegated parts of ACP to other primary care professionals, acquired financing and systematized documentation of ACP. Primary care professionals can overcome barriers to ACP with older patients by practicing, reflecting on experiences and pursuing continuing education, by preparing patients and involving family and by investing in support to approach ACP more efficiently.

Optimizing Barrier Removal to Restore Connectivity in Utah's Weber Basin

NASA Astrophysics Data System (ADS)

Kraft, M.; Null, S. E.

2016-12-01

Instream barriers, such as dams, culverts and diversions are economically important for water supply, but negatively affect river ecosystems and disrupt hydrologic processes. Removal of uneconomical and aging in-stream barriers to improve habitat connectivity is increasingly used to restore river connectivity. Most past barrier removal projects focused on individual barriers using a score-and-rank technique, ignoring cumulative change from multiple, spatially-connected barrier removals. Similarly, most water supply models optimize either human water use or aquatic connectivity, failing to holistically represent human and environmental benefits. In this study, a dual objective optimization model identified in-stream barriers that impede aquatic habitat connectivity for trout, using streamflow, temperature, and channel gradient as indicators of aquatic habitat suitability. Water scarcity costs are minimized using agricultural and urban economic penalty functions to incorporate water supply benefits and a budget monetizes costs of removing small barriers like culverts and road crossings. The optimization model developed is applied to a case study in Utah's Weber basin to prioritize removal of the most environmentally harmful barriers, while maintaining human water uses. The dual objective solution basis was developed to quantify and graphically visualize tradeoffs between connected quality-weighted habitat for Bonneville cutthroat trout and economic water uses. Modeled results include a spectrum of barrier removal alternatives based on budget and quality-weighted reconnected habitat that can be communicated with local stakeholders. This research will help prioritize barrier removals and future restoration decisions. The modeling approach expands current barrier removal optimization methods by explicitly including economic and environmental water uses.

Communicating with disabled children when inpatients: barriers and facilitators identified by parents and professionals in a qualitative study.

PubMed

Sharkey, Siobhan; Lloyd, Claire; Tomlinson, Richard; Thomas, Eleanor; Martin, Alice; Logan, Stuart; Morris, Christopher

2016-06-01

Communication is a fundamental part of health care, but can be more difficult with disabled children. Disabled children are more frequently admitted to hospital than other children. To explore experiences of ward staff and families to identify barriers and facilitators to effective communication with disabled children whilst inpatients. This was an exploratory qualitative study. We consulted 25 staff working on paediatric wards and 15 parents of disabled children recently admitted to those wards. We had difficulty in recruiting children and evaluating their experiences. Data were collected through interviews and focus groups. A thematic analysis of the data supported by the Framework Approach was used to explore experiences and views about communication. Emerging themes were subsequently synthesised to identify barriers and facilitators to good communication. Barriers to communication included time, professionals not prioritising communication in their role and poor information sharing between parents and professionals. Facilitators included professionals building rapport with a child, good relationships between professionals and parents, professionals having a family-centred approach, and the use of communication aids. Communication with disabled children on the ward was perceived as less than optimal. Parents are instrumental in the communication between their children and professionals. Although aware of the importance of communication with disabled children, staff perceived time pressures and lack of priority given to communicating directly with the child as major barriers. © 2014 John Wiley & Sons Ltd.

The Desires of Their Hearts: The Multidisciplinary Perspectives of African Americans on End-of-Life Care in the African American Community.

PubMed

Rhodes, Ramona L; Elwood, Bryan; Lee, Simon C; Tiro, Jasmin A; Halm, Ethan A; Skinner, Celette S

2017-07-01

Studies have identified racial differences in advance care planning and use of hospice for care at the end of life. Multiple reasons for underuse among African American patients and their families have been proposed and deserve further exploration. The goal of this study was to examine perceptions of advance care planning, palliative care, and hospice among a diverse sample of African Americans with varying degrees of personal and professional experience with end-of-life care and use these responses to inform a culturally sensitive intervention to promote awareness of these options. Semistructured interviews and focus groups were conducted with African Americans who had varying degrees of experience and exposure to end-of-life care both personally and professionally. We conducted in-depth qualitative analyses of these interviews and focus group transcripts and determined that thematic saturation had been achieved. Several themes emerged. Participants felt that advance care planning, palliative care, and hospice can be beneficial to African American patients and their families but identified specific barriers to completion of advance directives and hospice enrollment, including lack of knowledge, fear that these measures may hasten death or cause providers to deliver inadequate care, and perceived conflict with patients' faith and religious beliefs. Providers described approaches they use to address these barriers in their practices. Findings, which are consistent with and further elucidate those identified from previous research, will inform design of a culturally sensitive intervention to increase awareness and understanding of advance care planning, palliative care, and hospice among members of the African American community.

How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX.

PubMed

Boulos, Maged N Kamel; Wheeler, Steve; Tavares, Carlos; Jones, Ray

2011-04-05

The latest generation of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development. This paper provides a brief state-of-the-art overview of health and healthcare smartphone apps (applications) on the market today, including emerging trends and market uptake. Platforms available today include Android, Apple iOS, RIM BlackBerry, Symbian, and Windows (Windows Mobile 6.x and the emerging Windows Phone 7 platform). The paper covers apps targeting both laypersons/patients and healthcare professionals in various scenarios, e.g., health, fitness and lifestyle education and management apps; ambient assisted living apps; continuing professional education tools; and apps for public health surveillance. Among the surveyed apps are those assisting in chronic disease management, whether as standalone apps or part of a BAN (Body Area Network) and remote server configuration. We describe in detail the development of a smartphone app within eCAALYX (Enhanced Complete Ambient Assisted Living Experiment, 2009-2012), an EU-funded project for older people with multiple chronic conditions. The eCAALYX Android smartphone app receives input from a BAN (a patient-wearable smart garment with wireless health sensors) and the GPS (Global Positioning System) location sensor in the smartphone, and communicates over the Internet with a remote server accessible by healthcare professionals who are in charge of the remote monitoring and management of the older patient with multiple chronic conditions. Finally, we briefly discuss barriers to adoption of health and healthcare smartphone apps (e.g., cost, network bandwidth and battery power efficiency, usability, privacy issues, etc.), as well as some workarounds to mitigate those barriers.

Ligation of the Jugular Veins Does Not Result in Brain Inflammation or Demyelination in Mice

PubMed Central

Wojtkiewicz, Gregory R.; Pulli, Benjamin; Iwamoto, Yoshiko; Ueno, Takuya; Waterman, Peter; Truelove, Jessica; Oklu, Rahmi; Chen, John W.

2012-01-01

An alternative hypothesis has been proposed implicating chronic cerebrospinal venous insufficiency (CCSVI) as a potential cause of multiple sclerosis (MS). We aimed to evaluate the validity of this hypothesis in a controlled animal model. Animal experiments were approved by the institutional animal care committee. The jugular veins in SJL mice were ligated bilaterally (n = 20), and the mice were observed for up to six months after ligation. Sham-operated mice (n = 15) and mice induced with experimental autoimmune encephalomyelitis (n = 8) were used as negative and positive controls, respectively. The animals were evaluated using CT venography and 99mTc-exametazime to assess for structural and hemodynamic changes. Imaging was performed to evaluate for signs of blood-brain barrier (BBB) breakdown and neuroinflammation. Flow cytometry and histopathology were performed to assess inflammatory cell populations and demyelination. There were both structural changes (stenosis, collaterals) in the jugular venous drainage and hemodynamic disturbances in the brain on Tc99m-exametazime scintigraphy (p = 0.024). In the JVL mice, gadolinium MRI and immunofluorescence imaging for barrier molecules did not reveal evidence of BBB breakdown (p = 0.58). Myeloperoxidase, matrix metalloproteinase, and protease molecular imaging did not reveal signs of increased neuroinflammation (all p>0.05). Flow cytometry and histopathology also did not reveal increase in inflammatory cell infiltration or population shifts. No evidence of demyelination was found, and the mice remained without clinical signs. Despite the structural and hemodynamic changes, we did not identify changes in the BBB permeability, neuroinflammation, demyelination, or clinical signs in the JVL group compared to the sham group. Therefore, our murine model does not support CCSVI as a cause of demyelinating diseases such as multiple sclerosis. PMID:22457780

Serious Illness Conversations in ESRD

PubMed Central

Bernacki, Rachelle E.; Block, Susan D.

2017-01-01

Dialysis-dependent ESRD is a serious illness with high disease burden, morbidity, and mortality. Mortality in the first year on dialysis for individuals over age 75 years old approaches 40%, and even those with better prognoses face multiple hospitalizations and declining functional status. In the last month of life, patients on dialysis over age 65 years old experience higher rates of hospitalization, intensive care unit admission, procedures, and death in hospital than patients with cancer or heart failure, while using hospice services less. This high intensity of care is often inconsistent with the wishes of patients on dialysis but persists due to failure to explore or discuss patient goals, values, and preferences in the context of their serious illness. Fewer than 10% of patients on dialysis report having had a conversation about goals, values, and preferences with their nephrologist, although nearly 90% report wanting this conversation. Many nephrologists shy away from these conversations, because they do not wish to upset their patients, feel that there is too much uncertainty in their ability to predict prognosis, are insecure in their skills at broaching the topic, or have difficulty incorporating the conversations into their clinical workflow. In multiple studies, timely discussions about serious illness care goals, however, have been associated with enhanced goal-consistent care, improved quality of life, and positive family outcomes without an increase in patient distress or anxiety. In this special feature article, we will (1) identify the barriers to serious illness conversations in the dialysis population, (2) review best practices in and specific approaches to conducting serious illness conversations, and (3) offer solutions to overcome barriers as well as practical advice, including specific language and tools, to implement serious illness conversations in the dialysis population. PMID:28031417

How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX

PubMed Central

2011-01-01

The latest generation of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development. This paper provides a brief state-of-the-art overview of health and healthcare smartphone apps (applications) on the market today, including emerging trends and market uptake. Platforms available today include Android, Apple iOS, RIM BlackBerry, Symbian, and Windows (Windows Mobile 6.x and the emerging Windows Phone 7 platform). The paper covers apps targeting both laypersons/patients and healthcare professionals in various scenarios, e.g., health, fitness and lifestyle education and management apps; ambient assisted living apps; continuing professional education tools; and apps for public health surveillance. Among the surveyed apps are those assisting in chronic disease management, whether as standalone apps or part of a BAN (Body Area Network) and remote server configuration. We describe in detail the development of a smartphone app within eCAALYX (Enhanced Complete Ambient Assisted Living Experiment, 2009-2012), an EU-funded project for older people with multiple chronic conditions. The eCAALYX Android smartphone app receives input from a BAN (a patient-wearable smart garment with wireless health sensors) and the GPS (Global Positioning System) location sensor in the smartphone, and communicates over the Internet with a remote server accessible by healthcare professionals who are in charge of the remote monitoring and management of the older patient with multiple chronic conditions. Finally, we briefly discuss barriers to adoption of health and healthcare smartphone apps (e.g., cost, network bandwidth and battery power efficiency, usability, privacy issues, etc.), as well as some workarounds to mitigate those barriers. PMID:21466669

Factors Associated With Suicidal Ideation and Quality of Life in Adolescents from Puerto Rico With Type 1 Diabetes

PubMed Central

Guerrero-Ramírez, Grace; Cumba-Avilés, Eduardo

2018-01-01

Objective People with type 1 diabetes (T1D) may experience significant changes in their daily routines due to this condition, which frequently results in depressive symptoms and the deterioration of their quality of life. We examined the factors associated with suicidal ideation (SI) and diabetes-related quality of life (DRQOL) in adolescents (aged 12 to 17) with T1D. Methods The sample consisted of 51 youths (29 girls) recruited during a treatment study for depression. They completed the Diabetes Quality of Life for Youth questionnaire, the Suicidal Ideation Questionnaire-Junior, and other measures that explore emotional, cognitive, somatic, behavioral, and relational aspects. Their caregivers completed the Barriers to Adherence Questionnaire and the Somatic Complaints subscale of the Child Behavior Checklist, among other measures. We used correlation and multiple linear regression analyses to identify the factors associated with the dependent variables. Results The variables associated with SI were depression, somatic complaints, perceived family emotional support, self-care for diabetes, self-deprecation, helplessness, and hopelessness, among others. In a multiple regression analysis, the first 3 accounted for 46% of the variance. Those related to DRQOL included cognitive alterations, barriers to adherence, perceived family emotional support, self-efficacy for diabetes and for depression, helplessness, anxiety, and self-deprecation, among others. The first 4 accounted for 61% of the variance. Conclusion Our findings highlight the impact of emotional, cognitive, somatic, behavioral, and relational aspects on the quality of mental health and the DRQOL of youth with T1D, as well as their pertinence for the development of psychosocial interventions for this population. PMID:29547680

Is Amateur Astronomers’ Astronomy Knowledge a Barrier to Successful Outreach?

NASA Astrophysics Data System (ADS)

Slater, Timothy F.; Slater, S. J.; Price, C. A.; CenterAstronomy, CAPER; Education Research, Physics

2012-01-01

Considerable effort in astronomy education research has focused on developing assessment tools in the form of multiple-choice conceptual diagnostics and content knowledge surveys. This has been critically important for establishing the initial knowledge state of students and measure impacts of innovative instructional interventions over a universe of topics. Unfortunately, few of the existing instruments were constructed upon a solid list of clearly articulated and widely agreed upon learning objectives that span an entire introductory survey course. Moving beyond the 10-year old Astronomy Diagnostics Test, scholars at the CAPER Center for Astronomy & Physics Education Research developed and validated criterion referenced assessment tool, which is tightly aligned to the consensus learning goals stated by the AAS Chair's Conference on ASTRO 101, the AAAS Project 2061 Benchmarks, and the NRC National Science Education Standards, called the Test Of Astronomy STandards (TOAST). This multiple-choice instrument has a high degree of reliability and validity and is being deployed in a number of formal and informal learning environments. A collaborative research endeavor between the CAPER Team and the American Association of Variable Star Observers measured the astronomy content knowledge amateur astronomers, relative to widely agreed upon learning targets. We uncovered that our sample of 300 amateurs have higher than expected scores on the TOAST, significantly higher than students leaving our top-tier ASTRO 101 survey courses. Given recent learning sciences research demonstrating the potential of highly specialized languages that exist within some communities and rapidly declining membership rolls of formal amateur organizations, these scores could be interpreted as a potential communication barrier existing for engaging novices who are potential future club members. These results suggest that organizations may need to strategically clarify the nature of educational experiences they provide than can serve transformative in order to nurture a more robust pipeline of members.

Effect of seasonal and geographical differences on skin and effect of treatment with an osmoprotectant: Sorbitol.

PubMed

Muizzuddin, Neelam; Ingrassia, Michael; Marenus, Kenneth D; Maes, Daniel H; Mammone, Thomas

2013-01-01

Human skin maintains an optimal permeability barrier function in a terrestrial environment that varies considerably in humidity. Cells cultured under hyperosmotic stress accumulate osmolytes including sorbitol. Epidermal keratinocytes experience similar high osmolality under dry environmental conditions because of increased transepidermal water loss (TEWL) and concomitant drying of the skin. This study was designed to determine if epidermal keratinocytes, in vitro, could be protected from high osmotic stress, with the exogenous addition of sorbitol. In addition, we evaluated the effect of a formulation containing topical sorbitol on skin barrier and moisturization of subjects living in arid and humid regions in summer as well as in winter. Results from in vitro experiments showed that 50 mM sorbitol protected epidermal keratinocytes from osmotic toxicity induced by sodium chloride. Clinical studies indicated that skin chronically exposed to hot, dry environment appeared to exhibit stronger skin barrier and a lower baseline TEWL. In addition, skin barrier was stronger in summer than in winter. Sorbitol exhibited significant improvement in both barrier repair and moisturization, especially in individuals subjected to arid environmental conditions.

Debris Flow Risk mitigation by the means of flexible barriers. Experimental and field tests.

NASA Astrophysics Data System (ADS)

Canelli, L.; Ferrero, A. M.; Segalini, A.

2012-04-01

Debris flow risk mitigation using net barriers is an option that was not considered until few years ago, probably because of the lack of scientific evidences about their efficiency and solid guidelines for their design and construction. On site evidences (Segalini et al, 2008) showed that a rock fall deformable barrier can efficiently intercept the whole volume or just a portion of the mobilized debris without losing its stability and efficiency, actually performing a different task form that it was originally designed for. Although the final purpose of both types of barriers (rock fall and debris) is to reduce the impact energy of the moving mass by dissipating impact energy through the deformation of the net and of the dissipating elements, it is noteworthy that the physics of the impact is extremely different between the two phenomena. The rock fall barrier needs to dissipate the energy of a single block generally concentrated on the center of the net panel (design conditions). The debris flow barrier, generally installed inside a debris channel, should be able to dissipate the impact energy that the debris induces across the whole section of the channel. Moreover, the recurring characteristic of the debris flows will cause multiple impact on the barrier and therefore, the structure should be able to absorb a significant amount of energy even if partially filled and considerably deformed. In order to introduce useful guidelines for the design and production of debris flow net barriers, this paper describes: 1. Part of the results obtained from the laboratory experiment carried out in a scaled channel and aimed to estimate the most realistic thrust vs time relationship induced by a debris flow on a deformable and rigid structure; these results were partially presented last year at the EGU 2011; 2. A large scale field test carried out in a quarry located in Tambre d'Alpago (Belluno Province) on the Eastern Italian Dolomites for the analysis of the behavior of a real scale deformable net barrier subjected to recurring impacts of small volumes, substantially dry, debris flows until the complete filling up of the channel. Laboratory tests were carried out using a small scale channel (40 cm wide channel and 4 m long) designed and installed at University of Parma in which were triggered flows of water saturated sand impacting with different typologies of barriers installed in order to measure the impact force of the generated flow. The field test has been conducted by artificially mobilizing volumes of quarry debris along a 50 m long and 2 m wide channel at the end of which a real scale deformable net barrier was installed. The impacts were monitored using five high speed video cameras, the deformation progress of the barrier induced by the impacts was obtained using two high shutter speed cameras configured and synchronized for a stereoscopic restitution. Forces on the structural steel cables where measured by installing five load cells between the cable and its foundation. Results obtained are presented and compared with the relevant literature.

Notes from the Margins: Integrating Lesbian Experience into the Vocational Psychology of Women.

ERIC Educational Resources Information Center

Fassinger, Ruth E.

1996-01-01

Explores internal and external barriers to women's career choice, implementation, and adjustment, especially how such barriers function for lesbians. Examines issues related to coming out, workplace discrimination, and the home-work interface. (SK)

Effects of solid barriers on dispersion of roadway emissions

EPA Science Inventory

Several studies have found that exposure to traffic-generated air pollution is associated with several adverse health effects. Field studies, laboratory experiments, and numerical simulations indicate that roadside barriers represent a practical method of mitigating the impact of...

Racial Barrier Socialization and the Well-being of African American Adolescents: The Moderating Role of Mother-Adolescent Relationship Quality

PubMed Central

Cooper, Shauna M.; McLoyd, Vonnie C.

2012-01-01

Racial socialization has been suggested as an important factor in helping African American adolescents cope effectively with racism and discrimination. Although multiple studies have reported a positive link between racial pride socialization and psychological adjustment among African American youth, assessments of the association between adolescent adjustment and another dimension of racial socialization—racial barrier socialization—have yielded inconsistent findings. Using a sample of 190 African American adolescents, the present study focuses attention on the quality of mother-adolescent relations as an indicator of affective context, and examines its moderating influence on the association between racial barrier socialization and adolescent adjustment. Regression analyses indicated that the link between racial barrier socialization and adolescent adjustment is moderated by mother-adolescent relationship quality. However, these associations varied by gender. PMID:23152648

Barriers to and facilitators of the acceptance process for individuals with serious mental illness.

PubMed

Mizock, Lauren; Russinova, Zlatka; Millner, Uma Chandrika

2014-09-01

The process of acceptance of mental illness is a central component of recovery and has been linked to functioning, illness management, and quality of life. A number of barriers and facilitators have been theorized as impacting this process. This study was conducted with 30 participants with serious mental illness (a major psychiatric disorder with impairment in multiple areas of functioning) to elicit the barriers to and facilitators of the acceptance of mental illness. Grounded theory methodology was utilized to analyze the 30 semistructured interviews. Results revealed barriers to and facilitators of acceptance of mental illness at the micro level (cognitive, emotional, behavioral, identity-related), meso level (relational), and macro level (cultural, systemic). Clinical and research implications are discussed with regard to facilitating acceptance of mental illness. © The Author(s) 2014.

Strategies from bedside nurse perspectives in conducting evidence-based practice projects to improve care.

PubMed

Shaffer, Susan T; Zarnowsky, Colleen D; Green, Renee C; Lim, Mei-Lin Chen; Holtzer, Brenda M; Ely, Elizabeth A

2013-06-01

This article presents the bedside nurses' perspectives on their experience with conducting an evidence based practice project. This is especially important in the climate of hospitals working to achieve Magnet Recognition. The facilitators and barriers to project design and completion are discussed in detail. Strategies to overcome barriers are presented. Facilitators for bedside nurses include motivation and professional development. Most common barriers were lack of time and limited knowledge about the process. Interventions aimed at research utilization can be successful when mindful of commonly understood barriers to project completion with steps taken to resolve those barriers. Copyright © 2013 Elsevier Inc. All rights reserved.

A survey of exercise professionals' barriers and facilitators to working with stroke survivors.

PubMed

Condon, Marie; Guidon, Marie

2018-03-01

Stroke survivors (SSs) are largely inactive despite the benefits of exercise. Exercise professionals (EPs), skilled in exercise prescription and motivation, may have a role in promoting exercise among SSs. However, the number of EPs working with SSs is estimated to be low. This study aimed to investigate EPs' opinions on working with SSs by rating their agreement of barriers and facilitators to working with SSs. The study also investigated EPs skills, interest and experience working with SSs and the relationship between EPs' barriers and facilitators with their training on stroke. A descriptive cross-sectional study was conducted using a researcher-designed online survey between October and December 2015. Purposive sampling was used to survey EPs on the Register of Exercise Professionals in Ireland (n = 277). The response rate was 31% (87/277). Only 22% (19/86) of EPs had experience working with SSs. The primary barriers rated by EPs included insufficient training on psychological problems post-stroke (84%; 61/73), unsuitable equipment for SSs (69%; 50/73) and the level of supervision SSs require (56%; 41/73). The primary facilitators rated included access to suitable equipment (97%; 69/71), practical (100%; 71/71) and theoretical training (93%; 66/71) on stroke. Respondents with no training on stroke were significantly more likely to agree that insufficient training on psychological problems post-stroke and lack of experience were barriers. Seventy-six per cent of EPs (58/76) were interested in one-to-one exercise sessions with SSs but only 53% (40/76) were interested in group sessions. Eighty-two per cent of EPs (62/76) rated their motivational skills as good or very good but 42% (32/76) indicated having only acceptable skills dealing with psychological problems. Results indicate that EPs are interested in working with SSs despite limited experience and practical barriers. Training opportunities on stroke need to be developed; taking into account EPs' barriers, facilitators and skills along with access to suitable equipment. © 2017 John Wiley & Sons Ltd.

Strategies to Support Recruitment of Patients with Life-limiting illness for Research: The Palliative Care Research Cooperative Group

PubMed Central

Hanson, Laura C.; Bull, Janet; Wessell, Kathryn; Massie, Lisa; Bennett, Rachael E.; Kutner, Jean S.; Aziz, Noreen M.; Abernethy, Amy

2014-01-01

Context The Palliative Care Research Cooperative group (PCRC) is the first clinical trials cooperative for palliative care in the United States. Objectives To describe barriers and strategies for recruitment during the inaugural PCRC clinical trial. Methods The parent study was a multi-site randomized controlled trial enrolling adults with life expectancy anticipated to be 1–6 months, randomized to discontinue statins (intervention) vs. to continue on statins (control). To study recruitment best practices, we conducted semi-structured interviews with 18 site Principal Investigators (PI) and Clinical Research Coordinators (CRC), and reviewed recruitment rates. Interviews covered 3 topics – 1) successful strategies for recruitment, 2) barriers to recruitment, and 3) optimal roles of the PI and CRC. Results All eligible site PIs and CRCs completed interviews and provided data on statin protocol recruitment. The parent study completed recruitment of n=381 patients. Site enrollment ranged from 1–109 participants, with an average of 25 enrolled per site. Five major barriers included difficulty locating eligible patients, severity of illness, family and provider protectiveness, seeking patients in multiple settings, and lack of resources for recruitment activities. Five effective recruitment strategies included systematic screening of patient lists, thoughtful messaging to make research relevant, flexible protocols to accommodate patients’ needs, support from clinical champions, and the additional resources of a trials cooperative group. Conclusion The recruitment experience from the multi-site PCRC yields new insights into methods for effective recruitment to palliative care clinical trials. These results will inform training materials for the PCRC and may assist other investigators in the field. PMID:24863152

Implementation of a Family Planning Clinic-Based Partner Violence and Reproductive Coercion Intervention: Provider and Patient Perspectives.

PubMed

Miller, Elizabeth; McCauley, Heather L; Decker, Michele R; Levenson, Rebecca; Zelazny, Sarah; Jones, Kelley A; Anderson, Heather; Silverman, Jay G

2017-06-01

Despite multiple calls for clinic-based services to identify and support women victimized by partner violence, screening remains uncommon in family planning clinics. Furthermore, traditional screening, based on disclosure of violence, may miss women who fear reporting their experiences. Strategies that are sensitive to the signs, symptoms and impact of trauma require exploration. In 2011, as part of a cluster randomized controlled trial, staff at 11 Pennsylvania family planning clinics were trained to offer a trauma-informed intervention addressing intimate partner violence and reproductive coercion to all women seeking care, regardless of exposure to violence. The intervention sought to educate women about available resources and harm reduction strategies. In 2013, at the conclusion of the trial, 18 providers, five administrators and 49 patients completed semistructured interviews exploring acceptability of the intervention and barriers to implementation. Consensus and open coding strategies were used to analyze the data. Providers reported that the intervention increased their confidence in discussing intimate partner violence and reproductive coercion. They noted that asking patients to share the educational information with other women facilitated the conversation. Barriers to implementation included lack of time and not having routine reminders to offer the intervention. Patients described how receiving the intervention gave them important information, made them feel supported and less isolated, and empowered them to help others. A universal intervention may be acceptable to providers and patients. However, successful implementation in family planning settings may require attention to system-level factors that providers view as barriers. Copyright © 2017 by the Guttmacher Institute.

Prescriber and institutional barriers and facilitators of clozapine use: A systematic review.

PubMed

Verdoux, Hélène; Quiles, Clélia; Bachmann, Christian J; Siskind, Dan

2018-06-04

As clozapine is under-prescribed in persons with treatment-resistant schizophrenia (TRS), it is necessary to better identify the determinants of health inequalities in access to clozapine use. To identify mental health professionals' characteristics or attitudes and institutional characteristics facilitating or limiting clozapine prescribing. We systematically searched multiple electronic databases for articles reporting: (i) mental health professionals' attitudes and characteristics favoring or limiting clozapine prescribing; (ii) institutional characteristics associated with variations in clozapine prescribing; (iii) interventions aimed at enhancing clozapine prescribing. Data were synthesized narratively. A total of 31 articles reporting findings of 29 studies published from 1993 to 2017 in 11 countries fulfilled our inclusion criteria. The main prescriber-related barriers to clozapine prescribing are lack of personal prescribing experience and concern with pharmacological characteristics of clozapine (blood monitoring and adverse effects). Lack of knowledge about the effectiveness of clozapine does not appear as a major determinant of under-prescription. Institutional-related characteristics favoring clozapine prescribing are prescribers' adherence to evidence-based medicine principles and learning by modelling from experienced clozapine prescribers. Effective strategies to increase access to clozapine in persons with TRS include implementation of integrated clozapine clinics, simplification of blood monitoring, education for prescribers and contact with experienced prescribers. Programs addressing barriers in clozapine prescription need to be disseminated more broadly to ensure persons with TRS have access to evidenced based treatments such as clozapine. Inequality in access to clozapine care should be more systematically handled by mental health facilities and health regulatory agencies. Copyright © 2018 Elsevier B.V. All rights reserved.

Diagnosis is a team sport - partnering with allied health professionals to reduce diagnostic errors.

PubMed

Thomas, Dana B; Newman-Toker, David E

2016-06-01

Diagnostic errors are the most common, most costly, and most catastrophic of medical errors. Interdisciplinary teamwork has been shown to reduce harm from therapeutic errors, but sociocultural barriers may impact the engagement of allied health professionals (AHPs) in the diagnostic process. A qualitative case study of the experience at a single institution around involvement of an AHP in the diagnostic process for acute dizziness and vertigo. We detail five diagnostic error cases in which the input of a physical therapist was central to correct diagnosis. We further describe evolution of the sociocultural milieu at the institution as relates to AHP engagement in diagnosis. Five patients with acute vestibular symptoms were initially misdiagnosed by physicians and then correctly diagnosed based on input from a vestibular physical therapist. These included missed labyrinthine concussion and post-traumatic benign paroxysmal positional vertigo (BPPV); BPPV called gastroenteritis; BPPV called stroke; stroke called BPPV; and multiple sclerosis called BPPV. As a consequence of surfacing these diagnostic errors, initial resistance to physical therapy input to aid medical diagnosis has gradually declined, creating a more collaborative environment for 'team diagnosis' of patients with dizziness and vertigo at the institution. Barriers to AHP engagement in 'team diagnosis' include sociocultural norms that establish medical diagnosis as something reserved only for physicians. Drawing attention to the valuable diagnostic contributions of AHPs may help facilitate cultural change. Future studies should seek to measure diagnostic safety culture and then implement proven strategies to breakdown sociocultural barriers that inhibit effective teamwork and transdisciplinary diagnosis.