The School Experiences of Rural Youths: A Study in Appalachian Ohio

ERIC Educational Resources Information Center

Hoffman, Jill A.; Anderson-Butcher, Dawn; Fuller, Michael; Bates, Samantha

2017-01-01

Rural schools face unique challenges that affect student academic success or failure. Youths served in rural settings experience barriers to learning that negatively influence their achievement and developmental outcomes. To improve outcomes for rural youths, it is important for schools to understand overall school experiences so that school-wide…

Rural Community College Student Perceptions of Barriers to College Enrollment

ERIC Educational Resources Information Center

Scott, Shanda; Miller, Michael T.; Morris, Adam A.

2016-01-01

Rural community college students face unique difficulties in higher education for many reasons, including the resources they typically have access to, their collective histories, and in many cases, the preparation they received in high school. These challenges might be low-performing secondary schools, a lack of tradition and precedence in…

Social Justice and Juvenile Offenders: Examples of Fairness, Respect, and Access in Education Settings

ERIC Educational Resources Information Center

Sander, Janay B.; Sharkey, Jill D.; Groomes, Amber N.; Krumholz, Lauren; Walker, Kimberly; Hsu, Julie Y.

2011-01-01

Youths involved in juvenile justice face unique barriers to educational and mental health services. This qualitative study illustrates social justice violations that are particularly salient for this population. Youths on probation, their mothers, and juvenile probation staff participated in interviews as part of a multisite study conducted in…

Examining Conceptual and Operational Definitions of "First-Generation College Student" in Research on Retention

ERIC Educational Resources Information Center

Peralta, Karie Jo; Klonowski, Monica

2017-01-01

This research brief reports that students who have parents with little to no postsecondary education have an increasing presence in colleges and universities. Researchers recognize that these individuals face unique barriers in higher education programs that affect their ability to graduate. Given the wide concern about student retention,…

"If Only Someone Had Told Me ...": Lessons from Rural Providers

ERIC Educational Resources Information Center

Chipp, Cody; Dewane, Sarah; Brems, Christiane; Johnson, Mark E.; Warner, Teddy D.; Roberts, Laura W.

2011-01-01

Purpose: Health care providers face challenges in rural service delivery due to the unique circumstances of rural living. The intersection of rural living and health care challenges can create barriers to care that providers may not be trained to navigate, resulting in burnout and high turnover. Through the exploration of experienced rural…

Low- and middle-income countries face many common barriers to implementation of maternal health evidence products.

PubMed

Puchalski Ritchie, Lisa M; Khan, Sobia; Moore, Julia E; Timmings, Caitlyn; van Lettow, Monique; Vogel, Joshua P; Khan, Dina N; Mbaruku, Godfrey; Mrisho, Mwifadhi; Mugerwa, Kidza; Uka, Sami; Gülmezoglu, A Metin; Straus, Sharon E

2016-08-01

To explore similarities and differences in challenges to maternal health and evidence implementation in general across several low- and middle-income countries (LMICs) and to identify common and unique themes representing barriers to and facilitators of evidence implementation in LMIC health care settings. Secondary analysis of qualitative data. Meeting reports and articles describing projects undertaken by the authors in five LMICs on three continents were analyzed. Projects focused on identifying barriers to and facilitators of implementation of evidence products: five World Health Organization maternal health guidelines, and a knowledge translation strategy to improve adherence to tuberculosis treatment. Data were analyzed using thematic content analysis. Among identified barriers to evidence implementation, a high degree of commonality was found across countries and clinical areas, with lack of financial, material, and human resources most prominent. In contrast, few facilitators were identified varied substantially across countries and evidence implementation products. By identifying common barriers and areas requiring additional attention to ensure capture of unique barriers and facilitators, these findings provide a starting point for development of a framework to guide the assessment of barriers to and facilitators of maternal health and potentially to evidence implementation more generally in LMICs. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Barriers to Higher Education Entry--A Scottish Rural Perspective

ERIC Educational Resources Information Center

Lasselle, Laurence

2016-01-01

This paper explores some of the unique issues in accessing Higher Education (HE) faced by pupils living in some Scottish rural communities in Argyll & Bute, Highland, Eilean Siar (Western Isles), Orkney Islands and Shetland Islands. Many of these communities are hard to reach and in some of the least deprived areas of Scotland. Despite this,…

Building the Capacity of States to Ensure Inclusion of Rural Communities in State and Local Primary Violence Prevention Planning

ERIC Educational Resources Information Center

Cook-Craig, Patricia G.; Lane, Karen G.; Siebold, Wendi L.

2010-01-01

Rural, frontier, and geographically isolated communities face unique challenges associated with ensuring that they are equal partners in capacity-building and prevention planning processes at the state and local level despite barriers that can inhibit participation. By their nature, rural, frontier, and geographically isolated communities and…

Productive Tensions in a Cross-Cultural Peer Mentoring Women's Network: A Social Capital Perspective

ERIC Educational Resources Information Center

Esnard, Talia; Cobb-Roberts, Deirdre; Agosto, Vonzell; Karanxha, Zorka; Beck, Makini; Wu, Ke; Unterreiner, Ann

2015-01-01

A growing body of researchers documents the unique barriers women face in their academic career progression and the significance of mentoring networks for advancement of their academic trajectories as faculty. However, few researchers explore the embedded tensions and conflicts in the social processes and relations of mentoring networks, and the…

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.

Understanding Barriers and Facilitators to Breast and Cervical Cancer Screening among Muslim Women in New York City: Perspectives from Key Informants.

PubMed

Islam, Nadia; Patel, Shilpa; Brooks-Griffin, Quanza; Kemp, Patrice; Raveis, Victoria; Riley, Lindsey; Gummi, Sindhura; Nur, Potrirankamanis Queano; Ravenell, Joseph; Cole, Helen; Kwon, Simona

2017-01-01

Muslims are one of the fastest growing religious groups in the US. However, little is known about their health disparities, and how their unique cultural, religious, and social beliefs and practices affect health behaviors and outcomes. Studies demonstrate Muslim women may have lower rates of breast and cervical cancer screening compared to the overall population. The purpose of this study was to: 1) conduct key-informant interviews with Muslim community leaders in New York City (NYC), to understand contextual factors that impact Muslim women's beliefs and practices regarding breast and cervical cancer screening; and 2) inform the development and implementation of a research study on breast and cervical cancer screening among Muslims. Twelve key-informant interviews were conducted. The sample included imams, female religious leaders, physicians, community-based organization leaders, and social service representatives. The interview guide assessed: 1) unique healthcare barriers faced by Muslim women; 2) cultural and social considerations in conducting research; 3) potential strategies for increasing screening in this population; and 4) content and venues for culturally tailored programming and messaging. Key informants noted structure and culture as barriers and religion as a facilitator to breast and cervical cancer screening. Themes regarding the development of targeted health campaigns to increase screening included the importance of educational and in-language materials and messaging, and engaging mosques and religious leaders for dissemination. Although Muslim women face a number of barriers to screening, religious beliefs and support structures can be leveraged to facilitate screening and enhance the dissemination and promotion of screening.

Predictors of Colorectal Screening in Rural Colorado: Testing to Prevent Colon Cancer in the High Plains Research Network

ERIC Educational Resources Information Center

Young, Walter F.; McGloin, Joe; Zittleman, Linda; West, David R.; Westfall, John M.

2007-01-01

Context: Colorectal cancer is the second leading cause of cancer death in the United States, yet screening rates are well below target levels. Rural communities may face common and unique barriers to health care, particularly preventive health care. Purpose: To establish baseline attitudinal, knowledge, belief, and behavior measures on colorectal…

Brief Report: The Feasibility and Effectiveness of an Advocacy Program for Latino Families of Children with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Burke, Meghan M.; Magaña, Sandra; Garcia, Marlene; Mello, Maria P.

2016-01-01

Latino, Spanish-speaking families of children with autism spectrum disorder (ASD) face unique barriers in special education advocacy. Although advocacy programs are becoming more common in the United States, none of these programs target Latino families. This is a pilot study to examine the feasibility and effectiveness of an advocacy program for…

Breaking down information barriers: a guide to international research of medical resources on the World Wide Web.

PubMed

Risin, J A

1998-01-01

The purpose of this paper is to facilitate international research of medical resources on the World Wide Web. International research consists of overcoming a unique set of obstacles and challenges that are not involved when undertaking research tasks using only U.S.-based information. Utilizing the World Wide Web can help us to overcome most of the restraints we would have to face when we perform research outside of our local geography. Currently, there are a number of Internet Web sites that may assist us in breaking down the barriers to undertaking international research.

Young Men, Help-Seeking, and Mental Health Services: Exploring Barriers and Solutions.

PubMed

Lynch, Louise; Long, Maggie; Moorhead, Anne

2018-01-01

International research has identified young men as reluctant to seek help for mental health problems. This research explored barriers and solutions to professional help seeking for mental health problems among young men living in the North West of Ireland. A qualitative approach, using two focus groups with six participants each and five face-to-face interviews, was conducted with men aged 18 to 24 years (total N = 17). Data were analyzed using thematic analysis. Seven key themes of barriers to professional help seeking were identified: "acceptance from peers," "personal challenges," "cultural and environmental influences," "self-medicating with alcohol," "perspectives around seeking professional help," "fear of homophobic responses," and "traditional masculine ideals." Five key themes of solutions to these barriers included "tailored mental health advertising," "integrating mental health into formal education," "education through semiformal support services," "accessible mental health care," and "making new meaning." Interesting findings on barriers include fear of psychiatric medication, fear of homophobic responses from professionals, the legacy of Catholic attitudes, and the genuine need for care. This study offers an in-depth exploration of how young men experience barriers and uniquely offers solutions identified by participants themselves. Youth work settings were identified as a resource for engaging young men in mental health work. Young men can be encouraged to seek help if services and professionals actively address barriers, combining advertising, services, and education, with particular attention and respect to how and when young men seek help and with whom they want to share their problems.

Barriers to quality health care for the transgender population.

PubMed

Roberts, Tiffany K; Fantz, Corinne R

2014-07-01

The transgender community is arguably the most marginalized and underserved population in medicine. A special issue focusing on men's health would be incomplete without mention of this vulnerable population, which includes those transitioning to and from the male gender. Transgender patients face many barriers in their access to healthcare including historical stigmatization, both structural and financial barriers, and even a lack of healthcare provider experience in treating this unique population. Historical stigmatization fosters a reluctance to disclose gender identity, which can have dire consequences for long-term outcomes due to a lack of appropriate medical history including transition-related care. Even if a patient is willing to disclose their gender identity and transition history, structural barriers in current healthcare settings lack the mechanisms necessary to collect and track this information. Moreover, healthcare providers acknowledge that information is lacking regarding the unique needs and long-term outcomes for transgender patients, which contributes to the inability to provide appropriate care. All of these barriers must be recognized and addressed in order to elevate the quality of healthcare delivered to the transgender community to a level commensurate with the general population. Overcoming these barriers will require redefinition of our current system such that the care a patient receives is not exclusively linked to their sex but also considers gender identity. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

On and Off the Mat: Yoga Experiences of Middle-Aged and Older Adults.

PubMed

Wertman, Annette; Wister, Andrew V; Mitchell, Barbara A

2016-06-01

This article explores potential differences in yoga practice between middle-and older-aged adults. A health belief - life course model frames this research, and a mixed-methods analytic strategy is employed to examine life course pathways into yoga and motivations to practice, as well as perceived barriers and health benefits. For the quantitative analyses, a convenience sample of 452 participants was collected using an online questionnaire. For the qualitative analyses, face-to-face interviews were conducted with a sub-set of 20 participants. Unique differences between the age groups (both current age and age when started yoga) as well as by gender were found for selected pathways, reasons/motivations, and barriers to engage in yoga as well as for perceived health benefits. In addition, results underscore the importance of informational cues and social linkages that affect how individuals adopt and experience yoga. Implications for health promotion programs that target older adults are discussed.

Not Just a Walk in the Park: Case Study of a Greek Preschool Located on an Educational Farm

ERIC Educational Resources Information Center

Iskos, Eugenia; Karakosta, Stella

2015-01-01

This paper presents a case study of a private preschool in Thessaloniki, Greece. The school, located at the unique setting of an educational farm, has a curriculum focus on environmental education. An analysis of teacher interviews and lesson plans in the span of three years presents insights into the barriers teachers faced in implementing their…

Physical activity barriers and motivators among high-risk employees.

PubMed

Paguntalan, John C; Gregoski, Mathew

2016-11-22

Worksite wellness programs offer an ideal setting to target high-risk sedentary workers to improve health status. Lack of physical activity is associated with increased risk for coronary heart disease and mortality. Despite the risks, the number of sedentary workers is increasing. This study examined the perceived barriers and motivators for physical activity among employees at high-risk for coronary heart disease. A purposive sample of 24 high-risk workers participating in a wellness program in rural South Carolina were enrolled in the study. Qualitative data was obtained through semi-structured face-to-face interviews. Grounded theory was used to analyze qualitative data, and identify overarching themes. Physical limitations due to pain and weakness, lack of motivation, and lack of time emerged as the main barriers to physical activity. Family relationships were reported as the strongest motivator along with social support and potential health benefits. Findings highlight the unique experience of high-risk workers with physical activity. The findingsunderscore the need to design and implement effective interventions specifically designed to meet the needs of high-risk employees.

Understanding Barriers and Facilitators to Breast and Cervical Cancer Screening among Muslim Women in New York City: Perspectives from Key Informants

PubMed Central

Islam, Nadia; Patel, Shilpa; Brooks-Griffin, Quanza; Kemp, Patrice; Raveis, Victoria; Riley, Lindsey; Gummi, Sindhura; Nur, Potrirankamanis Queano; Ravenell, Joseph; Cole, Helen; Kwon, Simona

2017-01-01

Background Muslims are one of the fastest growing religious groups in the US. However, little is known about their health disparities, and how their unique cultural, religious, and social beliefs and practices affect health behaviors and outcomes. Studies demonstrate Muslim women may have lower rates of breast and cervical cancer screening compared to the overall population. Methods The purpose of this study was to: 1) conduct key-informant interviews with Muslim community leaders in New York City (NYC), to understand contextual factors that impact Muslim women’s beliefs and practices regarding breast and cervical cancer screening; and 2) inform the development and implementation of a research study on breast and cervical cancer screening among Muslims. Twelve key-informant interviews were conducted. The sample included imams, female religious leaders, physicians, community-based organization leaders, and social service representatives. The interview guide assessed: 1) unique healthcare barriers faced by Muslim women; 2) cultural and social considerations in conducting research; 3) potential strategies for increasing screening in this population; and 4) content and venues for culturally tailored programming and messaging. Results Key informants noted structure and culture as barriers and religion as a facilitator to breast and cervical cancer screening. Themes regarding the development of targeted health campaigns to increase screening included the importance of educational and in-language materials and messaging, and engaging mosques and religious leaders for dissemination. Conclusion Although Muslim women face a number of barriers to screening, religious beliefs and support structures can be leveraged to facilitate screening and enhance the dissemination and promotion of screening. PMID:29629435

Barrier properties of cultured retinal pigment epithelium.

PubMed

Rizzolo, Lawrence J

2014-09-01

The principal function of an epithelium is to form a dynamic barrier that regulates movement between body compartments. Each epithelium is specialized with barrier functions that are specific for the tissues it serves. The apical surface commonly faces a lumen, but the retinal pigment epithelium (RPE) appears to be unique by a facing solid tissue, the sensory retina. Nonetheless, there exists a thin (subretinal) space that can become fluid filled during pathology. RPE separates the subretinal space from the blood supply of the outer retina, thereby forming the outer blood-retinal barrier. The intricate interaction between the RPE and sensory retina presents challenges for learning how accurately culture models reflect native behavior. The challenge is heightened by findings that detail the variation of RPE barrier proteins both among species and at different stages of the life cycle. Among the striking differences is the expression of claudin family members. Claudins are the tight junction proteins that regulate ion diffusion across the spaces that lie between the cells of a monolayer. Claudin expression by RPE varies with species and life-stage, which implies functional differences among commonly used animal models. Investigators have turned to transcriptomics to supplement functional studies when comparing native and cultured tissue. The most detailed studies of the outer blood-retinal barrier have focused on human RPE with transcriptome and functional studies reported for human fetal, adult, and stem-cell derived RPE. Copyright © 2014 Elsevier Ltd. All rights reserved.

Barriers to performing stretching exercises among Korean-Chinese female migrant workers in Korea.

PubMed

Lee, Hyeonkyeong; Wilbur, JoEllen; Chae, Duckhee; Lee, Kyongeun; Lee, Meenhye

2015-01-01

The purpose of this study was to investigate the barriers to performing stretching exercise experienced by Korean-Chinese female migrant workers during a community-based 12-week stretching exercise intervention trial. Qualitative secondary data analysis was conducted using telephone counseling interview transcripts from 27 middle-aged, Korean-Chinese migrant women workers. A semistructured interview question asking barriers to performing stretching exercise was given to women who did not adhere to recommended stretching exercise. During the 12-week home-based stretching exercise intervention trial, six telephone calls were made to participants biweekly to elicit barriers to performing stretching exercise. Directed content analysis approach was utilized using three barrier categories: intrapersonal, interpersonal, and work-related environmental factors based on the ecological model. Participants experienced an average of 2.5 barriers during the study period. Intrapersonal barriers included lack of time and lack of motivation, and interpersonal barriers included no family to provide support and also a feeling resistance from coworkers. Work-related environmental barriers included frequent job changes, long working hours, lack of rest time, and unpredictable job demands. The findings highlight that migrant workers in Korea face unique work-related difficulties which present barriers to exercise. © 2014 Wiley Periodicals, Inc.

"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.

Safety-Net Hospitals Face More Barriers Yet Use Fewer Strategies to Reduce Readmissions

PubMed Central

Figueroa, Jose F.; Joynt, Karen E.; Zhou, Xiner; Orav, E. John; Jha, Ashish K.

2016-01-01

Objective U.S. hospitals that care for vulnerable populations, “safety-net hospitals” (SNHs), are more likely to incur penalties under the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with higher-than-expected readmissions. Understanding whether SNHs face unique barriers to reducing readmissions or whether they underuse readmission-prevention strategies is important. Design We surveyed leadership at 1,600 U.S. acute care hospitals, of whom 980 participated, between June 2013–January 2014. Responses on 28 questions on readmission-related barriers and strategies were compared between SNHs and non-SNHs, adjusting for non-response and sampling strategy. We further compared responses between high-performing SNHs and low-performing SNHs. Results We achieved a 62% response rate. SNHs were more likely to report patient-related barriers, including lack of transportation, homelessness, and language barriers compared to non-SNHs (p-values<0.001). Despite reporting more barriers, SNHs were less likely to use e-tools to share discharge summaries (70.1% vs. 73.7%, p<0.04) or verbally communicate (31.5% vs. 39.8%, p<0.001) with outpatient providers, track readmissions by race/ethnicity (23.9% vs. 28.6%, p<0.001), or enroll patients in post-discharge programs (13.3% vs. 17.2%, p<0.001). SNHs were also less likely to use discharge coordinators, pharmacists, and post-discharge programs. When we examined the use of strategies within SNHs, we found trends to suggest that high-performing SNHs were more likely to use several readmission strategies. Conclusions Despite reporting more barriers to reducing readmissions, SNHs were less likely to use readmission-reduction strategies. This combination of higher barriers and lower use of strategies may explain why SNHs have higher rates of readmissions and penalties under the HRRP. PMID:28060053

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

PubMed

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

2014-08-01

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

Barriers to offering French language physician services in rural and northern Ontario.

PubMed

Timony, Patrick E; Gauthier, Alain P; Serresse, Suzanne; Goodale, Natalie; Prpic, Jason

2016-01-01

Rural and Northern Ontario francophones face many health-related challenges including poor health status, a poor supply of French-speaking physicians, and the potential for an inability or reduced ability to effectively communicate with anglophone healthcare providers. As such, it can reasonably be expected that rural and Northern Ontario francophones experience barriers when receiving care. However, the experience of physicians working in areas densely populated by francophones is largely unexplored. This paper identifies barriers experienced by French-speaking and Non-French-speaking rural and Northern Ontario physicians when serving francophone patients. A series of key informant interviews were conducted with 18 family physicians practicing in rural and urban francophone communities of Northeastern Ontario. Interviews were analyzed using a thematic analysis process. Five categories of barrier were identified: (1) language discordance, (2) characteristics of francophone patients, (3) dominance of English in the medical profession, (4) lack of French-speaking medical personnel, and (5) physicians' linguistic (in)sensitivity. Some barriers identified were unique to Non-French-speaking physicians (eg language discordance, use of interpreters, feelings of inadequacy), some were unique to French-speaking physicians (eg limited French education and resources), and some were common to both groups (eg lack of French-speaking colleagues/staff, added time commitments, and the particularities of Franco-Ontarian preferences and culture). Healthcare providers and decision makers may take interest in these results. Although physicians were the focus of the present article, the barriers expressed are likely experienced by other healthcare providers, and thus the lessons learned from this article extend beyond the physician workforce. Efforts must be made to offer educational opportunities for physicians and other healthcare providers working in areas densely populated by francophones; these include linguistic and cultural sensitivity training, in addition to teaching strategies for the practice of 'active offer' of French-language services. In sum, the present study outlines the importance of linguistic concordant communication in healthcare delivery, and describes some of the challenges faced when providing French-language services in rural and Northern Ontario.

Enablers and barriers to using two-way information technology in the management of adults with diabetes: A descriptive systematic review.

PubMed

Macdonald, Emma M; Perrin, Byron M; Kingsley, Michael Ic

2017-01-01

Background This systematic review aimed to explore the enablers and barriers faced by adults with diabetes using two-way information communication technologies to support diabetes self-management. Methods Relevant literature was obtained from five databases using search strategies combining four major constructs: adults with diabetes, biomedical technology, communication technology and patient utilisation. Results Of 8430 unique articles identified, 48 were included for review. Risk of bias was assessed using either the Newcastle-Ottowa or Cochrane risk of bias assessment tools. Seventy-one percent of studies were of cohort design with the majority of studies assessed at high or unclear risk of bias. Consistently identified barriers included poorly designed interfaces requiring manual data entry and systems that lacked functionalities valued by patients. Commonly cited enablers included access to reliable technology, highly automated data entry and transmission, graphical display of data with immediate feedback, and supportive health care professionals and family members. Conclusions People with diabetes face a number of potentially modifiable barriers in using technology to support their diabetes management. In order to address these barriers, end users should be consulted in the design process and consideration given to theories of technology adoption to inform design and implementation. Systems should be designed to solve clinical or behavioural problems that are identified by patients as priorities. Technology should be as automated, streamlined, mobile, low cost and integrated as possible in order to limit the burden of usage for the patient and maximise clinical usefulness.

A Sort of Homecoming: Incarceration and the housing security of urban men

PubMed Central

Curtis, Marah A.

2011-01-01

While individuals returning from prison face many barriers to successful re-entry, among the most serious are the challenges they face in securing housing. Housing has long been recognized as a prerequisite for stable employment, access to social services, and other aspects of individual and family functioning. The formerly incarcerated face several administrative and de facto restrictions on their housing options; however, little is known about the unique instabilities that they face. We use a longitudinal survey of urban families to examine housing insecurity among nearly 3,000 urban men, including over 1,000 with incarceration histories. We find that men recently incarcerated face greater housing insecurity, including both serious hardships such as homelessness, and precursors to homelessness such as residential turnover and relying on others for housing expenses. Their increased risk is tied both to diminished annual earnings and other factors, including, potentially, evictions from public housing supported by Federal “one-strike” policies. PMID:21927519

Young Men, Help-Seeking, and Mental Health Services: Exploring Barriers and Solutions

PubMed Central

Lynch, Louise; Long, Maggie; Moorhead, Anne

2016-01-01

International research has identified young men as reluctant to seek help for mental health problems. This research explored barriers and solutions to professional help seeking for mental health problems among young men living in the North West of Ireland. A qualitative approach, using two focus groups with six participants each and five face-to-face interviews, was conducted with men aged 18 to 24 years (total N = 17). Data were analyzed using thematic analysis. Seven key themes of barriers to professional help seeking were identified: “acceptance from peers,” “personal challenges,” “cultural and environmental influences,” “self-medicating with alcohol,” “perspectives around seeking professional help,” “fear of homophobic responses,” and “traditional masculine ideals.” Five key themes of solutions to these barriers included “tailored mental health advertising,” “integrating mental health into formal education,” “education through semiformal support services,” “accessible mental health care,” and “making new meaning.” Interesting findings on barriers include fear of psychiatric medication, fear of homophobic responses from professionals, the legacy of Catholic attitudes, and the genuine need for care. This study offers an in-depth exploration of how young men experience barriers and uniquely offers solutions identified by participants themselves. Youth work settings were identified as a resource for engaging young men in mental health work. Young men can be encouraged to seek help if services and professionals actively address barriers, combining advertising, services, and education, with particular attention and respect to how and when young men seek help and with whom they want to share their problems. PMID:27365212

Acceptability of psychological treatment to Chinese- and Caucasian-Australians: Internet treatment reduces barriers but face-to-face care is preferred.

PubMed

Choi, Isabella; Sharpe, Louise; Li, Stephen; Hunt, Caroline

2015-01-01

Internet treatments have the potential to improve access, especially for cultural groups who face considerable treatment barriers. This study explored the perceived barriers and likelihood of using Internet and face-to-face treatments for depression among Chinese and Caucasian Australian participants. Three-hundred ninety-five (289 Chinese, 106 Caucasian) primary care patients completed a questionnaire about depression history, previous help-seeking, perceived barriers to Internet and face-to-face treatment, and likelihood of using either treatment for depressive symptoms. Internet treatment reduced perceived barriers (including stigma, lack of motivation, concerns of bringing up upsetting feelings, time constraints, transport difficulties, and cost) for both groups to a similar degree, except for time constraints. There were heightened concerns about the helpfulness, suitability, and confidentiality of Internet treatments. Chinese participants and individuals with a probable depression history reported increased perceived barriers across treatments. Both Chinese and Caucasian groups preferred face-to-face treatment across depression severity. However, when age was controlled, there were no significant concerns about Internet treatment, and face-to-face treatment was only preferred for severe depression. Only 12 % of the entire sample refused to try Internet treatment for depression. Endorsement of perceived Internet treatment barriers (including concerns of bringing up upsetting feelings, that treatment would be unhelpful or unsuitable, lack of motivation, cost, cultural sensitivity, and confidentiality) reduced the likelihood to try Internet treatments. Internet treatment reduced perceived treatment barriers across groups, with encouraging support for Internet treatment as an acceptable form of receiving help. Negative concerns about Internet treatment need to be addressed to encourage use.

Addressing the healthcare needs of older Lesbian, Gay, Bisexual, and Transgender patients in medical school curricula: a call to action.

PubMed

Cannon, Sophie M; Shukla, Vipul; Vanderbilt, Allison A

2017-01-01

Medical students matriculating in the coming years will be faced with treating an expansive increase in the population of older lesbian, gay, bisexual, and transgender (LGBT) patients. While these patients face healthcare concerns similar to their non-LGBT aging peers, the older LGBT community has distinct healthcare needs and faces well-documented healthcare disparities. In order to reduce these healthcare barriers, medical school curricula must prepare and educate future physicians to treat this population while providing high quality, culturally-competent care. This article addresses some of the unique healthcare needs of the aging LGBT population with an emphasis on social concerns and healthcare disparities. It provides additional curricular recommendations to aid in the progressive augmentation of medical school curricula. Liaison Committee on Medical Education (LCME); LGBT: Lesbian, gay, bisexual, transgender.

When Science is Not Enough: A Framework Towards More Customer-Focused Drug Development.

PubMed

Oraiopoulos, Nektarios; Dunlop, William C N

2017-07-01

The purpose of this study was to identify the key barriers to a customer-focused drug development process and develop a comprehensive framework to overcome them. The paper draws on existing literature, both academic and practitioner, across a range of disciplines (innovation management, marketing, organizational behavior, behavioral economics, health economics, industry reports). On the basis of this extensive review, a conceptual framework is developed that offers concrete suggestions on how organizations can overcome the barriers and enable a more customer-focused development process. The barriers to collaboration are organized into three distinct categories (economic, behavioral, organizational), and within each category, a one-to-one mapping between barriers and solutions is developed. The framework is specifically designed with the objective of offering actionable and practical advice to executives who face these challenges in their organizations. The paper provides a unique theoretical contribution by synthesizing findings from several academic disciplines with concrete examples from the pharmaceutical industry. Mundipharma International Limited.

Evidence-based practice and research utilization activities among rural nurses.

PubMed

Olade, Rosaline A

2004-01-01

To identify the extent to which rural nurses utilize evidence-based practice guidelines from scientific research in their practice; to describe both previous and current research utilization activities in which they have participated, and to identify the specific barriers they face in their practice settings. Data for this descriptive study were collected through questionnaires with open-ended questions focused on (a) current utilization of nursing research findings, (b) previous involvement in nursing research activities, and (c) participation in medical research activities. The participants were 106 nurses from various practice areas in six rural counties of a southwestern state in the United States. Results revealed that only 20.8% of the participants stated they were currently involved in research utilization, and they were mostly nurses with bachelor's degrees. The two most common areas of current research utilization were pain management and pressure ulcer prevention and management. Barriers to research utilization, such as rural isolation and lack of nursing research consultants, were identified. The types of research utilization activities identified by these nurses indicate how much the facilities in which these nurses work in the rural areas are striving with the utilization of available scientific evidence. Rural nurses face unique barriers related to situational and geographic factors, with implications for nursing administrators, researchers, and educators.

'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.

Addressing the unique psychosocial barriers to breast cancer treatment experienced by African-American women through integrative navigation.

PubMed

Chatman, Michelle C; Green, Rodney D

2011-12-01

African-American women face a disproportionally high breast cancer mortality rate and a significantly low five-year survival rate after breast cancer treatment. This study investigated, through a series of focus groups, how 32 African-American women (N = 32) breast cancer patients and survivors managed their cancer-related health needs. Participants also reported important barriers to care including problematic interactions with medical professionals, challenges in intimate relations, difficulties in handling the stigma and myths about breast cancer, and the psychological challenges that they faced. A patient navigation model was implemented at an eastern urban hospital that emphasized integrative therapies such as meditation, nutritional instruction, and yoga. Follow-up telephone interviews with 37 additional African-American participants (N = 37) indicated the rating of effectiveness to be at 3.8 to 3.9 out of 4 for the integrative patient navigation program. Over half of the survivors reported using some complementary techniques after treatment was completed, thus suggesting a long-term improvement in their quality of life as a result of the integrative techniques.

Concerns and Structural Barriers Associated with WIC Participation among WIC-Eligible Women.

PubMed

Liu, Cindy H; Liu, Heidi

2016-09-01

To examine sociodemographic status, psychosocial concerns, and structural barriers associated with women's participation in the USDA's Women, Infants, and Children (WIC) program among those eligible for the program. A total of 1,634 White, African-American, Hispanic, and Asian/Pacific Islander (A/PI) women from the New York City area completed the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2004 to 2007, a population-based survey. Data on WIC eligibility and participation, sociodemographic details, unintended pregnancy, social support, and structural barriers were evaluated. Hispanics and Blacks were 4.1 and 2.4 times more likely to participate, respectively, in the WIC program relative to Whites. Mothers reporting unplanned pregnancies, fewer social supports, and more structural barriers (e.g., transportation) were less likely to participate in WIC. Race-stratified analyses revealed race/ethnic differences in the pattern of barriers; unintended pregnancy and structural problems were barriers associated with WIC participation particularly for A/PI. WIC-eligible women with unintended pregnancies and fewer social supports tend to participate in WIC, but those who experience more structural barriers are less likely to participate. A/PI women may face specific challenges to WIC participation. Careful attention is needed to understand the unique attitudes and behaviors in the process of participating in WIC. © 2016 Wiley Periodicals, Inc.

The role of saliva in tick feeding.

PubMed

Francischetti, Ivo M B; Sa-Nunes, Anderson; Mans, Ben J; Santos, Isabel M; Ribeiro, Jose M C

2009-01-01

When attempting to feed on their hosts, ticks face the problem of host hemostasis (the vertebrate mechanisms that prevent blood loss), inflammation (that can produce itching or pain and thus initiate defensive behavior on their hosts) and adaptive immunity (by way of both cellular and humoral responses). Against these barriers, ticks evolved a complex and sophisticated pharmacological armamentarium, consisting of bioactive lipids and proteins, to assist blood feeding. Recent progress in transcriptome research has uncovered that hard ticks have hundreds of different proteins expressed in their salivary glands, the majority of which have no known function, and include many novel protein families (e.g., their primary structure is unique to ticks). This review will address the vertebrate mechanisms of these barriers as a guide to identify the possible targets of these large numbers of known salivary proteins with unknown function. We additionally provide a supplemental Table that catalogues over 3,500 putative salivary proteins from various tick species, which might assist the scientific community in the process of functional identification of these unique proteins. This supplemental file is accessble fromhttp://exon.niaid.nih.gov/transcriptome/tick_review/Sup-Table-1.xls.gz.

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

PubMed

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

2014-12-01

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

Healthcare e-commerce: connecting with patients.

PubMed

Joslyn, J S

2001-01-01

Electronically connecting with patients is a challenging frontier at which technical hurdles are probably exceeded by political, legal, and other barriers. The rise of consumerism, however, compels a response focused more on revenue and strategic advantage than on pure cost savings. Among the difficulties faced by providers is choosing among various models of connectivity and component function. Emerging models include "free-floating" personal medical records largely independent of the office-based physician, systems with compatible and intertwined physician and consumer relationships using an application services provider office practice system, and systems that connect patients and providers through e-mail, office triage, prescription refills, scheduling, and so on. This article discusses these and other combinations of technology that significantly overcome the barriers involved and that may be woven together to provide solutions uniquely suited to various competitive situations.

Refugee Health: An Ongoing Commitment and Challenge

PubMed Central

Efird, Jimmy T.; Bith-Melander, Pollie

2018-01-01

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

Women residents, women physicians and medicine's future.

PubMed

Serrano, Karen

2007-08-01

The number of women in medicine has increased dramatically in the last few decades, and women now represent half of all incoming medical students. Yet residency training still resembles the historical model when there were few women in medicine. This article reviews the issues facing women in residency today. Data suggest that the experience of female residents is more negative than that of males. Unique challenges facing female residents include the existence of gender bias and sexual harassment, a scarcity of female mentors in leadership positions, and work/family conflicts. Further research is needed to understand the experience of female residents and to identify barriers that hinder their optimal professional and personal development. Structural and cultural changes to residency programs are needed to better accommodate the needs of female trainees.

Future implications of eHealth interventions for chronic pain management in underserved populations.

PubMed

DeMonte, Colette M; DeMonte, William D; Thorn, Beverly E

2015-01-01

Many underserved communities, especially those in rural settings, face unique challenges that make high quality healthcare less accessible. The implementation of eHealth technologies has become a potentially valuable option to disseminate interventions. The authors' work in rural Alabama Federally Qualified Health Centers provide insights into the access to technology as well as the likelihood of utilizing eHealth technology in underserved communities. This paper will review current challenges related to digital dissemination of behavioral health interventions for chronic pain. Two major concerns are the lack of technological resources and the lack of appropriate materials for patients who may have low levels of reading, health and/or digital literacy. We will propose some recommendations to address common barriers faced by those providing care.

Exploring barriers to and enablers of adequate healthcare for Indigenous Australian prisoners with cancer: a scoping review drawing on evidence from Australia, Canada and the United States.

PubMed

Olds, Jessica; Reilly, Rachel; Yerrell, Paul; Stajic, Janet; Micklem, Jasmine; Morey, Kim; Brown, Alex

International frameworks supported by national principles in Australia stipulate that prisoners should be provided with health services equivalent to those provided in the general community. However, a number of barriers unique to the prison system may hinder the provision of equitable healthcare for this population. In Australia, Indigenous people carry a greater burden of cancer mortality, which the Cancer Data and Aboriginal Disparities (CanDAD) project is seeking to address. During the course of recruiting participants to the CanDAD study, Indigenous Australian prisoners with cancer emerged as an important, under-researched but difficult to access sub-group. This scoping review sought to identify barriers and facilitators of access to adequate and equitable healthcare for Indigenous Australian prisoners with cancer in Australia. This review demonstrated a lack of research and, as such, the scoping review was extended to prisoners with cancer in Australia, New Zealand, the United States and Canada. This approach was taken in order to summarise the existing body of evidence regarding the barriers and facilitators of access to adequate and equitable healthcare for those who are incarcerated and suffering from cancer, and highlight areas that may require further investigation. Eight studies or commentaries were found to meet the inclusion criteria. This limited set of findings pointed to a range of possible barriers faced by prisoners with cancer, including a tension between the prisons' concern with security versus the need for timely access to medical care. Findings identified here offer potential starting points for research and policy development. Further research is needed to better elucidate how barriers to adequate cancer care for prisoners may be identified and overcome, in Australia and internationally. Furthermore, given Indigenous Australians' over-burden of cancer mortality and over-representation in the prison system, further research is needed to identify whether there are a unique set of barriers for this group.

Getting to More Effective Weight Management in Antipsychotic-Treated Youth: A Survey of Barriers and Preferences.

PubMed

Nicol, Ginger; Worsham, Elizabeth; Haire-Joshu, Debra; Duncan, Alexis; Schweiger, Julia; Yingling, Michael; Lenze, Eric

2016-02-01

Mentally ill youth are at risk for developing obesity, especially when they require antipsychotic treatment; moreover, they may face unique challenges in adhering to behavioral weight loss interventions. The aims of this project were to characterize the challenges families of youth with psychiatric disorders face when engaging in weight loss treatment and to gather information on attitudes and preferences for weight management interventions in this population. We devised a telephone survey to evaluate caregiver-perceived barriers/challenges to and preferences for behavioral weight loss treatment in overweight or obese mentally ill youth ages 6-18 treated with an antipsychotic agent in an outpatient setting. A total of 26 parents or primary caregivers completed the survey. The most commonly cited barriers to participation in physical activity (PA) and maintaining a healthy diet were child's dislike of PA and child's preference for energy-dense foods, respectively, which were impacted by psychiatric symptoms. Preferences for weight loss treatment included individualized, prescribed meal plans and shopping lists, and exercise support/demonstration, with a preference for Internet or cell phone applications to help with monitoring food intake and exercise. These results suggest that targets for obesity treatment in this population include individualized, specific support that takes into account the child's motivation, which is effected by psychiatric symptoms. Tools for providing support may include the use of telehealth visits and mobile device applications for self-monitoring.

Identifying Barriers and Pathways to Success for Renewable Energy Development on American Indian Lands

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

Necefer, Len Edward; Jones, Thomas Elisha

American Indian tribes possess lands rich with renewable energy (RE) resources. Tribes have great potential and need to develop these resources, yet face a host of barriers that continue to impede development. Understanding these challenges as well as the pathways that can be taken to overcome them may facilitate more economic development to meet community needs and better position tribes to play a role in securing a low-carbon energy future for the United States. This paper presents the results of an expert elicitation of 24 tribal energy experts from federal, tribal, academic, and private industry backgrounds to identify barriers andmore » opportunities for federally recognized tribes in the lower 48 states. Experts identified a number of unique challenges facing tribes including financing and funding, infrastructure, tribal leadership and staff, state-level influence, and partnerships. Cultural factors were seen only to be of concern with large-scale development. Tribal sovereignty is a significant motivation for RE development and has yet to be fully realized. Cultural considerations are critical to the success of future projects; smaller residential and community-scale projects may be a better fit. Improving partnerships between tribes and the private sector can increase RE deployment and overcome historical distrust. States can have a double-ended influence on projects within tribal lands through taxation.« less

An innovative program to address learning barriers in small schools: Washington State School Nurse Corps.

PubMed

Fast, Gail Ann; Gray, Lorali; Miles-Koehler, Mona

2013-01-01

While all schools in Washington State have had to deal with shrinking financial resources, small, rural school districts, with fewer than 2,000 students, face unique circumstances that further challenge their ability to meet rising student health needs. This article will explore how small districts utilize the services of the Washington State School Nurse Corps (SNC), an innovative program that supports student health and safety while reducing barriers to learning. Through direct registered nursing services and regional nurse administrative consultation and technical assistance, the SNC strengthens rural school districts' capacity to provide a safe and healthy learning environment. In addition, we will examine current research that links health and learning to discover how the SNC model is successful in addressing health risks as barriers to learning. Lastly, as resources continue to dwindle, partnerships between schools, the SNC, and state and local health and education organizations will be critical in maintaining health services and learning support to small, rural schools.

Barrier Coverage for 3D Camera Sensor Networks

PubMed Central

Wu, Chengdong; Zhang, Yunzhou; Jia, Zixi; Ji, Peng; Chu, Hao

2017-01-01

Barrier coverage, an important research area with respect to camera sensor networks, consists of a number of camera sensors to detect intruders that pass through the barrier area. Existing works on barrier coverage such as local face-view barrier coverage and full-view barrier coverage typically assume that each intruder is considered as a point. However, the crucial feature (e.g., size) of the intruder should be taken into account in the real-world applications. In this paper, we propose a realistic resolution criterion based on a three-dimensional (3D) sensing model of a camera sensor for capturing the intruder’s face. Based on the new resolution criterion, we study the barrier coverage of a feasible deployment strategy in camera sensor networks. Performance results demonstrate that our barrier coverage with more practical considerations is capable of providing a desirable surveillance level. Moreover, compared with local face-view barrier coverage and full-view barrier coverage, our barrier coverage is more reasonable and closer to reality. To the best of our knowledge, our work is the first to propose barrier coverage for 3D camera sensor networks. PMID:28771167

Barrier Coverage for 3D Camera Sensor Networks.

PubMed

Si, Pengju; Wu, Chengdong; Zhang, Yunzhou; Jia, Zixi; Ji, Peng; Chu, Hao

2017-08-03

Barrier coverage, an important research area with respect to camera sensor networks, consists of a number of camera sensors to detect intruders that pass through the barrier area. Existing works on barrier coverage such as local face-view barrier coverage and full-view barrier coverage typically assume that each intruder is considered as a point. However, the crucial feature (e.g., size) of the intruder should be taken into account in the real-world applications. In this paper, we propose a realistic resolution criterion based on a three-dimensional (3D) sensing model of a camera sensor for capturing the intruder's face. Based on the new resolution criterion, we study the barrier coverage of a feasible deployment strategy in camera sensor networks. Performance results demonstrate that our barrier coverage with more practical considerations is capable of providing a desirable surveillance level. Moreover, compared with local face-view barrier coverage and full-view barrier coverage, our barrier coverage is more reasonable and closer to reality. To the best of our knowledge, our work is the first to propose barrier coverage for 3D camera sensor networks.

Small Groups in a Social Learning MOOC (sIMOOC): Strategies for Fostering Learning and Knowledge Creation

ERIC Educational Resources Information Center

Krasny, Marianne E.; DuBois, Bryce; Adameit, Mechthild; Atiogbe, Ronnie; Alfakihuddin, Muhammad Lukman Baihaqi; Bold-erdene, Tergel; Golshani, Zahra; González-González, Rodrigo; Kimirei, Ishmael; Leung, Yamme; Shian-Yun, Lo; Yao, Yue

2018-01-01

Social support and face-to-face learning may enhance outcomes for students who face barriers in accessing Massive Open Online Courses (MOOCs). This study investigated how self-identified volunteer leaders guide and foster interactions among small groups of students who face technical and conceptual barriers in accessing MOOC content. Several…

An emancipatory research on CBR and the barriers faced by persons with disabilities.

PubMed

Deepak, Sunil; Kumar, Jayanth; Ramasamy, Parthipan; Griffo, Giampiero

2014-01-01

Abstract Purpose: The aim of this research was to understand the barriers faced by persons with disabilities in their daily lives and the role of CBR projects in overcoming them. A group of persons with disabilities involved in CBR activities was identified and trained in participatory research methodologies. Research was carried out, with support from a scientific advisory group, through sharing of life stories in residential meetings focusing on specific themes. These meetings were attended by 368 persons with disabilities. The barriers identified ranged from isolation, neglect, abuse and violence to lack of access to social, health, education and livelihood opportunities. People faced their first barriers in their own families. Families also played an important role in overcoming some barriers at the individual level. CBR projects assisted people in overcoming barriers mainly by providing information, by facilitating access to existing support and by helping persons in communities to take collective action against the barriers. The research also stimulated DPOs and CBR projects to identify some gaps in tackling the barriers and to start action to overcome them. CBR projects can play a role in overcoming some barriers faced by persons with disabilities. Emancipatory research yields rich data, facilitates ownership and possibly future sustainability. Implications for Rehabilitation Community-based rehabilitation (CBR) programmes can promote mainstreaming and helping in overcoming some barriers faced by persons with disabilities in the communities. CBR programmes can facilitate collective action by persons with disabilities in overcoming barriers to inclusion and participation. Participatory research approaches such as emancipatory research can play a role in understanding disability issues and at the same time, help CBR programmes to identify gaps and strengthen activities.

Implementing an ally development model to promote safer schools for LGB youth: a trans-disciplinary approach.

PubMed

Zammitt, Kimberly A; Pepperell, Jennifer; Coe, Megan

2015-01-01

Lesbian, gay, and bisexual (LGB) students experience ongoing bullying, harassment, and lack of safety in school. Specialized instructional support personnel (SISPs), such as school counselors, school social workers, and school psychologists, are in a unique position to advocate for LGB students and to implement an ally development model. The purpose of this article is to describe the current climate for LGB students, to discuss the current barriers facing SISPs in advocating for change, and to provide a model of ally development for use at each level of the K-12 system.

Barriers to involvement in physical activities of persons with mental illness.

PubMed

Shor, Ron; Shalev, Anat

2016-03-01

Participating in physical activities could be essential for reducing the multiple risk factors for health problems that persons with severe mental illness (SMI) may suffer. However, people with SMI are significantly less active than the general population. To develop knowledge about factors related to the perceived barriers hindering this population's participation in physical activities and the benefits this participation would have, a study was conducted in Israel with 86 people with mental illness living in community mental health facilities prior to their participation in a health promotion program. A mixed method was implemented and included: a scale designed to measure participants' perceptions of the barriers to and benefits of involvement in physical activities; instruments focusing on bio-psycho-social factors that may affect the level of barriers experienced; and personal interviews. The findings revealed high ranking for accessibility barriers hindering the participation in physical activities. Bio-psycho-social factors stemming from the participants' mental health, such as level of depression, were correlated with higher ranking of accessibility barriers. Bio-psycho-social factors reflecting positive mental health and health, such as positive appraisal of body weight, were correlated with lower ranking of accessibility barriers. Other barriers may include organizational and broader systemic barriers in the mental health facilities where the participants reside. These findings illuminate the need to consider the unique challenges that persons with mental illness may face in any attempt to advance their involvement in physical activity. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Barriers and enablers to healthcare access and use among Arabic-speaking and Caucasian English-speaking patients with type 2 diabetes mellitus: a qualitative comparative study

PubMed Central

Alzubaidi, H; Mc Namara, K; Browning, Colette; Marriott, J

2015-01-01

Objective The objective of this study was to explore the decision-making processes and associated barriers and enablers that determine access and use of healthcare services in Arabic-speaking and English-speaking Caucasian patients with diabetes in Australia. Study setting and design Face-to-face semistructured individual interviews and group interviews were conducted at various healthcare settings—diabetes outpatient clinics in 2 tertiary referral hospitals, 6 primary care practices and 10 community centres in Melbourne, Australia. Participants A total of 100 participants with type 2 diabetes mellitus were recruited into 2 groups: 60 Arabic-speaking and 40 English-speaking Caucasian. Data collection Interviews were audio-taped, translated into English when necessary, transcribed and coded thematically. Sociodemographic and clinical information was gathered using a self-completed questionnaire and medical records. Principal findings Only Arabic-speaking migrants intentionally delayed access to healthcare services when obvious signs of diabetes were experienced, missing opportunities to detect diabetes at an early stage. Four major barriers and enablers to healthcare access and use were identified: influence of significant other(s), unique sociocultural and religious beliefs, experiences with healthcare providers and lack of knowledge about healthcare services. Compared with Arabic-speaking migrants, English-speaking participants had no reluctance to access and use medical services when signs of ill-health appeared; their treatment-seeking behaviours were straightforward. Conclusions Arabic-speaking migrants appear to intentionally delay access to medical services even when symptomatic. Four barriers to health services access have been identified. Tailored interventions must be developed for Arabic-speaking migrants to improve access to available health services, facilitate timely diagnosis of diabetes and ultimately to improve glycaemic control. PMID:26576809

A qualitative analysis of barriers, challenges, and successes in meeting the needs of Hurricane Katrina evacuee families.

PubMed

Legerski, John-Paul; Vernberg, Eric M; Noland, Brian J

2012-12-01

Hurricane Katrina caused many individuals to evacuate to towns and cities throughout the United States. Psychological First Aid (PFA) is a treatment program designed to help clinicians and other disaster relief workers address the needs of adults, youth, and families immediately following disasters. We conducted focus groups with disaster relief and evacuee service providers in the Kansas City Metro Area as an exploratory study to identify their perceptions of the needs of evacuees. Participants identified a number of mental health needs, as well as displacement-related challenges, including loss of social support, material loss, unemployment, and other stressful life events that were secondary to the hurricane. Many of these needs are consistent with principles presented in the PFA manual. We also found that service providers faced unique challenges when attempting to assist evacuees. We discuss implications of these findings for treatment programs and provide suggestions for addressing barriers to care.

Measurements of Sexuality-Based Stigma among Gay, Bisexual, and Other Men Who Have Sex with Men (GBMSM) in Resource-Poor Settings: A Review.

PubMed

Freeland, Ryan; Rogers, Erin; van Rooyen, Heidi; Darbes, Lynae; Saylor, Kate; Stephenson, Rob

2018-05-01

Gay, bisexual, and other men who have sex with men (GBMSM) in resource-poor settings are disproportionately affected by the HIV/AIDS epidemic. GBMSM living in these settings may face unique barriers to HIV prevention, including legal barriers and increased sexuality-based stigma. It is therefore imperative to tailor HIV prevention and care resources to recognize the lived realities of GBMSM in these settings. Central to this is the accurate measurement of sexuality-based stigma. However, there is wide inconsistency in how sexuality-based stigma is measured among GBMSM in resource-poor settings. This paper reviews recent studies of sexuality-based stigma among GBMSM in resource-poor settings, finding great variability in measurements. The results of the review call for greater attention to the development of contextually and culturally specific measures of sexuality-based stigma for GBMSM living in resource-poor settings.

Advancement of Women in the Biomedical Workforce: Insights for Success

PubMed Central

Barfield, Whitney L.; Plank-Bazinet, Jennifer L.; Clayton, Janine Austin

2016-01-01

Women continue to face unique barriers in the biomedical workforce that affect their advancement and retention in this field. The National Institutes of Health (NIH) formed the Working Group on Women in Biomedical Careers to address these issues. Through the efforts of the Working Group, the NIH funded 14 research grants to identify barriers or to develop and/or test interventions to support women in the biomedical workforce. The grantees that were funded through this endeavor later established the grassroots Research Partnership on Women in Biomedical Careers, and they continue to conduct research and disseminate information on the state of women in academic medicine. This Commentary explores the themes introduced in a collection of articles organized by the Research Partnership and published in this issue of Academic Medicine. The authors highlight the role government plays in the advancement of women in academic medicine and highlight the findings put forward in this collection. PMID:27306970

Advancement of Women in the Biomedical Workforce: Insights for Success.

PubMed

Barfield, Whitney L; Plank-Bazinet, Jennifer L; Austin Clayton, Janine

2016-08-01

Women continue to face unique barriers in the biomedical workforce that affect their advancement and retention in this field. The National Institutes of Health (NIH) formed the Working Group on Women in Biomedical Careers to address these issues. Through the efforts of the working group, the NIH funded 14 research grants to identify barriers or to develop and/or test interventions to support women in the biomedical workforce. The grantees that were funded through this endeavor later established the grassroots Research Partnership on Women in Biomedical Careers, and they continue to conduct research and disseminate information on the state of women in academic medicine. This Commentary explores the themes introduced in a collection of articles organized by the research partnership and published in this issue of Academic Medicine. The authors highlight the role that government plays in the advancement of women in academic medicine and highlight the findings put forward in this collection.

A service-learning project to eliminate barriers to oral care for children with special health care needs.

PubMed

DeMattei, Ronda R; Allen, Jessica; Goss, Breanna

2012-06-01

Children with special health care needs face many barriers to oral care and are at high risk for oral disease. School nurses are in a unique position to promote oral wellness in this vulnerable population. Collaboration between school nurses and dental hygiene faculty resulted in the formation of a partnership between a university-based dental hygiene program and two special education districts in rural southern Illinois. Senior dental hygiene students participated in a school-based service-learning project that provided dental examinations, preventive services, and education to children with special health care needs. Evidence-based behavioral interventions were used to teach children to comply with oral procedures. School nurses mentored dental hygiene students in behavior management of children. Dental exams were provided to 234 children from four special education schools with the majority receiving cleanings and fluoride.

Faculty' Technology Barriers Faced within the Framework of Quality Processes: SAU Sample

ERIC Educational Resources Information Center

Elmas, Muzaffer

2012-01-01

This research was carried out to determine technology barriers faced by the instructors within the framework of quality processes conducted at the University of Sakarya.Therefore, technology barriers encountered in the process of teaching while using web sites developed in order to manage quality operations from a single center were examined…

Intimate Partner Violence and Women with Severe Mental Illnesses: Needs and Challenges from the Perspectives of Behavioral Health and Domestic Violence Service Providers.

PubMed

Van Deinse, Tonya B; Wilson, Amy Blank; Macy, Rebecca J; Cuddeback, Gary S

2018-05-22

Women with severe mental illnesses face high rates of violence victimization, yet little is understood about the unique needs and challenges these women present to the domestic violence and behavioral health agencies that serve them. To help address this knowledge gap, focus groups were conducted with 28 staff members from local behavioral health and domestic violence service agencies. Results from this exploratory study suggest that women with severe mental illnesses who experience intimate partner violence face additional challenges that exacerbate behavioral health and domestic violence issues and put these women at greater risk for continued victimization. DV and behavioral health agency staff experience individual-, provider-, and system-level barriers to serving this high-risk, high-need population. Recommendations and implications for domestic violence and behavioral health providers are discussed.

Implementing a complex rehabilitation intervention in a stroke trial: a qualitative process evaluation of AVERT.

PubMed

Luker, Julie A; Craig, Louise E; Bennett, Leanne; Ellery, Fiona; Langhorne, Peter; Wu, Olivia; Bernhardt, Julie

2016-05-10

The implementation of multidisciplinary stroke rehabilitation interventions is challenging, even when the intervention is evidence-based. Very little is known about the implementation of complex interventions in rehabilitation clinical trials. The aim of study was to better understand how the implementation of a rehabilitation intervention in a clinical trial within acute stroke units is experienced by the staff involved. This qualitative process evaluation was part of a large Phase III stroke rehabilitation trial (AVERT). A descriptive qualitative approach was used. We purposively sampled 53 allied health and nursing staff from 19 acute stroke units in Australia, New Zealand and Scotland. Semi-structured interviews were conducted by phone, voice-internet, or face to face. Digitally recorded interviews were transcribed and analysed by two researchers using rigorous thematic analysis. Our analysis uncovered ten important themes that provide insight into the challenges of implementing complex new rehabilitation practices within complex care settings, plus factors and strategies that assisted implementation. Themes were grouped into three main categories: staff experience of implementing the trial intervention, barriers to implementation, and overcoming the barriers. Participation in the trial was challenging but had personal rewards and improved teamwork at some sites. Over the years that the trial ran some staff perceived a change in usual care. Barriers to trial implementation at some sites included poor teamwork, inadequate staffing, various organisational barriers, staff attitudes and beliefs, and patient-related barriers. Participants described successful implementation strategies that were built on interdisciplinary teamwork, education and strong leadership to 'get staff on board', and developing different ways of working. The AVERT stroke rehabilitation trial required commitment to deliver an intervention that needed strong collaboration between nurses and physiotherapists and was different to current care models. This qualitative process evaluation contributes unique insights into factors that may be critical to successful trials teams, and as AVERT was a pragmatic trial, success factors to delivering complex intervention in clinical practice. AVERT registered with Australian New Zealand Clinical Trials Registry ACTRN12606000185561 .

An Exploration of Turkish Teachers' Attributions to Barriers Faced within Learner-Centred Teaching

ERIC Educational Resources Information Center

Soysal, Y.; Radmard, S.

2017-01-01

This study explored Turkish teachers' attributional reasoning regarding the barriers they face when they attempted to undertake learner-centred teaching, which is a core requirement of educational reform-based initiations in Turkey. To achieve this aim, a naturalistic inquiry was conducted in order to capture the clarifications of the barriers and…

Barriers Facing Physicians Practicing Evidence-Based Medicine in Saudi Arabia

ERIC Educational Resources Information Center

Al-Almaie, Sameeh M.; Al-Baghli, Nadira

2004-01-01

Introduction: Tremendous advances in health care have been made through the development of evidence-based medicine (EBM). Studies show that physicians face barriers in practice, preventing the effective use of the best evidence available. Insight into these barriers should pave the way for an action plan to remove them. The aim of this study was…

Implementation of Technology-based Patient Engagement Strategies within Practice-based Research Networks.

PubMed

Careyva, Beth; Shaak, Kyle; Mills, Geoffrey; Johnson, Melanie; Goodrich, Samantha; Stello, Brian; Wallace, Lorraine S

2016-01-01

Technology-based patient engagement strategies (such as patient portals) are increasingly available, yet little is known about current use and barriers within practice-based research networks (PBRNs). PBRN directors have unique opportunities to inform the implementation of patient-facing technology and to translate these findings into practice. PBRN directors were queried regarding technology-based patient engagement strategies as part of the 2015 CAFM Educational Research Alliance (CERA) survey of PBRN directors. A total of 102 PBRN directors were identified via the Agency for Healthcare Research and Quality's registry; 54 of 96 eligible PBRN directors completed the survey, for a response rate of 56%. Use of technology-based patient engagement strategies within PBRNs was limited, with less than half of respondents reporting experience with the most frequently named tools (risk assessments/decision aids). Information technology (IT) support was the top barrier, followed by low rates of portal enrollment. For engaging participant practices, workload and practice leadership were cited as most important, with fewer respondents noting concerns about patient privacy. Given limited use of patient-facing technologies, PBRNs have an opportunity to clarify the optimal use of these strategies. Providing IT support and addressing clinician concerns regarding workload may facilitate the inclusion of innovative technologies in PBRNs. © Copyright 2016 by the American Board of Family Medicine.

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.

Engaging African American Faith-Based Organizations in Adolescent HIV Prevention.

PubMed

Woods-Jaeger, Briana A; Carlson, Mamie; Taggart, Tamara; Riggins, Linda; Lightfoot, Alexandra F; Jackson, Melvin R

2015-08-01

To reduce current HIV disparities among African American youth, it is imperative to find effective ways to extend the reach of evidence-based HIV prevention. One promising community resource to support this effort is faith-based organizations (FBOs), a credible and respected resource in the African American community. This paper describes the experiences, perceptions, and challenges that African American FBOs and faith leaders face in engaging in adolescent HIV prevention and highlights facilitators and barriers to implementing HIV prevention in African American FBOs. The findings suggest that African American FBOs and faith-based leaders are uniquely positioned to be instrumental resources in reducing African American youth HIV disparities.

Barriers faced by Ugandan university students in seeking medical care and sexual health counselling: a cross-sectional study.

PubMed

Boltena, Andualem Tadesse; Khan, Farhad Ali; Asamoah, Benedict O; Agardh, Anette

2012-11-16

Meeting the medical and sexual health care needs of young people is crucial for sustainable development. In Uganda, youth are faced with a number of challenges related to accessing medical care and sexual health counselling services. This study sought to investigate the barriers faced by Ugandan university students in seeking medical care and sexual health counselling. This study is part of a cross-sectional survey conducted in 2005 among 980 students at Mbarara University of Science and Technology. Data was collected by means of a self-administered 11-page questionnaire. The barriers encountered by respondents in seeking medical care and sexual health counselling were classified into three categories reflecting the acceptability, accessibility, or availability of services. Two out of five students reported unmet medical care needs, and one out of five reported unmet sexual health counselling needs. Acceptability of services was the main barrier faced by students for seeking medical care (70.4%) as well as for student in need of sexual health counselling (72.2%), regardless of age, gender, self-rated health, and rural/peri-urban or urban residence status. However, barriers differed within the various strata. There was a significant difference (p-value 0.01) in barriers faced by students originally from rural versus peri-urban/urban areas in seeking medical care (acceptability: 64.8%/74.5%, accessibility: 22.0% /12.6%, availability 13.2%/12.9%, respectively). Students who reported poor self-rated health encountered barriers in seeking both medical care and sexual health counselling that were significantly different from their other counterparts (p-value 0.001 and 0.007 respectively). Barriers faced by students in seeking medical and sexual health care should be reduced by interventions aimed at boosting confidence in health care services, encouraging young people to seek early treatment, and increasing awareness of where they can turn for services. The availability of medical services should be increased and waiting times and cost reduced for vulnerable groups.

A Conceptual Framework for Barriers to the Recruitment and Retention of Rural CVD Participants in Behavior Intervention Trials.

PubMed

Young, Lufei; Montgomery, Melody; Barnason, Sue; Schmidt, Cindy; Do, Van

2015-08-01

Rural residents diagnosed with cardiovascular disease (CVD) or with CVD-related risks are underrepresented in behavioral intervention trials based on an extensive review of published studies. The low participation rate of rural residents weakens both the internal and external validity of published studies. Moreover, compared to urban residents, limited research exists to describe the unique barriers that limit the participation of rural residents in behavioral intervention trials. The purpose of this review is to identify a conceptual framework (CF) underpinning common barriers faced by rural CVD patients to enroll in behavioral intervention trials. We conducted a literature review using several electronic databases to obtain a representative sample of research articles, synthesized the evidence, and developed a CF to explain the barriers that may affect the research participation rate of rural residents with CVD or related risks. We found our evidence-based CF well explained the barriers for rural CVD patients to take part in behavioral intervention trials. Besides contextual factors (i.e. patient, community and research levels), other common factors impacting rural patients' intent to enroll are lack of awareness and understanding about behavioral trials, limited support from their healthcare providers and social circles, unfavorable attitudes, and the lack of opportunity to participating research. The findings demonstrate the evidence-based model consisting of interlinked multi-level factors may help our understanding of the barriers encountered by rural CVD patients participating interventions to promote behavioral change. The implication for researchers is that identifying and developing strategies to overcome the barriers precedes conducting studies in rural communities.

Evaluation of Schottky barrier height on 4H-SiC m-face \\{ 1\\bar{1}00\\} for Schottky barrier diode wall integrated trench MOSFET

NASA Astrophysics Data System (ADS)

Kobayashi, Yusuke; Ishimori, Hiroshi; Kinoshita, Akimasa; Kojima, Takahito; Takei, Manabu; Kimura, Hiroshi; Harada, Shinsuke

2017-04-01

We proposed an Schottky barrier diode wall integrated trench MOSFET (SWITCH-MOS) for the purposes of shrinking the cell pitch and suppressing the forward degradation of the body diode. A trench Schottky barrier diode (SBD) was integrated into a trench gate MOSFET with a wide shielding p+ region that protected the trench bottoms of both the SBD and the MOS gate from high electrical fields in the off state. The SBD was placed on the trench sidewall of the \\{ 1\\bar{1}00\\} plane (m-face). Static and transient simulations revealed that SWITCH-MOS sufficiently suppressed the bipolar current that induced forward degradation, and we determined that the optimum Schottky barrier height (SBH) was from 0.8 to 2.0 eV. The SBH depends on the crystal planes in 4H-SiC, but the SBH of the m-face was unclear. We fabricated a planar m-face SBD for the first time, and we obtained SBHs from 1.4 to 1.8 eV experimentally with titanium or nickel as a Schottky metal.

Facilitators and barriers experienced by federal cross-sector partners during the implementation of a healthy eating campaign.

PubMed

Fernandez, Melissa Anne; Desroches, Sophie; Marquis, Marie; Turcotte, Mylène; Provencher, Véronique

2017-09-01

To identify facilitators and barriers that Health Canada's (HC) cross-sector partners experienced while implementing the Eat Well Campaign: Food Skills (EWC; 2013-2014) and describe how these experiences might differ according to distinct partner types. A qualitative study using hour-long semi-structured telephone interviews conducted with HC partners that were transcribed verbatim. Facilitators and barriers were identified inductively and analysed according partner types. Implementation of a national mass-media health education campaign. Twenty-one of HC's cross-sector partners (food retailers, media and health organizations) engaged in the EWC. Facilitators and barriers were grouped into seven major themes: operational elements, intervention factors, resources, collaborator traits, developer traits, partnership factors and target population factors. Four of these themes had dual roles as both facilitators and barriers (intervention factors, resources, collaborator traits and developer traits). Sub-themes identified as both facilitators and barriers illustrate the extent to which a facilitator can easily become a barrier. Partnership factors were unique facilitators, while operational and target population factors were unique barriers. Time was a barrier that was common to almost all partners regardless of partnership type. There appeared to be a greater degree of uniformity among facilitators, whereas barriers were more diverse and unique to the realities of specific types of partner. Collaborative planning will help public health organizations anticipate barriers unique to the realities of specific types of organizations. It will also prevent facilitators from becoming barriers. Advanced planning will help organizations manage time constraints and integrate activities, facilitating implementation.

Understanding contextual barriers, supports, and opportunities for physical activity among Mexican-origin children in Texas border colonias: a descriptive study.

PubMed

Umstattd Meyer, M Renée; Sharkey, Joseph R; Patterson, Megan S; Dean, Wesley R

2013-01-08

The increasing numbers of colonias along the U.S.-Mexico border are characterized by disproportionately poor families of Mexican-origin, limited access to resources and health services, and heightened risk for obesity and diabetes. Despite consistent evidence supporting physical activity (PA) in prevention of chronic diseases, many individuals of Mexican-origin, including children, fail to meet PA recommendations. Environmental influences on PA, founded in ecological and social cognitive perspectives, have not been examined among children living in colonias. The purpose of this study was to identify and better understand (1) household and neighborhood environmental PA resources/supports, (2) perceived barriers to engaging in PA, and (3) PA offerings, locations, and transportation characteristics for Mexican-origin children living in colonias. Data for this study were collected by promotora-researchers (indigenous community health workers trained in research methods) using face-to-face interviews conducted in Spanish. The sample consists of 94 mother-child dyads from Texas border colonias in Hidalgo County. Interviews included questionnaire items addressing PA barriers, household and neighborhood environmental support assessments conducted with each dyad, and open-ended questions that were coded to identify availability and locations of PA opportunities and transportation options. Descriptive statistics were calculated and differences between genders, birth countries, and BMI categories of children were determined using chi-square tests. All children were of Mexican-origin. The most frequently reported barriers were unleashed dogs in the street, heat, bad weather, traffic, no streetlights, and no place like a park to exercise. Prominent locations for current PA included schools, home, and parks. Common PA options for children were exercise equipment, running, playing, and sports. Environmental assessments identified exercise equipment (bicycles/tricycles, balls, etc.…), paved/good streets, yard/patio space, and social norms as the most frequent household or neighborhood resources within these colonias. Differences in PA barriers, options, and environmental resources for genders, birth countries, and BMI categories were detected. This study suggests that PA environmental resources, barriers, and opportunities for colonias children are similar to previous studies and distinctively unique. As expected, built resources in these communities are limited and barriers exist; however, knowledge of PA opportunities and available PA resources within colonias households and neighborhoods offers insight to help guide future research, policy, and PA initiatives.

Understanding contextual barriers, supports, and opportunities for physical activity among Mexican-origin children in Texas border colonias: A descriptive study

PubMed Central

2013-01-01

Background The increasing numbers of colonias along the U.S.-Mexico border are characterized by disproportionately poor families of Mexican-origin, limited access to resources and health services, and heightened risk for obesity and diabetes. Despite consistent evidence supporting physical activity (PA) in prevention of chronic diseases, many individuals of Mexican-origin, including children, fail to meet PA recommendations. Environmental influences on PA, founded in ecological and social cognitive perspectives, have not been examined among children living in colonias. The purpose of this study was to identify and better understand (1) household and neighborhood environmental PA resources/supports, (2) perceived barriers to engaging in PA, and (3) PA offerings, locations, and transportation characteristics for Mexican-origin children living in colonias. Methods Data for this study were collected by promotora-researchers (indigenous community health workers trained in research methods) using face-to-face interviews conducted in Spanish. The sample consists of 94 mother-child dyads from Texas border colonias in Hidalgo County. Interviews included questionnaire items addressing PA barriers, household and neighborhood environmental support assessments conducted with each dyad, and open-ended questions that were coded to identify availability and locations of PA opportunities and transportation options. Descriptive statistics were calculated and differences between genders, birth countries, and BMI categories of children were determined using chi-square tests. Results All children were of Mexican-origin. The most frequently reported barriers were unleashed dogs in the street, heat, bad weather, traffic, no streetlights, and no place like a park to exercise. Prominent locations for current PA included schools, home, and parks. Common PA options for children were exercise equipment, running, playing, and sports. Environmental assessments identified exercise equipment (bicycles/tricycles, balls, etc.…), paved/good streets, yard/patio space, and social norms as the most frequent household or neighborhood resources within these colonias. Differences in PA barriers, options, and environmental resources for genders, birth countries, and BMI categories were detected. Conclusions This study suggests that PA environmental resources, barriers, and opportunities for colonias children are similar to previous studies and distinctively unique. As expected, built resources in these communities are limited and barriers exist; however, knowledge of PA opportunities and available PA resources within colonias households and neighborhoods offers insight to help guide future research, policy, and PA initiatives. PMID:23297793

Making distance education accessible for students who are deaf and hard-of-hearing.

PubMed

Erath, Allison S; Larkin, Vivian M

2004-01-01

Distance education is based on providing learning "anytime, anywhere." The design of many distance education courses, however, may actually erect barriers to the full participation of some students with disabilities, particularly those with hearing impairments. Without careful consideration, distance education could become learning anytime, anywhere, but not for anybody. It is not only unethical, but also illegal to ignore the special needs of these learners. The specific impact of such legislation on distance education for those students with hearing impairments will be addressed. Students with disabilities are often faced with a double digital divide that must be bridged. Universal design uses an excellent proactive approach to closing this digital divide caused by inaccessible courses. Each medium of transmission in distance education poses unique access barriers. Even within the same medium, what is best for one student or class may not be the most ideal accommodation in another situation. Individualized accommodation methods will be examined, and specific technologies and software will be discussed.

A Qualitative Study of the Integration of Arab Muslim Israelis Suffering from Mental Disorders into the Normative Community.

PubMed

Gesser-Edelsburg, Anat; Shbat, Shbat

2017-06-01

This study focuses on the process of the integration of Arab Muslim Israelis suffering from mental disorders into the normative community, addressing perspectives of both people with mental disorders and the community. This qualitative-constructivist study seeks to understand the dynamics of face-to-face meetings by highlighting the participants' points of view. The main themes of the findings included stereotypes and prejudices, gender discrimination, and the effect of face-to-face meetings on integration of people with mental disorders (PMD) into the community. The findings support former studies about the integration of PMD into the normative community, but add a unique finding that females suffer from double discrimination: both as women in a conservative society and as PMD. The study findings indicate a perception of lack of self-efficacy of PMD as a key barrier preventing integration into the community, which also prevents community members and counselors from accepting them or treating them as equals. We recommend on a social marketing campaign to be undertaken with the Arab Muslim community to refute stigmas and prejudices, particulary with double gender discrimination suffered by women with mental disorders in the Muslim community and training of community center counselors who have contact with the PMD population.

Preventing HIV Among U.S. Women of Color With Severe Mental Illness: Perceptions of Mental Health Care Providers Working in Urban Community Clinics

PubMed Central

Agénor, Madina; Collins, Pamela Y.

2013-01-01

Given their knowledge of the behavioral issues related to psychiatric illness, mental health care providers are in a unique position to help prevent HIV among women with severe mental illness (SMI). We conducted in-depth interviews with providers at two New York City community clinics. We identified three major, interrelated themes pertaining to HIV prevention among women of color with SMI. Interventions that address the barriers that clinicians face in discussing sex, sexuality, and HIV with patients and train providers in the cultural considerations of cross-cultural mental health care are needed to help prevent HIV among women of color with SMI. PMID:23394326

Preventing HIV among U.S. women of color with severe mental illness: perceptions of mental health care providers working in urban community clinics.

PubMed

Agénor, Madina; Collins, Pamela Y

2013-01-01

Given their knowledge of the behavioral issues related to psychiatric illness, mental health care providers are in a unique position to help prevent HIV among women with severe mental illness (SMI). We conducted in-depth interviews with providers at two New York City community clinics. We identified three major, interrelated themes pertaining to HIV prevention among women of color with SMI. Interventions that address the barriers that clinicians face in discussing sex, sexuality, and HIV with patients and train providers in the cultural considerations of cross-cultural mental health care are needed to help prevent HIV among women of color with SMI.

Women and health coverage: the affordability gap.

PubMed

Patchias, Elizabeth M; Waxman, Judy

2007-04-01

Although men and women have some similar challenges with regard to health insurance, women face unique barriers to becoming insured. More significantly, women have greater difficulty affording health care services even once they are insured. On average, women have lower incomes than men and therefore have greater difficulty paying premiums. Women also are less likely than men to have coverage through their own employer and more likely to obtain coverage through their spouses; are more likely than men to have higher out-of-pocket health care expenses; and use more healthcare services than men and consequently are in greater need of comprehensive coverage. Proposals for improving health policy need to address these disparities.

Marshalling Social Support: A “Care-Getting” Model for Persons Living with Cancer

PubMed Central

Kahana, Eva; Kahana, Boaz; Wykle, May; Kulle, Diana

2009-01-01

This paper offers a stress theory based conceptual framework for understanding proactive options for care-getting for patients living with cancer that is also relevant to patients living with other chronic or life threatening illnesses. Barriers and facilitators to active efforts for obtaining responsive care from both informal and formal sources are discussed. This “Care-Getting” model explores benefits of proactive care-getting for diminishing physical discomfort/suffering, burden of illness and disability, and psychological distress. We highlight unique issues in care-getting that patients face at different stages of the life course. Implications of prior research related to the model for practice and intervention are discussed. PMID:20107524

Perspectives on barriers and facilitators to minority recruitment for clinical trials among cancer center leaders, investigators, research staff, and referring clinicians: enhancing minority participation in clinical trials (EMPaCT).

PubMed

Durant, Raegan W; Wenzel, Jennifer A; Scarinci, Isabel C; Paterniti, Debora A; Fouad, Mona N; Hurd, Thelma C; Martin, Michelle Y

2014-04-01

The study of disparities in minority recruitment to cancer clinical trials has focused primarily on inquiries among minority populations. Yet very little is known about the perceptions of individuals actively involved in minority recruitment to clinical trials within cancer centers. Therefore, the authors assessed the perspectives of cancer center clinical and research personnel on barriers and facilitators to minority recruitment. In total, 91 qualitative interviews were conducted at 5 US cancer centers among 4 stakeholder groups: cancer center leaders, principal investigators, research staff, and referring clinicians. All interviews were recorded and transcribed. Qualitative analyses of response data was focused on identifying prominent themes related to barriers and facilitators to minority recruitment. The perspectives of the 4 stakeholder groups were largely overlapping with some variations based on their unique roles in minority recruitment. Four prominent themes were identified: 1) racial and ethnic minorities are influenced by varying degrees of skepticism related to trial participation, 2) potential minority participants often face multilevel barriers that preclude them from being offered an opportunity to participate in a clinical trial, 3) facilitators at both the institutional and participant level potentially encourage minority recruitment, and 4) variation between internal and external trial referral procedures may limit clinical trial opportunities for racial and ethnic minorities. Multilevel approaches are needed to address barriers and optimize facilitators within cancer centers to enhance minority recruitment for cancer clinical trials. © 2014 American Cancer Society.

Barriers and enablers to healthcare access and use among Arabic-speaking and Caucasian English-speaking patients with type 2 diabetes mellitus: a qualitative comparative study.

PubMed

Alzubaidi, H; Mc Namara, K; Browning, Colette; Marriott, J

2015-11-17

The objective of this study was to explore the decision-making processes and associated barriers and enablers that determine access and use of healthcare services in Arabic-speaking and English-speaking Caucasian patients with diabetes in Australia. Face-to-face semistructured individual interviews and group interviews were conducted at various healthcare settings-diabetes outpatient clinics in 2 tertiary referral hospitals, 6 primary care practices and 10 community centres in Melbourne, Australia. A total of 100 participants with type 2 diabetes mellitus were recruited into 2 groups: 60 Arabic-speaking and 40 English-speaking Caucasian. Interviews were audio-taped, translated into English when necessary, transcribed and coded thematically. Sociodemographic and clinical information was gathered using a self-completed questionnaire and medical records. Only Arabic-speaking migrants intentionally delayed access to healthcare services when obvious signs of diabetes were experienced, missing opportunities to detect diabetes at an early stage. Four major barriers and enablers to healthcare access and use were identified: influence of significant other(s), unique sociocultural and religious beliefs, experiences with healthcare providers and lack of knowledge about healthcare services. Compared with Arabic-speaking migrants, English-speaking participants had no reluctance to access and use medical services when signs of ill-health appeared; their treatment-seeking behaviours were straightforward. Arabic-speaking migrants appear to intentionally delay access to medical services even when symptomatic. Four barriers to health services access have been identified. Tailored interventions must be developed for Arabic-speaking migrants to improve access to available health services, facilitate timely diagnosis of diabetes and ultimately to improve glycaemic control. 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/

Barriers to providing the sexuality education that teachers believe students need.

PubMed

Eisenberg, Marla E; Madsen, Nikki; Oliphant, Jennifer A; Sieving, Renee E

2013-05-01

Sexuality education teachers' perspectives are important to gain a full understanding of the issues surrounding teaching this subject. This study uses a statewide sample of public school teachers to examine what sexuality education content is taught, what barriers teachers face, and which barriers are associated with teaching specific topics. Participants included 368 middle and high school teachers with sexuality education assignments in Minnesota. Survey data included topics they teach, what they think they should teach, and barriers they face. Logistic regression was used to examine associations between barriers and teaching each of 9 sexual health topics, among those who believed the topic should be taught. Almost two thirds of participants faced structural barriers; 45% were concerned about parent, student, or administrator response; and one quarter reported restrictive policies. Structural barriers were inversely associated with teaching about communication (OR = 0.20), teen parenting (OR = 0.34), and abortion (OR = 0.32); concerns about responses were associated only with teaching about sexual violence (OR = 0.42); and restrictive policies were inversely associated with teaching about abortion (OR = 0.23) and sexual orientation (OR = 0.47). Addressing teachers' barriers requires a multipronged approach, including curriculum development and evaluation, training, and reframing the policy debate to support a wider range of sexuality education topics. © 2013, American School Health Association.

Barriers and enablers of kangaroo mother care practice: a systematic review.

PubMed

Seidman, Gabriel; Unnikrishnan, Shalini; Kenny, Emma; Myslinski, Scott; Cairns-Smith, Sarah; Mulligan, Brian; Engmann, Cyril

2015-01-01

Kangaroo mother care (KMC) is an evidence-based approach to reducing mortality and morbidity in preterm infants. Although KMC is a key intervention package in newborn health initiatives, there is limited systematic information available on the barriers to KMC practice that mothers and other stakeholders face while practicing KMC. This systematic review sought to identify the most frequently reported barriers to KMC practice for mothers, fathers, and health practitioners, as well as the most frequently reported enablers to practice for mothers. We searched nine electronic databases and relevant reference lists for publications reporting barriers or enablers to KMC practice. We identified 1,264 unique publications, of which 103 were included based on pre-specified criteria. Publications were scanned for all barriers / enablers. Each publication was also categorized based on its approach to identification of barriers / enablers, and more weight was assigned to publications which had systematically sought to understand factors influencing KMC practice. Four of the top five ranked barriers to KMC practice for mothers were resource-related: "Issues with the facility environment / resources," "negative impressions of staff attitudes or interactions with staff," "lack of help with KMC practice or other obligations," and "low awareness of KMC / infant health." Considering only publications from low- and middle-income countries, "pain / fatigue" was ranked higher than when considering all publications. Top enablers to practice were included "mother-infant attachment" and "support from family, friends, and other mentors." Our findings suggest that mother can understand and enjoy KMC, and it has benefits for mothers, infants, and families. However, continuous KMC may be physically and emotionally difficult, and often requires support from family members, health practitioners, or other mothers. These findings can serve as a starting point for researchers and program implementers looking to improve KMC programs.

Impact of culture on depressive symptoms of elderly Chinese immigrants.

PubMed

Lai, Daniel W L

2004-12-01

The impact of culture on mental health has been inadequately researched. This study examines the effect of cultural factors on the depressive symptoms reported by elderly Chinese immigrants in Canada. Data from 1537 elderly Chinese immigrants who took part in a cross-sectional multisite survey on the health and well-being of older Chinese-Canadians were used. Participants were identified through telephone screening of randomly selected telephone numbers listed with Chinese surnames. A structured questionnaire was used to conduct face-to-face interviews. A Chinese version of the 15-item Geriatric Depression Scale was used to assess depressive symptoms. Close to one-quarter of the elderly Chinese immigrants reported having at least a mild level of depressive symptoms. Having more cultural barriers and a higher level of identification with Chinese cultural values resulted in a higher probability of being depressive. The importance of the sociocultural determinants of mental health is demonstrated. The health delivery system should be more sensitive to the unique ethnic and cultural differences of older immigrants.

Africa has unique and urgent barriers to cleft care: lessons from practitioners at the Pan-African Congress on Cleft Lip and Palate.

PubMed

Adetayo, Oluwaseun; Ford, Rachel; Martin, Mark

2012-01-01

The goals of this study were to delineate the protocols employed for managing patients with cleft lip and palate deformities, delineate the challenges facing practitioners and patients, and to determine the patient and physician barriers to cleft care delivery in the region. Survey questionnaires were administered to practitioners attending the second Pan-African Congress on Cleft Lip and Palate (PACCLIP), which took place in Ibadan, Nigeria, West Africa from February 4-7, 2007. The conference included 225 participants, representing 17 African countries Protocols for repair of cleft lip and palate deformities were varied, with Millard's and von Langenbeck's techniques being the preferred approach for the management of cleft lip and palate deformities, respectively. A large proportion of providers have limited access to core cleft care supporting teams, especially speech language pathologists, orthodontists, and audiologists. Several challenging barriers to cleft care were also identified at both the institutional and individual levels and are reported. Geographic separation in Africa presents a similar challenge due to isolationism as it does to surgeons in Europe. Specific to Africa are the increased barriers to care, and economic and financial hardship at various levels. A focus on funding, team building, infrastructural support, and patient education appear to be crucial in improving the care and lives of children with facial clefts in Africa.

Growing Up Whole

PubMed Central

Alarcon, Renato D.

2005-01-01

Objective: This is the second phase of a study aimed at determining the cultural characteristics, psychiatric needs, acculturative stressors, and management approaches of immigrant Somali children's experience in the United States. Methods: A 10-year demographics review of the Minnesota Departments of Human Services, and Children, Families, and Learning was completed. Data was obtained through unstructured interviews with educational staff, healthcare providers, and Somali children and their families in three communities, regarding cultural characteristics, barriers to care, perceptions of medical/psychiatric needs, and issues of acculturation. Health professionals/psychiatrists at a tertiary care center were also surveyed. Results: Identified acculturation issues of adolescent Somali immigrants included acculturative stress, racial discrimination, khat use, legal difficulties, language barriers, school opportunities, changes in family dynamics and developmental issues, clinical vulnerabilities, unique experiences of adolescent females, and development of new public/social behavior patterns. Conclusion: Immigrant Somali adolescents are at high risk for mental health problems due to the unique challenges they face as they attempt to assimilate two very polar cultures into one self-identity during a phase of development characterized by physical, cognitive, and emotional upheaval. Current management experiences warrant recommendations that include integration of community services, schools, and the medical system to provide education in cultural diversity, multicultural school and community publications, team sports, individual education plans, support groups, and Somali representation in school staff that has established trust with families and acceptance of mental health issues and care. PMID:21152169

Need for uniqueness as a mediator of the relationship between face consciousness and status consumption in China.

PubMed

Sun, Gong; Chen, Jun; Li, Jie

2017-10-01

Strong economic development in China has led to a surge in status consumption as a means of gaining face. In Eastern culture, people interpret uniqueness as status distinction rather than separateness or deviance. This type of uniqueness can be used to meet others' expectations and gain social approval. Thus its relationship with face consciousness and status consumption is to be expected. This study investigates 2 hypotheses: (a) Face consciousness has a positive effect on status consumption and (b) Consumer need for uniqueness mediates the relationship between face consciousness and status consumption. Two-hundred and forty-six working respondents in eastern China completed a survey. Regression analysis of the results supported both hypotheses. © 2015 International Union of Psychological Science.

Overcoming Barriers between Volunteer Professionals Advising Project-Based Learning Teams with Regulation Tools

ERIC Educational Resources Information Center

Rees Lewis, Daniel G.; Easterday, Matthew W.; Harburg, Emily; Gerber, Elizabeth M.; Riesbeck, Christopher K.

2018-01-01

To provide the substantial support required for project-based learning (PBL), educators can incorporate professional experts as "design coaches." However, previous work shows barriers incorporating design coaches who can rarely meet face-to-face: (1) communication online is time-consuming, (2) updating coaches online is not perceived as…

Durability of Peace Education Effects in the Shadow of Conflict

ERIC Educational Resources Information Center

Rosen, Yigal; Salomon, Gavriel

2011-01-01

Value-oriented instructional programs, such as anti-racism, may often face societal barriers. A case in point are peace education programs in conflictual contexts. Close analysis of peace education programs in regions of conflict and tension suggest that they face formidable barriers that would appear to prevent the attainment of their goals of…

Access Barriers to Distance Education in Secondary Career and Technical Education Programs in Central Virginia

ERIC Educational Resources Information Center

Goodwyn, Patrell Vachyi

2010-01-01

The qualitative phenomenological study explored the perceived institutional access barriers to distance education at comprehensive high schools with secondary career and technical education programs in central Virginia. Semi-structured interviews were conducted to gather data via email, telephone, and face-to-face. A purposive sample of 24…

Facilitators, challenges, and collaborative activities in faith and health partnerships to address health disparities.

PubMed

Kegler, Michelle C; Hall, Sarah M; Kiser, Mimi

2010-10-01

Interest in partnering with faith-based organizations (FBOs) to address health disparities has grown in recent years. Yet relatively little is known about these types of partnerships. As part of an evaluation of the Institute for Faith and Public Health Collaborations, representatives of 34 faith-health teams (n = 61) completed semi-structured interviews. Interviews were tape recorded, transcribed, and coded by two members of the evaluation team to identify themes. Major facilitators to faith-health collaborative work were passion and commitment, importance of FBOs in communities, favorable political climate, support from community and faith leaders, diversity of teams, and mutual trust and respect. Barriers unique to faith and health collaboration included discomfort with FBOs, distrust of either health agencies or FBOs, diversity within faith communities, different agendas, separation of church and state, and the lack of a common language. Findings suggest that faith-health partnerships face unique challenges but are capable of aligning resources to address health disparities.

Victims' barriers to discussing domestic violence in clinical consultations: a qualitative enquiry.

PubMed

Othman, Sajaratulnisah; Goddard, Chris; Piterman, Leon

2014-05-01

Victims of domestic violence frequently attend health care facilities. In many cases, their abusive experience is neither disclosed nor discussed during clinical consultations. This study examined the barriers faced by women when discussing abuse with health care providers, specifically in cases involving Malaysian women with a history of domestic violence. A qualitative study using in-depth interviews was conducted with 10 women with a history of domestic violence residing at a shelter. Purposive sampling was conducted until data saturation. Using the grounded theory approach of analysis, themes that emerged from these interviews were then further analyzed to examine the barriers faced by these women. Women who experienced domestic violence faced multiple barriers while discussing their accounts of abuse with others. Values placed on the privacy of domestic violence; upholding the traditional gender roles; preserving the family unity; minimizing the abuse, the feeling of shame, self-blame; and fearing their abuser generally create internal barriers when discussing their encounters of abuse with health care providers. The perceived unknown role of health care professionals when dealing with patients experiencing domestic violence as well as the previous negative experiences in clinical consultations acted as external barriers for discussing abuse with health care providers. Women with domestic violence experiences faced internal and external barriers to discussing their abuse during clinical consultations. Physicians and health care providers must consider domestic violence in consultations with female patients. A good doctor-patient relationship that encompasses empathy, confidence, trust, support, assurance, confidentiality, and guidance can help patients with abusive backgrounds overcome these barriers, leading to the disclosure and discussion of their abusive encounters. Proper education, guidelines, and support for health care providers are required to help them assist women with histories of domestic violence.

Skin barrier function recovery after diamond microdermabrasion.

PubMed

Kim, Hei Sung; Lim, Sook Hee; Song, Ji Youn; Kim, Mi-Yeon; Lee, Ji Ho; Park, Jong Gap; Kim, Hyung Ok; Park, Young Min

2009-10-01

Microdermabrasion is a popular method for facial rejuvenation and is performed worldwide. Despite its extensive usage, there are few publications on skin barrier change after microdermabrasion and none concerning diamond microdermabrasion. Our object was to see changes in transepidermal water loss (TEWL), hydration and erythema of the face following diamond microdermabrasion. Twenty-eight patients were included in this spilt face study. TEWL, stratum corneum hydration and the degree of erythema were measured from the right and left sides of the face (forehead and cheek) at baseline. One side of the face was treated with diamond microdermabrasion and the other side was left untreated. Measurements were taken right after the procedure and repeated at set time intervals. Diamond microdermabrasion was associated with a statistically significant increase in TEWL immediately after the procedure and at 24 h. However, on day 2, levels of TEWL were back to baseline. An increase in hydration and erythema was observed right after microdermabrasion, but both returned to baseline on day 1. The results show that skin barrier function of the forehead and cheek recovers within 2 days of diamond microdermabrasion. Diamond microdermabrasion performed on a weekly basis, as presently done, is expected to allow sufficient time for the damaged skin to recover its barrier function in most parts of the face.

Screening for Intimate Partner Violence: The Impact of Screener and Screening Environment on Victim Comfort

ERIC Educational Resources Information Center

Thackeray, Jonathan; Stelzner, Sarah; Downs, Stephen M.; Miller, Carleen

2007-01-01

The barriers that professionals face when screening victims for intimate partner violence (IPV) are well studied. The specific barriers that victims face however when being screened are not. The authors sought to identify characteristics of the screener and screening environment that make a victim feel more or less comfortable when disclosing a…

Investigation of the prominent barriers to lean manufacturing implementation in Malaysian food and beverages industry using Rasch Model

NASA Astrophysics Data System (ADS)

Khusaini, N. S.; Ismail, A.; Rashid, A. A.

2016-02-01

This paper presents a preliminary study on the prominent barriers to lean manufacturing implementation in Malaysian Food and Beverages Industry. A survey was carried out to determine the most prominent barriers of lean manufacturing implementation that are currently being faced in this industry. The amount of barriers identified for this study is twenty seven. Out of 1309 available organizations, a total of 300 organizations have been randomly selected as respondents, and 53 organizations responded. From the variable map, the analysis shows that, the negative perception towards lean manufacturing top the list as the most agreeable barrier, while the technical barriers came after it. It can also be seen from the variable map that averagely, lack of vision and direction is the barrier that is being faced. Finally, this is perhaps the first attempt in investigating the prominent barriers to Lean Manufacturing implementation in Malaysian food and beverages industry using Rasch Model.

Australian blue-collar men's health and well-being: contextual issues for workplace health promotion interventions.

PubMed

Du Plessis, Karin; Cronin, David; Corney, Tim; Green, Emma

2013-09-01

In Australia, blue-collar workers are predominantly male and form a unique and large (approximately 30%) subset of the Australian workforce. They exhibit particular health-related issues and, in comparison to other groups, often a lack of health promoting behavior. This article briefly discusses the Australian context and some of the key health issues blue-collar men face, in particular as it relates to construction workers. It reviews the impact of gender and socioeconomic factors in designing workplace health promotion interventions. This article considers practice strategies for health promoters in a specific workplace setting: it looks at meta-factors and industry-based contextual factors, including barriers to implementation and participation, while addressing common misconceptions about Australian blue-collar workers.

Regulation of stem cell-based therapies in Canada: current issues and concerns.

PubMed

von Tigerstrom, Barbara; Nguyen, Thu Minh; Knoppers, Bartha Maria

2012-09-01

Stem cell therapies offer enormous potential for the treatment of a wide range of diseases and conditions. Despite the excitement over such advances, regulators are faced with the challenge of determining criteria to ensure stem cells and their products are safe and effective for human use. However, stem cell-based products and therapies present unique regulatory challenges because standard drug development models do not wholly apply given the complexity and diversity of these products and therapies. As a result, regulatory requirements are often unclear and ambiguous creating unnecessary barriers for research. In order to better understand the barriers that might affect Canadian stem cell researchers, we sought feedback from stakeholders regarding areas of uncertainty or concern about existing regulatory oversight of cell therapies. A selection of Canadian researchers and clinicians working in the area of stem cell research were interviewed to assess certain key questions: 1) whether current regulatory requirements are easily accessible and well understood; 2) whether regulatory requirements create important challenges or barriers; and 3) whether there is a need for further guidance on the issue. The results of this survey are summarized and compared to issues and concerns experienced in other countries, as reported in the literature, to identify challenges which may be on the horizon and to provide possible solutions for regulatory reform.

Barriers Teachers Face in Integrating ICT during English Lessons: A Case Study

ERIC Educational Resources Information Center

Raman, Kumutha; Yamat, Hamidah

2014-01-01

The government has assured all Malaysians that no one; both in rural and urban areas; would be deprived of the Information and Communication Technology (ICT) development. This calls for a need for teachers nationwide to make necessary adjustments to the teaching and learning process. This paper takes a closer look at the barriers faced by teachers…

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

PubMed

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

2015-11-01

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

Feasibility of two modes of treatment delivery for child anxiety in primary care.

PubMed

Chavira, Denise A; Drahota, Amy; Garland, Ann F; Roesch, Scott; Garcia, Maritza; Stein, Murray B

2014-09-01

In this study, we examine the feasibility of cognitive behavior therapy (CBT) for children with anxiety in primary care, using two modes of treatment delivery. A total of 48 parents and youth (8-13) with anxiety disorders were randomly assigned to receive 10-sessions of CBT either delivered by a child anxiety specialist in the primary care clinic or implemented by the parent with therapist support by telephone (i.e., face-to-face or therapist-supported bibliotherapy). Feasibility outcomes including satisfaction, barriers to treatment participation, safety, and dropout were assessed. Independent evaluators, blind to treatment condition, administered the Anxiety Disorders Interview Schedule for Children (ADIS) and the Clinical Global Impression of Improvement (CGI-I) at baseline, post-treatment and 3-month follow-up; clinical self-report questionnaires were also administered. Findings revealed high satisfaction, low endorsement of barriers, low drop out rates, and no adverse events across the two modalities. According to the CGI-I, 58.3%-75% of participants were considered responders (i.e., much or very much improved) at the various time points. Similar patterns were found for remission from "primary anxiety disorder" and "all anxiety disorders" as defined by the ADIS. Clinically significant improvement was seen on the various parent and child self-report measures of anxiety. Findings suggest that both therapy modalities are feasible and associated with significant treatment gains in the primary care setting. (clinicaltrials.gov unique identifier: NCT00769925). Copyright © 2014 Elsevier Ltd. All rights reserved.

A meaningful MESS (Medical Education Scholarship Support).

PubMed

Whicker, Shari A; Engle, Deborah L; Chudgar, Saumil; DeMeo, Stephen; Bean, Sarah M; Narayan, Aditee P; Grochowski, Colleen O'Connor; Nagler, Alisa

2016-01-01

Graduate medical education faculty bear the responsibility of demonstrating active research and scholarship; however, faculty who choose education-focused careers may face unique obstacles related to the lack of promotion tracks, funding, career options, and research opportunities. Our objective was to address education research and scholarship barriers by providing a collaborative peer-mentoring environment and improve the production of research and scholarly outputs. We describe a Medical Education Scholarship Support (MESS) group created in 2013. MESS is an interprofessional, multidisciplinary peer-mentoring education research community that now spans multiple institutions. This group meets monthly to address education research and scholarship challenges. Through this process, we develop new knowledge, research, and scholarly products, in addition to meaningful collaborations. MESS originated with eight founding members, all of whom still actively participate. MESS has proven to be a sustainable unfunded local community of practice, encouraging faculty to pursue health professions education (HPE) careers and fostering scholarship. We have met our original objectives that involved maintaining 100% participant retention; developing increased knowledge in at least seven content areas; and contributing to the development of 13 peer-reviewed publications, eight professional presentations, one Masters of Education project, and one educational curriculum. The number of individuals engaged in HPE research continues to rise. The MESS model could be adapted for use at other institutions, thereby reducing barriers HPE researchers face, providing an effective framework for trainees interested in education-focused careers, and having a broader impact on the education research landscape.

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…

Expertise, Time, Money, Mentoring, and Reward: Systemic Barriers That Limit Education Researcher Productivity-Proceedings From the AAMC GEA Workshop.

PubMed

Yarris, Lalena M; Juve, Amy Miller; Artino, Anthony R; Sullivan, Gail M; Rougas, Steven; Joyce, Barbara; Eva, Kevin

2014-09-01

To further evolve in an evidence-based fashion, medical education needs to develop and evaluate new practices for teaching, learning, and assessment. However, educators face barriers in designing, conducting, and publishing education research. To explore the barriers medical educators face in formulating, conducting, and publishing high-quality medical education research, and to identify strategies for overcoming them. A consensus workshop was held November 5, 2013, at the Association of American Medical Colleges annual meeting. A working group of education research experts and educators completed a preconference literature review focusing on barriers to education research. During the workshop, consensus-based and small group techniques were used to refine the broad themes into content categories. Attendees then ranked the most important barriers and strategies for overcoming them with the highest potential impact. Barriers participants faced in conducting quality education research included lack of (1) expertise, (2) time, (3) funding, (4) mentorship, and (5) reward. The strategy considered most effective in overcoming these barriers involved building communities of education researchers for collaboration and networking, and advocating for education researchers' interests. Other suggestions included trying to secure increased funding opportunities, developing mentoring programs, and encouraging mechanisms to ensure protected time. Barriers to education research productivity clearly exist. Many appear to result from feelings of isolation that may be overcome with systemic efforts to develop and enable communities of practice across institutions. Finally, the theme of "reward" is novel and complex and may have implications for education research productivity.

Development of a conceptual framework for understanding financial barriers to care among patients with cardiovascular-related chronic disease: a protocol for a qualitative (grounded theory) study.

PubMed

Campbell, David J T; Manns, Braden J; Hemmelgarn, Brenda R; Sanmartin, Claudia; King-Shier, Kathryn M

2016-01-01

Patients with cardiovascular-related chronic diseases may face financial barriers to accessing health care, even in Canada, where universal health care insurance is in place. No current theory or framework is adequate for understanding the impact of financial barriers to care on these patients or how they experience financial barriers. The overall objective of this study is to develop a framework for understanding the role of financial barriers to care in the lives of patients with cardiovascular-related chronic diseases and the impact of such barriers on their health. We will perform an inductive qualitative grounded theory study to develop a framework to understand the effect of financial barriers to care on patients with cardiovascular-related chronic diseases. We will use semistructured interviews (face-to-face and telephone) with a purposive sample of adult patients from Alberta with at least 1 of hypertension, diabetes, heart disease or stroke. We will analyze interview transcripts in triplicate using grounded theory coding techniques, including open, focused and axial coding, following the principle of constant comparison. Interviews and analysis will be done iteratively to theoretical saturation. Member checking will be used to enhance rigour. A comprehensive framework for understanding financial barriers to accessing health care is instrumental for both researchers and clinicians who care for patients with chronic diseases. Such a framework would enable a better understanding of patient behaviour and nonadherence to recommended medical therapies and lifestyle modifications.

Connecting Refugees to Substance Use Treatment: A Qualitative Study.

PubMed

McCleary, Jennifer S; Shannon, Patricia J; Cook, Tonya L

2016-01-01

An emerging body of literature identifies substance use as a growing concern among refugees resettling in the United States. Like immigrants, refugees may face cultural, linguistic, or systems barriers to connecting with mainstream substance use treatment programs, which may be compounded by refugees' unique experiences with exposure to trauma, displacement in refugee camps, and resettlement. This qualitative study explores factors that support and prevent refugees from connecting with chemical health treatment. Fifteen participants who identified as social service or public health professionals who work with refugees responded to an online, semistructured survey about their experiences referring refugees to substance use treatment. Resulting data was analyzed using thematic analysis. Themes emerged identifying a lack of culturally informed treatment models, policy issues, and client characteristics such as motivation and past trauma as barriers to engaging with treatment. Ongoing case management and coordination were identified as important to successful linkage. Findings from this study contribute to a better understanding of how to support refugees seeking substance use treatment and suggest that developing trauma informed, culturally relevant models of treatment that are integrated with primary health care and geographically accessible may enhance treatment linkage.

Barriers and Facilitators to Engagement and Retention in Care among Transgender Women Living with Human Immunodeficiency Virus

PubMed Central

Sevelius, Jae M.; Patouhas, Enzo; Keatley, JoAnne G.; Johnson, Mallory O.

2014-01-01

Background Transgender women have 49 times the odds of human immunodeficiency virus (HIV) infection compared to other groups, yet they are disproportionately underserved by current treatment efforts. Purpose To examine culturally unique barriers and facilitators to engagement and retention in HIV care and strengthen efforts to mitigate health disparities, guided by the Models of Gender Affirmation and Health Care Empowerment. Methods Through 20 interviews and 5 focus groups (n=38), transgender women living with HIV discussed their experiences and life contexts of engagement in and adherence to HIV care and treatment. Results Our participants faced substantial challenges to adhering to HIV care and treatment, including avoidance of healthcare due to stigma and past negative experiences, prioritization of hormone therapy, and concerns about adverse interactions between antiretroviral treatment for HIV and hormone therapy. Receiving culturally competent, transgender-sensitive healthcare was a powerful facilitator of healthcare empowerment. Conclusions Recommendations are offered to inform intervention research and guide providers, emphasizing gender affirming HIV care that integrates transition-related healthcare needs. PMID:24317955

Structural Competency in the U.S. Healthcare Crisis: Putting Social and Policy Interventions Into Clinical Practice.

PubMed

Hansen, H; Metzl, J

2016-06-01

This symposium of the Journal of Bioethical Inquiry illustrates structural competency: how clinical practitioners can intervene on social and institutional determinants of health. It will require training clinicians to see and act on structural barriers to health, to adapt imaginative structural approaches from fields outside of medicine, and to collaborate with disciplines and institutions outside of medicine. Case studies of effective work on all of these levels are presented in this volume. The contributors exemplify structural competency from many angles, from the implications of epigenetics for environmental intervention in personalized medicine to the ways clinicians can act on fundamental causes of disease, address abuses of power in clinical training, racially desegregate cities to reduce health disparities, address the systemic causes of torture by police, and implement harm-reduction programs for addiction in the face of punitive drug laws. Together, these contributors demonstrate the unique roles that clinicians can play in breaking systemic barriers to health and the benefit to the U.S. healthcare system of adopting innovations from outside of the United States and outside of clinical medicine.

Reducing Transaction Costs for Energy Efficiency Investments and Analysis of Economic Risk Associated With Building Performance Uncertainties: Small Buildings and Small Portfolios Program

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

Langner, R.; Hendron, B.; Bonnema, E.

2014-08-01

The small buildings and small portfolios (SBSP) sector face a number of barriers that inhibit SBSP owners from adopting energy efficiency solutions. This pilot project focused on overcoming two of the largest barriers to financing energy efficiency in small buildings: disproportionately high transaction costs and unknown or unacceptable risk. Solutions to these barriers can often be at odds, because inexpensive turnkey solutions are often not sufficiently tailored to the unique circumstances of each building, reducing confidence that the expected energy savings will be achieved. To address these barriers, NREL worked with two innovative, forward-thinking lead partners, Michigan Saves and Energi,more » to develop technical solutions that provide a quick and easy process to encourage energy efficiency investments while managing risk. The pilot project was broken into two stages: the first stage focused on reducing transaction costs, and the second stage focused on reducing performance risk. In the first stage, NREL worked with the non-profit organization, Michigan Saves, to analyze the effects of 8 energy efficiency measures (EEMs) on 81 different baseline small office building models in Holland, Michigan (climate zone 5A). The results of this analysis (totaling over 30,000 cases) are summarized in a simple spreadsheet tool that enables users to easily sort through the results and find appropriate small office EEM packages that meet a particular energy savings threshold and are likely to be cost-effective.« less

Barriers to Online Postsecondary Education Crumble: Enrollment in Traditional Face-to-Face Courses Declines as Enrollment in Online Courses Increases

ERIC Educational Resources Information Center

Gray, Dahli

2013-01-01

Contrary to expectations, total postsecondary enrollment in the United States (US) declined in Fall 2011. In fact, it continues to decline while online enrollment continues to increase. Students can more easily cross geographic boundaries as online access causes barriers to postsecondary education to crumble, and more than 50% of the demand for…

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…

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…

Barriers and Perceived Stress Levels of Internationals Living in the United States

ERIC Educational Resources Information Center

Davis, Terah L.

2017-01-01

This study explored the perceived stress level of international students who faced barriers to employment upon graduation from an American post-secondary institution. The Barriers to Employment Success Inventory (BESI) was used to assess employment barriers and the Perceived Stress Scale (PSS) assessed the perceived level of stress experienced by…

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…

Nested barriers to low-carbon infrastructure investment

NASA Astrophysics Data System (ADS)

Granoff, Ilmi; Hogarth, J. Ryan; Miller, Alan

2016-12-01

Low-carbon, 'green' economic growth is necessary to simultaneously improve human welfare and avoid the worst impacts of climate change and environmental degradation. Infrastructure choices underpin both the growth and the carbon intensity of the economy. This Perspective explores the barriers to investing in low-carbon infrastructure and some of the policy levers available to overcome them. The barriers to decarbonizing infrastructure 'nest' within a set of barriers to infrastructure development more generally that cause spending on infrastructure--low-carbon or not--to fall more than 70% short of optimal levels. Developing countries face additional barriers such as currency and political risks that increase the investment gap. Low-carbon alternatives face further barriers, such as commercialization risk and financial and public institutions designed for different investment needs. While the broader barriers to infrastructure investment are discussed in other streams of literature, they are often disregarded in literature on renewable energy diffusion or climate finance, which tends to focus narrowly on the project costs of low- versus high-carbon options. We discuss how to overcome the barriers specific to low-carbon infrastructure within the context of the broader infrastructure gap.

Healthcare access among circular and undocumented Mexican migrants: results from a pilot survey on the Mexico-US border

PubMed Central

Martinez-Donate, Ana P.; Zhang, Xiao; Rangel, M. Gudelia; Hovell, Melbourne; Simon, Norma-Jean; Amuedo-Dorantes, Catalina; Sipan, Carol; Guendelman, Sylvia

2014-01-01

Background Temporary and unauthorized migrants may face unique obstacles to access health care services in the U.S. Objective This study estimated levels of health care access among Mexican migrants returning to Mexico from the U.S. and factors associated with access to health care, with emphasis on the role of modifiable, enabling factors. Methods We conducted a pilot probability health care survey of migrants in the border city of Tijuana, Mexico (N=186). Results Approximately 42% of migrants reported having used health care services in the U.S. during the past year. Only 38% had a usual source of care and approximately 11% went without needed medical care in the U.S. About 71% of migrants did not have health insurance in the U.S. Lack of health insurance and transportation limitations were significantly related to various access indicators. Conclusion These results have implications for future policies and programs aimed to address modifiable health care access barriers faced by these vulnerable and underserved segments of the Mexican migrant population. PMID:25364381

Immigration as a crisis tendency for HIV vulnerability among racialised women living with HIV in Ontario, Canada: an anti-oppressive lens.

PubMed

Kteily-Hawa, Roula N; Islam, Shazia; Loutfy, Mona

2018-04-16

South Asian immigrant women in Canada face unique structural barriers that influence their HIV vulnerability. Using an intersectional and anti-oppressive lens, we explored the role of immigration in bringing about changes in gender roles and the structure of gender relations and their effect on HIV risk among immigrant women as they experienced crisis tendencies in the face of hegemonic masculinity. Informed by Connell's theory of gender, the study entailed in-depth interviews with 12 self-identified South Asian immigrant women living in the Greater Toronto Area, in Ontario, Canada. A thematic analysis yielded four themes: power relations, emotional relations, gendered division of labour and social norms. Our findings revealed interdependencies between immigration and each of structural, individual and normative factors (the themes) as they pertain to crisis tendencies when patriarchy is disrupted. Given the rapid increase in global immigration, the connections between transnationalism and hegemony, and the established link between immigration and HIV, future research should extend this work to other immigrant communities.

Lung Cancer Screening With Low-Dose CT: Implementation Amid Changing Public Policy at One Health Care System.

PubMed

Begnaud, Abbie; Hall, Thomas; Allen, Tadashi

2016-01-01

Screening for lung cancer with low-dose CT has evolved rapidly in recent years since the National Lung Screening Trial (NLST) results. Subsequent professional and governmental organization guidelines have shaped policy and reimbursement for the service. Increasingly available guidance describes eligible patients and components necessary for a high-quality lung cancer screening program; however, practical instruction and implementation experience is not widely reported. We launched a lung cancer screening program in the face of reimbursement and guideline uncertainties at a large academic health center. We report our experience with implementation, including challenges and proposed solutions. Initially, we saw less referrals than expected for screening, and many patients referred for screening did not clearly meet eligibility guidelines. We educated primary care providers and implemented system tools to encourage referral of eligible patients. Moreover, in response to the Centers for Medicare & Medicaid Services (CMS) final coverage determination, we report our programmatic adaptation to meet these requirements. In addition to the components common to all quality programs, individual health delivery systems will face unique barriers related to patient population, available resources, and referral patterns.

Contactless electroreflectance studies of surface potential barrier for N- and Ga-face epilayers grown by molecular beam epitaxy

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

Kudrawiec, R.; Janicki, L.; Gladysiewicz, M.

2013-07-29

Two series of N- and Ga-face GaN Van Hoof structures were grown by plasma-assisted molecular beam epitaxy to study the surface potential barrier by contactless electroreflectance (CER). A clear CER resonance followed by strong Franz-Keldysh oscillation of period varying with the thickness of undoped GaN layer was observed for these structures. This period was much shorter for N-polar structures that means smaller surface potential barrier in these structures than in Ga-polar structures. From the analysis of built-in electric field it was determined that the Fermi-level is located 0.27 ± 0.05 and 0.60 ± 0.05 eV below the conduction band formore » N- and Ga-face GaN surface, respectively.« less

External and Internal Barriers to Studying Can Affect Student Success and Retention in a Diverse Classroom.

PubMed

Clement, Laurence

2016-12-01

Although a majority of under-represented minority (URM) students begin their postsecondary education at community colleges, little is known about barriers to success and retention for transfer-bound science students. This study focuses on some of the barriers that affect these students' ability to study adequately for a community college "gateway" course. It tests whether instructors' expectations of study time were realistic for community college students and whether students reported facing external barriers, such as job and family responsibilities, or internal barriers to studying, such as lack of motivational, cognitive, and metacognitive abilities, all of which have been shown to impact academic success and retention. It also tests whether students who faced such barriers were less likely to succeed in and complete the course, as well as whether time spent studying was related to course success. The findings reported here show that community college students do not have enough available time to study and that external and internal barriers are both prevalent among these students. In addition, students who faced such barriers are more likely to fail or drop the class. Results also show that study time is positively correlated with retention, but not performance, as well as with some motivational, cognitive, and metacognitive dimensions of self-regulated learning. These findings lead to new questions, including whether student success in a community college class is associated with the use of cognitive and metacognitive learning strategies for students with no prior degrees, and whether increased course structure may improve success for college students with lower self-regulated abilities.

External and Internal Barriers to Studying Can Affect Student Success and Retention in a Diverse Classroom

PubMed Central

Clement, Laurence

2016-01-01

Although a majority of under-represented minority (URM) students begin their postsecondary education at community colleges, little is known about barriers to success and retention for transfer-bound science students. This study focuses on some of the barriers that affect these students’ ability to study adequately for a community college “gateway” course. It tests whether instructors’ expectations of study time were realistic for community college students and whether students reported facing external barriers, such as job and family responsibilities, or internal barriers to studying, such as lack of motivational, cognitive, and metacognitive abilities, all of which have been shown to impact academic success and retention. It also tests whether students who faced such barriers were less likely to succeed in and complete the course, as well as whether time spent studying was related to course success. The findings reported here show that community college students do not have enough available time to study and that external and internal barriers are both prevalent among these students. In addition, students who faced such barriers are more likely to fail or drop the class. Results also show that study time is positively correlated with retention, but not performance, as well as with some motivational, cognitive, and metacognitive dimensions of self-regulated learning. These findings lead to new questions, including whether student success in a community college class is associated with the use of cognitive and metacognitive learning strategies for students with no prior degrees, and whether increased course structure may improve success for college students with lower self-regulated abilities. PMID:28101261

Barriers and Enablers of Kangaroo Mother Care Practice: A Systematic Review

PubMed Central

Seidman, Gabriel; Unnikrishnan, Shalini; Kenny, Emma; Myslinski, Scott; Cairns-Smith, Sarah; Mulligan, Brian; Engmann, Cyril

2015-01-01

Kangaroo mother care (KMC) is an evidence-based approach to reducing mortality and morbidity in preterm infants. Although KMC is a key intervention package in newborn health initiatives, there is limited systematic information available on the barriers to KMC practice that mothers and other stakeholders face while practicing KMC. This systematic review sought to identify the most frequently reported barriers to KMC practice for mothers, fathers, and health practitioners, as well as the most frequently reported enablers to practice for mothers. We searched nine electronic databases and relevant reference lists for publications reporting barriers or enablers to KMC practice. We identified 1,264 unique publications, of which 103 were included based on pre-specified criteria. Publications were scanned for all barriers / enablers. Each publication was also categorized based on its approach to identification of barriers / enablers, and more weight was assigned to publications which had systematically sought to understand factors influencing KMC practice. Four of the top five ranked barriers to KMC practice for mothers were resource-related: “Issues with the facility environment / resources,” “negative impressions of staff attitudes or interactions with staff,” “lack of help with KMC practice or other obligations,” and “low awareness of KMC / infant health.” Considering only publications from low- and middle-income countries, “pain / fatigue” was ranked higher than when considering all publications. Top enablers to practice were included “mother-infant attachment” and “support from family, friends, and other mentors.” Our findings suggest that mother can understand and enjoy KMC, and it has benefits for mothers, infants, and families. However, continuous KMC may be physically and emotionally difficult, and often requires support from family members, health practitioners, or other mothers. These findings can serve as a starting point for researchers and program implementers looking to improve KMC programs. PMID:25993306

Free-standing epitaxial graphene on silicon carbide and transport barriers in layered materials

NASA Astrophysics Data System (ADS)

Shivaraman, Shriram

This thesis is based on the topic of layered materials, in which different layers interact with each other via van der Waals forces. The majority of this thesis deals with epitaxial graphene (EG) obtained from silicon carbide (SiC). Free-standing epitaxial graphene (FSEG) structures are produced from EG using a photoelectrochemical (PEC) etching process developed for making suspended graphene structures on a large-scale. These structures are investigated for their mechanical and electrical properties. For doubly-clamped FSEG structures, a unique U-beam effect is observed which causes orders of magnitude increase in their mechanical resonance frequency compared to that expected using simple beam theory. Combined magnetotransport and Raman spectroscopy studies reveal that FSEG devices produced from nominally monolayer graphene on the Si-face of SiC exhibit properties of an inhomogeneously doped bilayer after becoming suspended. This suggests that the buffer layer which precedes graphene growth on the Si-face of SiC gets converted to a graphene layer after the PEC etching process. In the second theme of this thesis, transport barriers in layered materials are investigated. The EG-SiC interface is studied using a combination of electrical (I-V, C-V) and photocurrent spectroscopy techniques. It is shown that the interface may be described as having a Schottky barrier for electron transport with a Gaussian distribution of barrier heights. Another interface explored in this work is that between different layers of MoS 2, a layered material belonging to the class of transition metal dichalcogenides. This interface maybe thought of as a one-dimensional junction. Four-point transport measurements indicate the presence of a barrier for electron transport at this interface. A simple model of the junction as a region with an increased threshold voltage and degraded mobility is suggested. The final chapter is a collection of works based on the topic of layered materials, which are not related to the main theme of the thesis. They include fabrication and characterization details of a dual-gated bilayer graphene device, an investigation of the graphene-Si interface and hexagonal boron nitride-based membranes. These are presented in the hope that they may be useful for further investigations along those directions.

Barriers to a healthy lifestyle post gestational-diabetes: An Australian qualitative study.

PubMed

Zulfiqar, Tehzeeb; Lithander, Fiona E; Banwell, Cathy; Young, Rosemary; Boisseau, Lynelle; Ingle, Martha; Nolan, Christopher J

2017-08-01

Overseas-born-women from certain ethnicities are at high risk of type-2 diabetes and related metabolic disorders. This study explored the barriers and facilitators to long-term healthy lifestyle recommendations among Australian-born and overseas-born-women who attended health promotion sessions at a tertiary Australian Hospital for gestational diabetes 3-4 years previously. Face-to-face semi-structured interviews were conducted. Data were analyzed to identify major themes and the differing experiences of both groups of women. Women in both groups faced many barriers to improve post-gestational-diabetes lifestyle. Women from both groups recalled healthy lifestyle recommendations for during pregnancy they received at the service, but had difficulty recalling the long-term lifestyle recommendations. Timing of the health information, non-reiteration of lifestyle recommendations, uncoordinated and fragmented health system support after childbirth were barriers faced by all women. Additional barriers for overseas-born women included the cultural competence of the health education material, their cultural preferences for food and physical activities and unsupportive family and partner. Both groups had excellent compliance with the first annual postnatal oral-glucose-tolerance-test. This was attributed to the personal motivation and health professional reminder. Women only reverted to the healthy lifestyles postnatally for weight loss. A better understanding of the barriers to healthy lifestyle by women in their everyday lives will assist in the development of culturally appropriate health promotion guidelines and strategies. Constant un-fragmented postnatal engagement by the specialised diabetes clinics and primary health care services is crucial to sustain the healthy lifestyle in the long-term for women with previous gestational-diabetes. Copyright © 2017 Australian College of Midwives. All rights reserved.

Perceptions of school nurses on the challenges of service provision to ESL students.

PubMed

Whitman, Marilyn V; Davis, Jullet A; Terry, Allison J

2010-04-01

The number of English-as-as second-language (ESL) students in public schools across the country is rising creating unique challenges for school health services with the introduction of new cultures and languages. This study describes the perceptions of school nurses in Alabama schools regarding the challenges they face when communicating with ESL students and their parents. The population consists of school nurses in Alabama public schools. The obtained sample of 1,429 responses is presented and discussed. Urban school nurses were more likely to have access to an interpreter, yet they were more likely to rely on an ESL student to act as a translator when speaking to his/her parents. Kindergarten through elementary school nurses were more likely to witness an increase in ESL students and encounter difficulty communicating with these students and their parents. School nurses have a unique opportunity to engage parents of ESL students in the health of their child, thus it is vital that they be provided with cultural facts and encouraged to use interpreter services to lessen language barriers.

Delivering free healthcare to rural Central Appalachia population: the case of the Health Wagon.

PubMed

Gardner, T; Gavaza, P; Meade, P; Adkins, D M

2012-01-01

Central Appalachia residents present unique healthcare challenges. This vulnerable population faces poor health status and low access to health care. 'The Health Wagon' was established to innovatively enhance access to health care for the poor and marginalized rural population of Central Appalachia. This article describes the operations of the Health Wagon, a full mobile medical clinic, in delivering free health care to those in rural Southwest Virginia in Central Appalachia. The Health Wagon provides a wide range of comprehensive healthcare services, such as acute and chronic disease management, laboratory and diagnostic services, medication assistance, dental and eye care and specialty clinics for marginalized, poor and disenfranchised patients living in the mountains of that region. In 2009, a total of 157 clinics were provided and 2900 patients were seen (3165 patient encounters) in addition to 268 telemedicine specialty consultations at no cost to the patients. The work of the Health Wagon has broken down a financial barrier to healthcare access and offers unique and profound opportunities to improve health and expand health care in rural Central Appalachia.

Overcoming Barriers in Working with Families

ERIC Educational Resources Information Center

Heru, Alison M.; Drury, Laura

2006-01-01

Objective: The Accreditation Council for Graduate Medical Education and the Residency Review Committee for psychiatry outline the expected competencies for residents. These competencies include working with families. This article describes barriers that residents face when working with families, and offers ways to overcome these barriers. Method:…

Barriers to cancer screening in Hmong Americans: the influence of health care accessibility, culture, and cancer literacy.

PubMed

Lee, Hee Yun; Vang, Suzanne

2010-06-01

Hmong Americans face high cancer mortality rates even in comparison to their Asian American counterparts, and report low utilization of cancer screenings. To date, no study has been conducted on the cultural barriers this population faces in undergoing cancer screenings. A systematic review of the literature was conducted to examine the existing knowledge regarding the barriers to cancer screening for Hmong Americans. Potential barriers were identified from this examination to include: health access factors (type of health insurance, ethnicity of provider, low English proficiency, and years spent in the U.S.); cultural factors (belief in the spiritual etiology of diseases, patriarchal values, modesty, and mistrust of the western medical system); and cancer literacy factors (cancer and prevention illiteracy). Based on this review, potential cultural and ethnic group-specific prevention strategies and cancer health policies are discussed to address these barriers and enhance screening behavior among the Hmong.

Gas seal for an in situ oil shale retort and method of forming thermal barrier

DOEpatents

Burton, III, Robert S.

1982-01-01

A gas seal is provided in an access drift excavated in a subterranean formation containing oil shale. The access drift is adjacent an in situ oil shale retort and is in gas communication with the fragmented permeable mass of formation particles containing oil shale formed in the in situ oil shale retort. The mass of formation particles extends into the access drift, forming a rubble pile of formation particles having a face approximately at the angle of repose of fragmented formation. The gas seal includes a temperature barrier which includes a layer of heat insulating material disposed on the face of the rubble pile of formation particles and additionally includes a gas barrier. The gas barrier is a gas-tight bulkhead installed across the access drift at a location in the access drift spaced apart from the temperature barrier.

Barriers to the conduct of randomised clinical trials within all disease areas.

PubMed

Djurisic, Snezana; Rath, Ana; Gaber, Sabrina; Garattini, Silvio; Bertele, Vittorio; Ngwabyt, Sandra-Nadia; Hivert, Virginie; Neugebauer, Edmund A M; Laville, Martine; Hiesmayr, Michael; Demotes-Mainard, Jacques; Kubiak, Christine; Jakobsen, Janus C; Gluud, Christian

2017-08-01

Randomised clinical trials are key to advancing medical knowledge and to enhancing patient care, but major barriers to their conduct exist. The present paper presents some of these barriers. We performed systematic literature searches and internal European Clinical Research Infrastructure Network (ECRIN) communications during face-to-face meetings and telephone conferences from 2013 to 2017 within the context of the ECRIN Integrating Activity (ECRIN-IA) project. The following barriers to randomised clinical trials were identified: inadequate knowledge of clinical research and trial methodology; lack of funding; excessive monitoring; restrictive privacy law and lack of transparency; complex regulatory requirements; and inadequate infrastructures. There is a need for more pragmatic randomised clinical trials conducted with low risks of systematic and random errors, and multinational cooperation is essential. The present paper presents major barriers to randomised clinical trials. It also underlines the value of using a pan-European-distributed infrastructure to help investigators overcome barriers for multi-country trials in any disease area.

Environmental, Nutrition and Health Issues in a US Refugee Resettlement Community.

PubMed

Sastre, Lauren; Haldeman, Lauren

2015-10-01

INTRODUCTION In 2012, North Carolina ranked in the top ten states in refugee resettlement, with central Guilford County one of the most diverse in the southeast. OBJECTIVE Examine the local resettlement environmental, nutrition and health barriers and needs of refugees in Guilford County, as perceived by individuals providing services to them. METHODS Participants (n = 40) included: medical and social service providers, educators, faith-based volunteers, resettlement agency caseworkers and liaisons to a variety of refugee communities. Guided semistructured interviews were audio-recorded and transcribed verbatim. Themes were identified using deductive content analysis and categorized by frequency of reporting by participants. RESULTS Perceptions were consistent across participants regarding a diverse local refugee population. Resettlement housing was observed to be in poor condition, located in areas of poverty with transportation barriers. However, refugees rarely relocated, due to strong community relationships and support. Perceived dietary risks included: difficulties budgeting and maintaining food assistance, hoarding food, high consumption of sodas and sweets, misperceptions regarding US products (e.g., perceived need for infant formula), and limited health knowledge. Respondents observed that most refugees preferred "fresh" foods, and had strong agricultural skills but lacked green space. Major barriers to health care reported were: poverty, short duration of initial Medicaid coverage, and language (both lack of interpretation services and translated materials). Providers consistently observed type 2 diabetes, weight gain and dental problems across refugee groups. CONCLUSIONS Direct service providers' experiences and observations working with a diverse resettlement population provide unique insight into consistent barriers to achieving good health that confront refugees. While refugees face many barriers, groups often have impressive strengths, such as agricultural skills, on which to focus. KEYWORDS Refugees, emigration, immigration, minority health, health care disparities, diet, environment, USA.

A Look at Poor Dads Who Don't Pay Child Support. Discussion Papers. Assessing the New Federalism: An Urban Institute Program To Assess Changing Social Policies.

ERIC Educational Resources Information Center

Sorensen, Elaine; Zibman, Chava

The barriers that poor fathers face in paying child support and how existing programs assist them were studied and contrasted to the barriers faced by poor custodial mothers using data from the National Survey of America's Families (NSAF). Efforts to serve these fathers through Temporary Assistance for Needy Families welfare-to-work grants, and…

Overcoming barriers to high performance seismic design using lessons learned from the green building industry

NASA Astrophysics Data System (ADS)

Glezil, Dorothy

NEHRP's Provisions today currently governing conventional seismic resistant design. These provisions, though they ensure the life-safety of building occupants, extensive damage and economic losses may still occur in the structures. This minimum performance can be enhanced using the Performance-Based Earthquake Engineering methodology and passive control systems like base isolation and energy dissipation systems. Even though these technologies and the PBEE methodology are effective reducing economic losses and fatalities during earthquakes, getting them implemented into seismic resistant design has been challenging. One of the many barriers to their implementation has been their upfront costs. The green building community has faced some of the same challenges that the high performance seismic design community currently faces. The goal of this thesis is to draw on the success of the green building industry to provide recommendations that may be used overcome the barriers that high performance seismic design (HPSD) is currently facing.

Barriers, Successes and Enabling Practices of Education for Sustainability in Far North Queensland Schools: A Case Study

ERIC Educational Resources Information Center

Evans, Neus; Whitehouse, Hilary; Gooch, Margaret

2012-01-01

There are many documented barriers to implementing school-based sustainability. This article examines a) the barriers faced by principals and staff in two regional primary schools in Far North Queensland, Australia, well known for their exemplary practice, and b) ways the barriers were overcome. Through interviews conducted with principals and key…

Maternal depression in Syrian refugee women recently moved to Canada: a preliminary study.

PubMed

Ahmed, Asma; Bowen, Angela; Feng, Cindy Xin

2017-07-24

Refugee women are almost five times more likely to develop postpartum depression than Canadian-born women. This can be attributed to various difficulties they faced before coming to Canada as well as during resettlement. Moreover, refugee women usually face many obstacles when accessing health services, including language and cultural barriers, as well as unique help-seeking behaviors that are influenced by various cultural and practical factors. There has been a recent, rapid influx of Syrian refugees to Canada, and many of them are childbearing women. However, little is known about the experiences that these women have encountered pre- and post-resettlement, and their perceptions of mental health issues. Thus, there is an urgent need to understand refugee women's experiences of having a baby in Canada from a mental health perspective. A mixed methods research design included 12 Syrian refugee women who migrated to Saskatoon in 2015-16 and who were either pregnant or 1 year postpartum. The data were collected during a single focus group discussion and a structured questionnaire. Our results showed that more than half of participants have depressive symptoms, half of them have anxiety symptoms, and one sixth have PTSD symptoms. Three major themes emerged from the qualitative data: 1) Understanding of maternal depression; 2) Protective factors for mental health; and 3) Barriers to mental health services. Maternal depression is an important feature in Syrian refugee women recently resettled in Canada. Reuniting these women with their families and engaging them in culturally appropriate support programs may improve their mental health outcomes.

Community pharmacists' perspectives of online health-related information: A qualitative insight from Kuala Lumpur, Malaysia.

PubMed

See Wan, Ong; Hassali, Mohamed Azmi; Saleem, Fahad

2017-01-01

The Internet is a resource used by health professionals as well as the public to access health information. Within this context, little is reported on community pharmacists' (CPs') perceptions of online health-related information. The objective of this study was to explore the attitudes of Malaysian CPs towards online health-related information. A qualitative research method was adopted with face-to-face interviews, using a semi-structured interview guide. Purposive and snowball sampling techniques were used to recruit a convenient sample of CPs who were practising in the Federal Territory of Kuala Lumpur, Malaysia. All interviews were audio recorded and transcribed verbatim. The data were analysed by the research team using a thematic content analysis framework. Eleven CPs participated in the study. Participants reported that online health-related information was accessible, useful, fast, and in some respects, the Internet is a unique source of information. It was reported that there was a need to establish websites for trusted information. CPs also reported that training was needed in Internet searching and website evaluation skills. Most information accessed by CPs related to drugs and diseases and to knowledge-based information. Barriers to efficacy of Internet usage were related to the reliability and volume of information available on the Internet. Frequent use of online health-related information among CPs was reported. Many CPs supported the use of the Internet for health-related information but certain reservations were also reported. An analysis of the reasons for information seeking and barriers suggests that a wider range of influences on health information seeking should be investigated.

Expanding Robust HCCI Operation with Advanced Valve and Fuel Control Technologies

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

Szybist, J. P.; Confer, K.

2012-09-11

Delphi Automotive Systems and ORNL established this CRADA to advance the commercialization potential of the homogeneous charge compression ignition (HCCI) advanced combustion strategy for gasoline engine platforms. HCCI combustion has been shown by others to produce high diesel-like efficiency on a gasoline engine platform while simultaneously producing low NOX and particulate matter emissions. However, the commercialization barriers that face HCCI combustion are significant, with requirements for a more active engine control system, likely with next-cycle closed-loop feedback control, and with advanced valve train technologies to enable negative valve overlap conditions. In the partnership between Delphi and ORNL, each organization broughtmore » a unique and complementary set of skills to the project. Delphi has made a number of breakthroughs with production-intent valve train technologies and controls in recent years to make a part time production-intent HCCI engine plausible. ORNL has extensive knowledge and expertise with HCCI combustion, and also has a versatile research engine with hydraulic valve actuation (HVA) that is useful for guiding production of a cam-based HCCI system. Partnering these knowledge bases and capabilities was essential towards making progress to better understand HCCI combustion and the commercialization barriers that it faces. ORNL and Delphi maintained strong collaboration throughout the project. Meetings were held regularly, with additional reports, presentations, and meetings as necessary to maintain progress. Delphi provided guidance to ORNL regarding operational strategies to investigate on their single-cylinder research engine with HVA and data from their experimental multi-cylinder engine for modeling. ORNL provided single-cylinder engine data and modeling results.« less

Barriers to Accommodation Use for Students with Disabilities in Postsecondary Education

ERIC Educational Resources Information Center

Lyman, Michael James

2013-01-01

Students with disabilities at the postsecondary level face a number of different barriers to accommodation use. Past research has shown that students with disabilities that use accommodations obtain greater academic achievement and higher graduation rates. Limited research has been conducted to identify barriers to accommodation use, and the…

Reusable Thermal Barrier for Insulation Gaps

NASA Technical Reports Server (NTRS)

Saladee, C. E.

1985-01-01

Filler composed of resilient, heat-resistant materials. Thermal barrier nestles snugly in gap between two tiles with minimal protrusion beyond faces of surrounding tiles. When removed from gap, barrier springs back to nearly original shape. Developed for filling spaces between tiles on Space Shuttle, also used in furnaces and kilns.

A Qualitative Study of Barriers to Accessing Water, Sanitation and Hygiene for Disabled People in Malawi.

PubMed

White, Sian; Kuper, Hannah; Itimu-Phiri, Ambumulire; Holm, Rochelle; Biran, Adam

2016-01-01

Globally, millions of people lack access to improved water, sanitation and hygiene (WASH). Disabled people, disadvantaged both physically and socially, are likely to be among those facing the greatest inequities in WASH access. This study explores the WASH priorities of disabled people and uses the social model of disability and the World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework to look at the relationships between impairments, contextual factors and barriers to WASH access. 36 disabled people and 15 carers from urban and rural Malawi were purposively selected through key informants. The study employed a range of qualitative methods including interviews, emotion mapping, free-listing of priorities, ranking, photo voice, observation and WASH demonstrations. A thematic analysis was conducted using nVivo 10. WASH access affected all participants and comprised almost a third of the challenges of daily living identified by disabled people. Participants reported 50 barriers which related to water and sanitation access, personal and hand hygiene, social attitudes and participation in WASH programs. No two individuals reported facing the same set of barriers. This study found that being female, being from an urban area and having limited wealth and education were likely to increase the number and intensity of the barriers faced by an individual. The social model proved useful for classifying the majority of barriers. However, this model was weaker when applied to individuals who were more seriously disabled by their body function. This study found that body function limitations such as incontinence, pain and an inability to communicate WASH needs are in and of themselves significant barriers to adequate WASH access. Understanding these access barriers is important for the WASH sector at a time when there is a global push for equitable access.

A Qualitative Study of Barriers to Accessing Water, Sanitation and Hygiene for Disabled People in Malawi

PubMed Central

Kuper, Hannah; Itimu-Phiri, Ambumulire; Holm, Rochelle; Biran, Adam

2016-01-01

Globally, millions of people lack access to improved water, sanitation and hygiene (WASH). Disabled people, disadvantaged both physically and socially, are likely to be among those facing the greatest inequities in WASH access. This study explores the WASH priorities of disabled people and uses the social model of disability and the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) framework to look at the relationships between impairments, contextual factors and barriers to WASH access. 36 disabled people and 15 carers from urban and rural Malawi were purposively selected through key informants. The study employed a range of qualitative methods including interviews, emotion mapping, free-listing of priorities, ranking, photo voice, observation and WASH demonstrations. A thematic analysis was conducted using nVivo 10. WASH access affected all participants and comprised almost a third of the challenges of daily living identified by disabled people. Participants reported 50 barriers which related to water and sanitation access, personal and hand hygiene, social attitudes and participation in WASH programs. No two individuals reported facing the same set of barriers. This study found that being female, being from an urban area and having limited wealth and education were likely to increase the number and intensity of the barriers faced by an individual. The social model proved useful for classifying the majority of barriers. However, this model was weaker when applied to individuals who were more seriously disabled by their body function. This study found that body function limitations such as incontinence, pain and an inability to communicate WASH needs are in and of themselves significant barriers to adequate WASH access. Understanding these access barriers is important for the WASH sector at a time when there is a global push for equitable access. PMID:27171520

Exploring the impact of financial barriers on secondary prevention of heart disease.

PubMed

Dhaliwal, Kirnvir K; King-Shier, Kathryn; Manns, Braden J; Hemmelgarn, Brenda R; Stone, James A; Campbell, David J T

2017-02-14

Patients with coronary artery disease experience various barriers which impact their ability to optimally manage their condition. Financial barriers may result in cost related non-adherence to medical therapies and recommendations, impacting patient health outcomes. Patient experiences regarding financial barriers remain poorly understood. Therefore, we used qualitative methods to explore the experience of financial barriers to care among patients with heart disease. We conducted a qualitative descriptive study of participants in Alberta, Canada with heart disease (n = 13) who perceived financial barriers to care. We collected data using semi-structured face-to-face or telephone interviews inquiring about patients experience of financial barriers and the strategies used to cope with such barriers. Multiple analysts performed inductive thematic analysis and findings were bolstered by member checking. The aspects of care to which participants perceived financial barriers included access to: medications, cardiac rehabilitation and exercise, psychological support, transportation and parking. Some participants demonstrated the ability to successfully self-advocate in order to effectively navigate within the healthcare and social service systems. Financial barriers impacted patients' ability to self-manage their cardiovascular disease. Financial barriers contributed to non-adherence to essential medical therapies and health recommendations, which may lead to adverse patient outcomes. Given that it is such a key skill, enhancing patients' self-advocacy and navigation skills may assist in improving patient health outcomes.

Role of coordination geometry in dictating the barrier to hydride migration in d6 square-pyramidal iridium and rhodium pincer complexes.

PubMed

Findlater, Michael; Cartwright-Sykes, Alison; White, Peter S; Schauer, Cynthia K; Brookhart, Maurice

2011-08-10

Syntheses of the olefin hydride complexes [(POCOP)M(H)(olefin)][BAr(f)(4)] (6a-M, M = Ir or Rh, olefin = C(2)H(4); 6b-M, M = Ir or Rh, olefin = C(3)H(6); POCOP = 2,6-bis(di-tert-butylphosphinito)benzene; BAr(f) = tetrakis(3,5-trifluoromethylphenyl)borate) are reported. A single-crystal X-ray structure determination of 6b-Ir shows a square-pyramidal coordination geometry for Ir, with the hydride ligand occupying the apical position. Dynamic NMR techniques were used to characterize these complexes. The rates of site exchange between the hydride and the olefinic hydrogens yielded ΔG(++) = 15.6 (6a-Ir), 16.8 (6b-Ir), 12.0 (6a-Rh), and 13.7 (6b-Rh) kcal/mol. The NMR exchange data also established that hydride migration in the propylene complexes yields exclusively the primary alkyl intermediate arising from 1,2-insertion. Unexpectedly, no averaging of the top and bottom faces of the square-pyramidal complexes is observed in the NMR spectra at high temperatures, indicating that the barrier for facial equilibration is >20 kcal/mol for both the Ir and Rh complexes. A DFT computational study was used to characterize the free energy surface for the hydride migration reactions. The classical terminal hydride complexes, [M(POCOP)(olefin)H](+), are calculated to be the global minima for both Rh and Ir, in accord with experimental results. In both the Rh ethylene and propylene complexes, the transition state for hydride migration (TS1) to form the agostic species is higher on the energy surface than the transition state for in-place rotation of the coordinated C-H bond (TS2), while for Ir, TS2 is the high point on the energy surface. Therefore, only for the case of the Rh complexes is the NMR exchange rate a direct measure of the hydride migration barrier. The trends in the experimental barriers as a function of M and olefin are in good agreement with the trends in the calculated exchange barriers. The calculated barriers for the hydride migration reaction in the Rh complexes are ∼2 kcal/mol higher than for the Ir complexes, despite the fact that the energy difference between the olefin hydride ground state and the agostic alkyl structure is ∼4 kcal/mol larger for Ir than for Rh. This feature, together with the high barrier for interchange of the top and bottom faces of the complexes, is proposed to arise from the unique coordination geometry of the agostic complexes and the strong preference for a cis-divacant octahedral geometry in four-coordinate intermediates. © 2011 American Chemical Society

Perceived barriers to healthy eating and physical activity among adolescents in seven Arab countries: a cross-cultural study.

PubMed

Musaiger, Abdulrahman O; Al-Mannai, Mariam; Tayyem, Reema; Al-Lalla, Osama; Ali, Essa Y A; Kalam, Faiza; Benhamed, Mofida M; Saghir, Sabri; Halahleh, Ismail; Djoudi, Zahra; Chirane, Manel

2013-01-01

To highlight the perceived personal, social, and environmental barriers to healthy eating and physical activity among Arab adolescents. A multistage stratified sampling method was used to select 4698 students aged 15-18 years (2240 males and 2458 females) from public schools. Seven Arab counties were included in the study, namely, Algeria, Jordan, Kuwait, Libya, Palestine, Syria, and the United Arab Emirates. Self-reported questionnaire was used to list the barriers to healthy eating and physical activity facing these adolescents. It was found that lack of information on healthy eating, lack of motivation to eat a healthy diet, and not having time to prepare or eat healthy food were the main barriers to healthy eating among both genders. For physical activity, the main barriers selected were lack of motivation to do physical activity, less support from teachers, and lack of time to do physical activity. In general, females faced more barriers to physical activity than males in all countries included. There were significant differences between males and females within each country and among countries for most barriers. Intervention programmes to combat obesity and other chronic noncommunicable diseases in the Arab world should include solutions to overcome the barriers to weight maintenance, particularly the sociocultural barriers to practising physical activity.

Architecture for Absorption Based Heaters

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

Moghaddam, Saeed; Chugh, Devesh

An absorption based heater is constructed on a fluid barrier heat exchanging plate such that it requires little space in a structure. The absorption based heater has a desorber, heat exchanger, and absorber sequentially placed on the fluid barrier heat exchanging plate. The vapor exchange faces of the desorber and the absorber are covered by a vapor permeable membrane that is permeable to a refrigerant vapor but impermeable to an absorbent. A process fluid flows on the side of the fluid barrier heat exchanging plate opposite the vapor exchange face through the absorber and subsequently through the heat exchanger. Themore » absorption based heater can include a second plate with a condenser situated parallel to the fluid barrier heat exchanging plate and opposing the desorber for condensation of the refrigerant for additional heating of the process fluid.« less

Face recognition in the thermal infrared domain

NASA Astrophysics Data System (ADS)

Kowalski, M.; Grudzień, A.; Palka, N.; Szustakowski, M.

2017-10-01

Biometrics refers to unique human characteristics. Each unique characteristic may be used to label and describe individuals and for automatic recognition of a person based on physiological or behavioural properties. One of the most natural and the most popular biometric trait is a face. The most common research methods on face recognition are based on visible light. State-of-the-art face recognition systems operating in the visible light spectrum achieve very high level of recognition accuracy under controlled environmental conditions. Thermal infrared imagery seems to be a promising alternative or complement to visible range imaging due to its relatively high resistance to illumination changes. A thermal infrared image of the human face presents its unique heat-signature and can be used for recognition. The characteristics of thermal images maintain advantages over visible light images, and can be used to improve algorithms of human face recognition in several aspects. Mid-wavelength or far-wavelength infrared also referred to as thermal infrared seems to be promising alternatives. We present the study on 1:1 recognition in thermal infrared domain. The two approaches we are considering are stand-off face verification of non-moving person as well as stop-less face verification on-the-move. The paper presents methodology of our studies and challenges for face recognition systems in the thermal infrared domain.

Edge enhanced growth induced shape transition in the formation of GaN nanowall network

NASA Astrophysics Data System (ADS)

Nayak, Sanjay; Kumar, Rajendra; Shivaprasad, S. M.

2018-01-01

We address the mechanism of early stages of growth and shape transition of the unique nanowall network (NwN) of GaN by experimentally monitoring its morphological evolution and complementing it by first-principles calculations. Using atomic force and scanning electron microscopy, we observe the formation of oval shaped islands at very early stages of the growth which later transformed into tetrahedron shaped (3 faced pyramid) islands. These tetrahedron shaped islands further grow anisotropically along their edges of the (20 2 ¯ 1) facets to form the wall-like structure as the growth proceeds. The mechanism of this crystal growth is discussed in light of surface free energies of the different surfaces, adsorption energy, and diffusion barrier of Ga ad-atoms on the (20 2 ¯ 1) facets. By first-principles calculations, we find that the diffusion barrier of ad-atoms reduces with decreasing width of facets and is responsible for the anisotropic growth leading to the formation of NwN. This study suggests that formation of NwN is an archetype example of structure dependent attachment kinetic instability induced shape transition in thin film growth.

Cryptococcal pathogenic mechanisms: a dangerous trip from the environment to the brain.

PubMed

Esher, Shannon K; Zaragoza, Oscar; Alspaugh, James Andrew

2018-01-01

Cryptococcus neoformans is an opportunistic pathogenic yeast that causes serious infections, most commonly of the central nervous system (CNS). C. neoformans is mainly found in the environment and acquired by inhalation. It could be metaphorically imagined that cryptococcal disease is a "journey" for the microorganism that starts in the environment, where this yeast loads its suitcase with virulence traits. C. neoformans first encounters the infected mammalian host in the lungs, a site in which it must choose the right elements from its "virulence suitcase" to survive the pulmonary immune response. However, the lung is often only the first stop in this journey, and in some individuals the fungal trip continues to the brain. To enter the brain, C. neoformans must "open" the main barrier that protects this organ, the blood brain barrier (BBB). Once in the brain, C. neoformans expresses a distinct set of protective attributes that confers a strong neurotropism and the ability to cause brain colonisation. In summary, C. neoformans is a unique fungal pathogen as shown in its ability to survive in the face of multiple stress factors and to express virulence factors that contribute to the development of disease.

Application of Porter’s Five Forces Model and generic strategies for vascular surgery: should be stuck in the middle?

PubMed

Sumpio, Bauer E

2013-06-01

There are many stakeholders in the vascular marketplace from clinicians to hospitals, third party payers, medical device manufacturers and the government. Economic stress, threats of policy reform and changing health-care delivery are adding to the challenges faced by vascular surgeons. Use of Porter's Five Forces analysis to identify the sources of competition, the strength and likelihood of that competition existing, and barriers to competition that affect vascular surgery will help our specialty understand both the strength of our current competition and the strength of a position that our specialty will need to move to. By understanding the nature of the Porter's Five Forces as it applies to vascular surgery, and by appreciating their relative importance, our society would be in a stronger position to defend itself against threats and perhaps influence the forces with a long-term strategy. Porter's generic strategies attempt to create effective links for business with customers and suppliers and create barriers to new entrants and substitute products. It brings an initial perspective that is convenient to adapt to vascular surgery in order to reveal opportunities.Vascular surgery is uniquely situated to pursue both a differentiation and high value leadership strategy.

Cryptococcal pathogenic mechanisms: a dangerous trip from the environment to the brain

PubMed Central

Esher, Shannon K; Zaragoza, Oscar; Alspaugh, James Andrew

2018-01-01

Cryptococcus neoformans is an opportunistic pathogenic yeast that causes serious infections, most commonly of the central nervous system (CNS). C. neoformans is mainly found in the environment and acquired by inhalation. It could be metaphorically imagined that cryptococcal disease is a “journey” for the microorganism that starts in the environment, where this yeast loads its suitcase with virulence traits. C. neoformans first encounters the infected mammalian host in the lungs, a site in which it must choose the right elements from its “virulence suitcase” to survive the pulmonary immune response. However, the lung is often only the first stop in this journey, and in some individuals the fungal trip continues to the brain. To enter the brain, C. neoformans must “open” the main barrier that protects this organ, the blood brain barrier (BBB). Once in the brain, C. neoformans expresses a distinct set of protective attributes that confers a strong neurotropism and the ability to cause brain colonisation. In summary, C. neoformans is a unique fungal pathogen as shown in its ability to survive in the face of multiple stress factors and to express virulence factors that contribute to the development of disease. PMID:29668825

Strategies for Increasing Academic Achievement in Higher Education

ERIC Educational Resources Information Center

Ensign, Julene; Woods, Amelia Mays

2014-01-01

Higher education today faces unique challenges. Decreasing student engagement, increasing diversity, and limited resources all contribute to the issues being faced by students, educators, and administrators alike. The unique characteristics and expectations that students bring to their professional programs require new methods of addressing…

A Study of Perceived Admission and Achievement Barriers of Learning-Disabled Students in Postsecondary Institutions

ERIC Educational Resources Information Center

Lamberg, Catherine Denise

2012-01-01

Learning-disabled students face ongoing challenges in higher education. Despite efforts to promote recruitment and retention of students with learning disabilities to trade schools, colleges, and universities, barriers to enrollment and academic achievement persist. Barriers for learning-disabled students are not fully understood and might be…

Barriers to Participation in Vocational Orientation Programmes among Prisoners

ERIC Educational Resources Information Center

Brosens, Dorien; De Donder, Liesbeth; Dury, Sarah; Verté, Dominique

2015-01-01

This study investigates the barriers to prisoners' participation in vocational orientation programmes, as well as the predictors of different types of barriers. Survey data derived from a project in a remand prison in Belgium (N = 468) provided the empirical evidence for the analyses. The results indicate that facing situational and informational…

Barriers to Providing the Sexuality Education That Teachers Believe Students Need

ERIC Educational Resources Information Center

Eisenberg, Marla E.; Madsen, Nikki; Oliphant, Jennifer A.; Sieving, Renee E.

2013-01-01

Background: Sexuality education teachers' perspectives are important to gain a full understanding of the issues surrounding teaching this subject. This study uses a statewide sample of public school teachers to examine what sexuality education content is taught, what barriers teachers face, and which barriers are associated with teaching specific…

Dos Hermanas Chicanas: Overcoming Barriers to Professional Advancement

ERIC Educational Resources Information Center

Prospero, Moises

2007-01-01

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

Deconstructing Barriers: Perceptions of Students Labeled with Learning Disabilities in Higher Education

ERIC Educational Resources Information Center

Denhart, Hazel

2008-01-01

This phenomenological study investigated barriers to higher education faced by 11 college students labeled with learning disabilities (LD) using their voice as the primary data. Data were analyzed and interpreted through a disability theory perspective revealing barriers stemmed largely from external social causes rather than individual pathology.…

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.

49 CFR 587.13 - General description.

Code of Federal Regulations, 2011 CFR

2011-10-01

... a deformable face (Figure 1). The fixed rigid barrier is adequate to not deflect or displace more than 10 mm during the vehicle impact. The deformable face consists of aluminum honeycomb and aluminum...

49 CFR 587.13 - General description.

Code of Federal Regulations, 2013 CFR

2013-10-01

... a deformable face (Figure 1). The fixed rigid barrier is adequate to not deflect or displace more than 10 mm during the vehicle impact. The deformable face consists of aluminum honeycomb and aluminum...

49 CFR 587.13 - General description.

Code of Federal Regulations, 2014 CFR

2014-10-01

... a deformable face (Figure 1). The fixed rigid barrier is adequate to not deflect or displace more than 10 mm during the vehicle impact. The deformable face consists of aluminum honeycomb and aluminum...

49 CFR 587.13 - General description.

Code of Federal Regulations, 2012 CFR

2012-10-01

... a deformable face (Figure 1). The fixed rigid barrier is adequate to not deflect or displace more than 10 mm during the vehicle impact. The deformable face consists of aluminum honeycomb and aluminum...

Exploring the Potential of Technology-Based Mental Health Services for Homeless Youth: A Qualitative Study

PubMed Central

Adkins, Elizabeth C.; Zalta, Alyson K.; Boley, Randy A.; Glover, Angela; Karnik, Niranjan S.; Schueller, Stephen

2017-01-01

Homelessness has serious consequences for youth that heighten the need for mental health services; however, these individuals face significant barriers to access. New models of intervention delivery are required to improve the dissemination of mental health interventions that tailor these services to the unique challenges faced by homeless youth. The purpose of this study was to better understand homeless youths’ use of technology, mental health experiences and needs, and willingness to engage with technology-supported mental health interventions to help guide the development of future youth-facing technology-supported interventions. Five focus groups were conducted with 24 homeless youth (62.5% female) in an urban shelter. Youth were 18 to 20 years old with current periods of homelessness ranging from six days to four years. Transcripts of these focus groups were coded to identify themes. Homeless youth reported using mobile phones frequently for communication, music, and social media. They indicated a lack of trust and a history of poor relationships with mental health providers despite recognizing the need for general support as well as help for specific mental health problems. Although initial feelings towards technology that share information with a provider were mixed, they reported an acceptance of tracking and sharing information under certain circumstances. Based on these results, we provide recommendations for the development of mental health interventions for this population focusing on technology-based treatment options. PMID:28481610

Threats, conservation strategies, and prognosis for suckers (Catostomidae) in North America: insights from regional case studies of a diverse family of non-game fishes

USGS Publications Warehouse

Cooke, Steven J.; Bunt, Christopher M.; Hamilton, Steven J.; Jennings, Cecil A.; Pearson, Micheal P.; Cooperman, Michael S.; Markle, Douglas F.

2005-01-01

Catostomid fishes are a diverse family of 76+ freshwater species that are distributed across North America in many different habitats. This group of fish is facing a variety of impacts and conservation issues that are somewhat unique relative to more economically valuable and heavily managed fish species. Here, we present a brief series of case studies to highlight the threats such as migration barriers, flow regulation, environmental contamination, habitat degradation, exploitation and impacts from introduced (non-native) species that are facing catostomids in different regions. Collectively, the case studies reveal that individual species usually are not threatened by a single, isolated factor. Instead, species in general face numerous stressors that threaten multiple stages of their life history. Several factors have retarded sucker conservation including widespread inabilities of field workers to distinguish some species, lack of basic natural history and ecological knowledge of life history, and the misconception that suckers are tolerant of degraded conditions and are of little social or ecological value. Without a specific constituent group lobbying for conservation of non-game fishes, all such species, including members of the catostomid family, will continue to face serious risks because of neglect, ignorance, and misunderstanding. We suggest that conservation strategies should incorporate research and education/outreach components. Other conservation strategies that would be effective for protecting suckers include freshwater protected areas for critical habitat, restoration of degraded habitat, and design of catostomid-friendly fish bypass facilities. We believe that the plight of the catostomids is representative of the threats facing many other non-game freshwater fishes with diverse life-history strategies globally.

Possible Barriers to Enrollment in Substance Abuse Treatment among a Diverse Sample of Asian Americans and Pacific Islanders: Opinions of Treatment Clients

PubMed Central

Masson, Carmen L.; Shopshire, Michael S.; Sen, Soma; Hoffman, Kim; Hengl, Nicholas; Bartolome, John; McCarty, Dennis; Sorensen, James L.; Iguchi, Martin

2012-01-01

This mixed methods study examined motivations and barriers to substance abuse treatment entry and treatment continuation among Asian American and Pacific Islander (AAPI) substance users. AAPI substance users (N = 61) were recruited from substance abuse treatment programs in California and Hawaii. Semi-structured interviews and interviewer-administered surveys assessed barriers and facilitators to entering substance abuse treatment. Barriers included peer pressure, family influences, and face loss concerns. Facilitators included peer support, involvement in the criminal justice system, a perceived need for treatment, and culturally competent substance abuse treatment services. Family and peer influences may act as both facilitators and impediments. AAPI substance using populations face many of the same individual-level and structural and systems barriers to entry to treatment as other substance using populations. However, similar to other racial/ethnic minority groups, it is important to address cultural differences and develop culturally competent substance abuse treatments for the AAPI population. PMID:22985677

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

PubMed Central

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

2012-01-01

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

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

PubMed

Roberts, K J

2000-03-01

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

Possible barriers to enrollment in substance abuse treatment among a diverse sample of Asian Americans and Pacific Islanders: opinions of treatment clients.

PubMed

Masson, Carmen L; Shopshire, Michael S; Sen, Soma; Hoffman, Kim A; Hengl, Nicholas S; Bartolome, John; McCarty, Dennis; Sorensen, James L; Iguchi, Martin Y

2013-03-01

This mixed methods study examined motivations and barriers to substance abuse treatment entry and treatment continuation among Asian American and Pacific Islander (AAPI) substance users. AAPI substance users (N = 61) were recruited from substance abuse treatment programs in California and Hawaii. Semi-structured interviews and interviewer-administered surveys assessed barriers and facilitators to entering substance abuse treatment. Barriers included peer pressure, family influences, and face loss concerns. Facilitators included peer support, involvement in the criminal justice system, a perceived need for treatment, and culturally competent substance abuse treatment services. Family and peer influences may act as both facilitators and impediments. AAPI substance using populations face many of the same individual-level and structural and systems barriers to entry to treatment as other substance using populations. However, similar to other racial/ethnic minority groups, it is important to address cultural differences and develop culturally competent substance abuse treatments for the AAPI population. Copyright © 2013 Elsevier Inc. All rights reserved.

Working the kinks out of nucleosomal DNA

PubMed Central

Olson, Wilma K.; Zhurkin, Victor B.

2011-01-01

Condensation of DNA in the nucleosome takes advantage of its double-helical architecture. The DNA deforms at sites where the base pairs face the histone octamer. The largest so-called kink-and-slide deformations occur in the vicinity of arginines that penetrate the minor groove. Nucleosome structures formed from the 601 positioning sequence differ subtly from those incorporating an AT-rich human α-satellite DNA. Restraints imposed by the histone arginines on the displacement of base pairs can modulate the sequence-dependent deformability of DNA and potentially contribute to the unique features of the different nucleosomes. Steric barriers mimicking constraints found in the nucleosome induce the simulated large-scale rearrangement of canonical B-DNA to kink-and-slide states. The pathway to these states shows non-harmonic behavior consistent with bending profiles inferred from AFM measurements. PMID:21482100

The Syrian Refugee Crisis: What Nurses Need to Know.

PubMed

Almontaser, Esmihan; Baumann, Steven L

2017-04-01

The civil war in Syria that began in 2011 has displaced millions of Syrians of all ages. While the number that have arrived in the United States is small in comparison to many other countries, it is important that nurses and other healthcare workers here understand that many of them have faced considerable trauma and endured stresses. Most of them are Muslims. Muslims in the United States and elsewhere represent a heterogeneous group of people with a long intellectual and cultural history. Islamic cultural patterns do pose unique barriers to a primarily Anglo-Saxon medical system that medical practitioners need to consider in order to avoid misunderstanding and provide culturally sensitive care. The authors discuss the Syrian refugee crisis and the experience of being a Muslim or Arab American patient in U.S. healthcare settings.

Providing Competent and Affirming Services for Transgender and Gender Nonconforming Older Adults.

PubMed

Porter, Kristen E; Brennan-Ing, Mark; Chang, Sand C; Dickey, Lore M; Singh, Anneliese A; Bower, Kyle L; Witten, Tarynn M

2016-01-01

Despite the growing visibility and acceptance of transgender and gender nonconforming (TGNC) individuals, TGNC older adults experience many barriers in accessing competent and affirming health and social services due to anti-TGNC prejudice, discrimination, and lack of competent healthcare training on the part of healthcare workers. Clinical gerontologists and geriatricians will likely encounter TGNC adults in their practice given population aging and greater numbers of TGNC people who are living in their affirmed gender identities. The American Psychological Association recently published its Guidelines for Psychological Practice with Transgender and Gender Nonconforming People, which document the unique needs of TGNC individuals and outlines approaches for competent and affirming service provision (APA, 2015). We interpret these Guidelines using a gerontological lens to elucidate specific issues faced by the TGNC older adult along with the practice and policy implications for this population.

What interventions are needed for women and girls who use drugs? A global perspective.

PubMed

Malinowska-Sempruch, Kasia

2015-06-01

Women and girls who inject drugs are more likely than their male counterparts to acquire HIV. In addition to criminalization, punitive laws, and social stigma that puts all injecting drug users at increased risk, women are made even more vulnerable by social, economic, and culturally embedded power imbalances. Women and girls are also less likely to seek treatment and healthcare, even when they are pregnant. This is in part due to underfunded harm reduction and drug treatment programs limited in their ability to surmount the unique barriers women face. This does not have to be the reality. There are steps-some simple, some more complex-that can reduce infection rates and provide women and girls with health care and harm reduction services that are designed with their needs and concerns in mind.

Effectiveness of cable barriers, guardrails, and concrete barrier walls in reducing the risk of injury.

PubMed

Zou, Yaotian; Tarko, Andrew P; Chen, Erdong; Romero, Mario A

2014-11-01

Roadway departure crashes tend to be severe, especially when the roadside exposes the occupants of errant vehicles to excessive injury hazards. As a cost-effective method when the clear zone width is insufficient, road barriers are often installed to prevent errant vehicles from colliding with dangerous obstacles or traversing steep slopes. This paper focuses on the safety performance of road barriers in Indiana in reducing the risk of injury. The objective of the study presented here is to compare the risk of injury among different hazardous events faced by an occupant in a single-vehicle crash. The studied hazardous events include rolling over, striking three types of barriers (guardrails, concrete barrier walls, and cable barriers) with different barrier offsets to the edge of the travelled way, and striking various roadside objects. A total of 2124 single-vehicle crashes (3257 occupants) that occurred between 2008 and 2012 on 517 pair-matched homogeneous barrier and non-barrier segments were analyzed. A binary logistic regression model with mixed effects was estimated for vehicle occupants. The segment pairing process and the use of random effects were able to handle the commonality within the same segment pair as well as the heterogeneity across segment pairs. The modeling results revealed that hitting a barrier is associated with lower risk of injury than a high-hazard event (hitting a pole, rollover, etc.). The odds of injury are reduced by 39% for median concrete barrier walls offset 15-18ft from the travelled way, reduced by 65% for a guardrail face offset 5-55ft, reduced by 85% for near-side median cable barriers (offset between 10ft and 29ft), and reduced by 78% with far-side median cable barriers (offset at least 30ft). Comparing different types of barriers is useful where some types of barriers can be used alternatively. This study found that the odds of injury are 43% lower when striking a guardrail instead of a median concrete barrier offset 15-18ft and 65% lower when striking a median concrete barrier offset 7-14ft. The odds of injury when striking a near-side median cable barrier is 57% lower than the odds for a guardrail face. This reduction for a far side median cable barrier is 37%. Thus, a guardrail should be preferred over a concrete wall and a cable barrier should be preferred over a guardrail where the road and traffic conditions allow. In the light of the results, installing median cable barriers on both sides of the median to reduce their lateral offset is beneficial for safety. The study also found that the unexplained heterogeneity across vehicles is much larger than it was across matched segment pairs. Copyright © 2014 Elsevier Ltd. All rights reserved.

Barriers to and Reasons for Treatment Initiation Among Gambling Help-line Callers.

PubMed

Khayyat-Abuaita, Ula; Ostojic, Dragana; Wiedemann, Ashley; Arfken, Cynthia L; Ledgerwood, David M

2015-08-01

Identifying barriers to seeking treatment is essential for increasing problem gambler treatment initiation in the community, given that as few as 1 in 10 problem gamblers ever seek treatment. Further, many problem gamblers who take the initial step of contacting problem gambling help-lines do not subsequently go on to attend face-to-face treatment. There is limited research examining reasons for attending treatment among this population. This study addressed these gaps in the literature by examining barriers and attractions to treatment among callers to the State of Michigan Problem Gambling Help-line. In total, 143 callers (n = 86 women) completed the Barriers to Treatment for Problem Gambling (BTPG) questionnaire and responded to open-ended questions regarding barriers to and reasons for treatment initiation, as part of a telephone interview. Greater endorsement of barriers to treatment was associated with a lower likelihood of initiating treatment, especially perceived absence of problem and treatment unavailability. Correspondingly, problem gamblers who identified more reasons to attend treatment were more likely to attend, with positive treatment perceptions being the most influential. These findings can help get people into treatment by addressing barriers and fostering reasons for attending treatment, as well as reminding clinicians of the importance of identifying and addressing individual treatment barriers among patients with problem gambling.

The 4A Metric Algorithm: A Unique E-Learning Engineering Solution Designed via Neuroscience to Counter Cheating and Reduce Its Recidivism by Measuring Student Growth through Systemic Sequential Online Learning

ERIC Educational Resources Information Center

Osler, James Edward

2016-01-01

This paper provides a novel instructional methodology that is a unique E-Learning engineered "4A Metric Algorithm" designed to conceptually address the four main challenges faced by 21st century students, who are tempted to cheat in a myriad of higher education settings (face to face, hybrid, and online). The algorithmic online…

``How am I going to work?'' Barriers to employment for immigrant Latinos and Latinas living with HIV in Toronto.

PubMed

Serrano, Angel

2015-06-05

For individuals with HIV positive status, multiple barriers exist to accessing and re-entering employment. Studies on employment for people living with HIV lack a detailed consideration of race and ethnicity. This is the first article that focuses on barriers to employment for the HIV positive Latino community in the Canadian context. To document the barriers that a sample of HIV positive Latinos and Latinas encounter in finding and maintaining employment in Toronto. A non-probability sample of immigrant and refugee Latino men and women living with HIV/AIDS in Toronto participated in in-depth interviews concerning their experiences in the labor market, emphasizing the barriers that they have faced in access to employment. Interviews were audio recorded, transcribed and later analysed with NVivo 9. Two sets of barriers emerged from the analysis: structural barriers that immigrants encounter in access to employment, such as language difficulties, lack of Canadian work experience and anti-immigrant feelings and barriers to employment for HIV positive individuals, principally HIV related stigma and health related issues. Due to their intersectional identities as immigrants/refugees and HIV positive individuals, participants face compounded barriers to employment: Language difficulties, lack of migrant status and Canadian work experience, anti-immigrant sentiments in the labor market, ageism, HIV related stigma and side effects of medications among other barriers related with an HIV positive condition. Such barriers locate participants in a marginalized position in Canadian society.

Electronic health records: what are the most important barriers?

PubMed

Ayatollahi, Haleh; Mirani, Nader; Haghani, Hamid

2014-01-01

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

Barriers and enablers to the implementation of the 6-PACK falls prevention program: A pre-implementation study in hospitals participating in a cluster randomised controlled trial

PubMed Central

Brand, Caroline A.; Landgren, Fiona S.; Melhem, Mayer M.; Bian, Evelyn; Brauer, Sandra G.; Hill, Keith D.; Livingston, Patricia M.

2017-01-01

Evidence for effective falls prevention interventions in acute wards is limited. One reason for this may be suboptimal program implementation. This study aimed to identify perceived barriers and enablers of the implementation of the 6-PACK falls prevention program to inform the implementation in a randomised controlled trial. Strategies to optimise successful implementation of 6-PACK were also sought. A mixed-methods approach was applied in 24 acute wards from 6 Australian hospitals. Participants were nurses working on participating wards and senior hospital staff including Nurse Unit Managers; senior physicians; Directors of Nursing; and senior personnel involved in quality and safety or falls prevention. Information on barriers and enablers of 6-PACK implementation was obtained through surveys, focus groups and interviews. Questions reflected the COM-B framework that includes three behaviour change constructs of: capability, opportunity and motivation. Focus group and interview data were analysed thematically, and survey data descriptively. The survey response rate was 60% (420/702), and 12 focus groups (n = 96 nurses) and 24 interviews with senior staff were conducted. Capability barriers included beliefs that falls could not be prevented; and limited knowledge on falls prevention in patients with complex care needs (e.g. cognitive impairment). Capability enablers included education and training, particularly face to face case study based approaches. Lack of resources was identified as an opportunity barrier. Leadership, champions and using data to drive practice change were recognised as opportunity enablers. Motivation barriers included complacency and lack of ownership in falls prevention efforts. Motivation enablers included senior staff articulating clear goals and a commitment to falls prevention; and use of reminders, audits and feedback. The information gained from this study suggests that regular practical face-to-face education and training for nurses; provision of equipment; audit, reminders and feedback; leadership and champions; and the provision of falls data is key to successful falls prevention program implementation in acute hospitals. PMID:28207841

Participation in recreational physical activity: why do socioeconomic groups differ?

PubMed

Burton, Nicola W; Turrell, Gavin; Oldenburg, Brian

2003-04-01

This qualitative study explored how influences on recreational physical activity (RPA) were patterned by socioeconomic position. Face-to-face interviews were conducted with 10 males and 10 females in three socioeconomic groups (N = 60). Influences salient across all groups included previous opportunities, physical health. social assistance. safety. environmental aesthetics and urban design, physical and health benefits, and barriers of self-consciousness, low skill, and weather/time of year. Influences more salient to the high socioeconomic group included social benefits, achieving a balanced lifestyle, and the barrier of an unpredictable lifestyle. Influences more salient to the high and mid socioeconomic groups included efficacy, perceived need, activity demands, affiliation, emotional benefits, and the barrier of competing demands. Influences more salient to the low socioeconomic group included poor health and barriers of inconvenient access and low personal functioning. Data suggest that efforts to increase RPA in the population should include both general and socioeconomically targeted strategies.

Bridging the Gender Divide: Facilitating the Educational Path for Men in Nursing.

PubMed

Hodges, Eric A; Rowsey, Pamela Johnson; Gray, Tamryn Fowler; Kneipp, Shawn M; Giscombe, Cheryl Woods; Foster, Beverly B; Alexander, G Rumay; Kowlowitz, Vicki

2017-05-01

Although the number of men entering the nursing profession over the past century has increased incrementally, the proportion of men remains low in contrast to the U.S. On matriculation into nursing school, men face stereotypes about the nursing profession and the characteristics of the men who enter it. Men may also face a number of gender-based barriers, including lack of history about men in nursing, lack of role models, role strain, gender discrimination, and isolation. This article describes each of these barriers and provides strategies to improve male students' learning experience. The efforts of one nursing school to address many of these barriers are also described. Through acknowledging gender barriers and taking intentional steps to address them with prenursing and nursing students, schools of nursing may create a more inclusive environment and enhance the profession's diversity. [J Nurs Educ. 2017;56(5):295-299.]. Copyright 2017, SLACK Incorporated.

Health communication cards as a tool for behaviour change.

PubMed

Matteson, Carrie L; Merth, Thomas D N; Finegood, Diane T

2014-01-01

Individuals seeking healthcare treatment in the context of obesity often experience difficulty engaging in discussions around their health and face challenges finding consensus with practitioners on care plans that best suit their lives. The complex set of biological, social, and environmental variables that have contributed to the higher prevalence of obesity are well illustrated in the foresight obesity system map. Effectively understanding and addressing key variables for each individual has proven to be difficult, with clinicians facing barriers and limited resources to help address patients' unique needs. However, productive discussions inspired by patient centered care may be particularly effective in promoting behaviour change. Tools based on systems science that facilitate patient centered care and help identify behaviour change priorities have not been developed to help treat adult obesity. This project created and pilot tested a card based clinical communication tool designed to help facilitate conversations with individuals engaged in health behaviour change. The health communication cards were designed to help direct conversation between patients and healthcare providers toward issues relevant to the individual. Use of the cards to facilitate patient driven conversations in clinical care may help to streamline conversations, set realistic care plan goals, and improve long term rates of compliance.

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

PubMed

Ben-Assuli, Ofir

2015-03-01

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

Chronic Disease and Depression Among Hispanic Americans: Reconceptualizing the Masculine Self.

PubMed

Chan, Isabella; Corvin, Jaime A

2016-11-01

Hispanic Americans are the fastest growing minority group in the United States. They face a distinct set of health challenges, resulting in persistent health disparities. Chronic disease self-management programs hold promise in addressing individual-level, behavioral risks factors, such as dietary habits and physical activity patterns. In light of the unique barriers Hispanic men face, including low participation in evidence-based health intervention research, this article argues for a gendered perspective when approaching Hispanic men's physical and mental health needs. Through the analysis of data collected from male-only focus groups (N = 3, n = 15) with Hispanic Americans in west central Florida, this study identified that masculine identity is influenced by chronic disease and comorbid depression status. Diagnosis with a chronic disease and/or depression is accompanied by lifestyle adaptations, activity restrictions, and changes in income and health care demands that can undermine traditional notions of Hispanic masculinity. Consequently, masculine identity is associated with self-management strategies in complex ways. Public health interventions aimed at addressing comorbid chronic disease and depression among Hispanic men must take into consideration the role of gender identity and relevant conceptualizations of masculinity in order to better serve this underserved and understudied population. © The Author(s) 2015.

Perceived Barriers to Healthy Eating and Physical Activity among Adolescents in Seven Arab Countries: A Cross-Cultural Study

PubMed Central

Musaiger, Abdulrahman O.; Tayyem, Reema; Al-Lalla, Osama; Ali, Essa Y. A.; Kalam, Faiza; Benhamed, Mofida M.; Saghir, Sabri; Halahleh, Ismail; Djoudi, Zahra; Chirane, Manel

2013-01-01

Objective. To highlight the perceived personal, social, and environmental barriers to healthy eating and physical activity among Arab adolescents. Method. A multistage stratified sampling method was used to select 4698 students aged 15–18 years (2240 males and 2458 females) from public schools. Seven Arab counties were included in the study, namely, Algeria, Jordan, Kuwait, Libya, Palestine, Syria, and the United Arab Emirates. Self-reported questionnaire was used to list the barriers to healthy eating and physical activity facing these adolescents. Results. It was found that lack of information on healthy eating, lack of motivation to eat a healthy diet, and not having time to prepare or eat healthy food were the main barriers to healthy eating among both genders. For physical activity, the main barriers selected were lack of motivation to do physical activity, less support from teachers, and lack of time to do physical activity. In general, females faced more barriers to physical activity than males in all countries included. There were significant differences between males and females within each country and among countries for most barriers. Conclusion. Intervention programmes to combat obesity and other chronic noncommunicable diseases in the Arab world should include solutions to overcome the barriers to weight maintenance, particularly the sociocultural barriers to practising physical activity. PMID:24348144

Mobile Devices and the Teacher Perceived Barriers Impacting Effective Integration in the K-5 Classroom

ERIC Educational Resources Information Center

Nixon, Tina S.

2013-01-01

This qualitative, phenomenological study explored the teacher perceived barriers of using mobile devices in the K-5 classroom. Research confirms teachers face various types of variables and become reluctant to use technology within their curriculum driven lessons. This study sought to understand what teachers perceive as barriers, and how the…

Barriers and Strategies for Success for American Indian College Students: A Review

ERIC Educational Resources Information Center

Keith, Jill F.; Stastny, Sherri N.; Brunt, Ardith

2016-01-01

American Indian and Alaska Native students have a significantly lower college graduation rate than that of other ethnic groups in the United States. These students often face a variety of barriers to the completion of their education. Overcoming barriers for the achievement of an advanced education takes commitment, hard work, and dedication on…

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…

Translation, Cross-cultural Adaptation and Psychometric Validation of the Korean-Language Cardiac Rehabilitation Barriers Scale (CRBS-K).

PubMed

Baek, Sora; Park, Hee-Won; Lee, Yookyung; Grace, Sherry L; Kim, Won-Seok

2017-10-01

To perform a translation and cross-cultural adaptation of the Cardiac Rehabilitation Barriers Scale (CRBS) for use in Korea, followed by psychometric validation. The CRBS was developed to assess patients' perception of the degree to which patient, provider and health system-level barriers affect their cardiac rehabilitation (CR) participation. The CRBS consists of 21 items (barriers to adherence) rated on a 5-point Likert scale. The first phase was to translate and cross-culturally adapt the CRBS to the Korean language. After back-translation, both versions were reviewed by a committee. The face validity was assessed in a sample of Korean patients (n=53) with history of acute myocardial infarction that did not participate in CR through semi-structured interviews. The second phase was to assess the construct and criterion validity of the Korean translation as well as internal reliability, through administration of the translated version in 104 patients, principle component analysis with varimax rotation and cross-referencing against CR use, respectively. The length, readability, and clarity of the questionnaire were rated well, demonstrating face validity. Analysis revealed a six-factor solution, demonstrating construct validity. Cronbach's alpha was greater than 0.65. Barriers rated highest included not knowing about CR and not being contacted by a program. The mean CRBS score was significantly higher among non-attendees (2.71±0.26) than CR attendees (2.51±0.18) (p<0.01). The Korean version of CRBS has demonstrated face, content and criterion validity, suggesting it may be useful for assessing barriers to CR utilization in Korea.

Barriers to mental health treatment: results from the WHO World Mental Health surveys.

PubMed

Andrade, L H; Alonso, J; Mneimneh, Z; Wells, J E; Al-Hamzawi, A; Borges, G; Bromet, E; Bruffaerts, R; de Girolamo, G; de Graaf, R; Florescu, S; Gureje, O; Hinkov, H R; Hu, C; Huang, Y; Hwang, I; Jin, R; Karam, E G; Kovess-Masfety, V; Levinson, D; Matschinger, H; O'Neill, S; Posada-Villa, J; Sagar, R; Sampson, N A; Sasu, C; Stein, D J; Takeshima, T; Viana, M C; Xavier, M; Kessler, R C

2014-04-01

To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders. Data were from the World Health Organization (WHO) World Mental Health (WMH) surveys. Representative household samples were interviewed face to face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n = 63,678) and analyzed at different levels of clinical severity. Among those with a DSM-IV disorder in the past 12 months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. A desire to handle the problem on one's own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers to both initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment drop-out (39.3%), followed by negative experiences with treatment providers (26.9% of respondents with severe disorders). Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide.

Barriers to Mental Health Treatment: Results from the WHO World Mental Health (WMH) Surveys

PubMed Central

Andrade, L. H.; Alonso, J.; Mneimneh, Z.; Wells, J. E.; Al-Hamzawi, A.; Borges, G.; Bromet, E.; Bruffaerts, R.; de Girolamo, G.; de Graaf, R.; Florescu, S.; Gureje, O.; Hinkov, H. R.; Hu, C.; Huang, Y.; Hwang, I.; Jin, R.; Karam, E. G.; Kovess-Masfety, V.; Levinson, D.; Matschinger, H.; O’Neill, S.; Posada-Villa, J.; Sagar, R.; Sampson, N. A.; Sasu, C.; Stein, D.; Takeshima, T.; Viana, M. C.; Xavier, M.; Kessler, R. C.

2014-01-01

Background To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders. Methods Data are from the WHO World Mental Health (WMH) Surveys. Representative household samples were interviewed face-to-face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n= 63,678) and analyzed at different levels of clinical severity. Results Among those with a DSM-IV disorder in the past twelve months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. Desire to handle the problem on one’s own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers both to initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment dropout (39.3%) followed by negative experiences with treatment providers (26.9% of respondents with severe disorders). Conclusions Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide. PMID:23931656

Nutrition: Unique to Older Adults

MedlinePlus

... with supplements may help reduce falls. Social and Economic Barriers to Good Nutrition : Researchers have found that people in lower social or economic situations have some predictable barriers to eating a ...

Challenges of Pre- and Post-Test Counseling for Orthodox Jewish Individuals in the Premarital Phase.

PubMed

Rose, E; Schreiber-Agus, N; Bajaj, K; Klugman, S; Goldwaser, T

2016-02-01

The Jewish community has traditionally taken ownership of its health, and has taken great strides to raise awareness about genetic issues that affect the community, such as Tay-Sachs disease and Hereditary Breast and Ovarian Cancer syndrome. Thanks in part to these heightened awareness efforts, many Orthodox Jewish individuals are now using genetics services as they begin to plan their families. Due to unique cultural and religious beliefs and perceptions, the Orthodox Jewish patients who seek genetic counseling face many barriers to a successful counseling session, and often seek the guidance of programs such as the Program for Jewish Genetic Health (PJGH). In this article, we present clinical vignettes from the PJGH's clinical affiliate, the Reproductive Genetics practice at the Montefiore Medical Center. These cases highlight unique features of contemporary premarital counseling and screening within the Orthodox Jewish Community, including concerns surrounding stigma, disclosure, "marriageability," the use of reproductive technologies, and the desire to include a third party in decision making. Our vignettes demonstrate the importance of culturally-sensitive counseling. We provide strategies and points to consider when addressing the challenges of pre- and post-test counseling as it relates to genetic testing in this population.

Development and evaluation of an educational training package to promote health and wellbeing.

PubMed

Gartshore, Emily; Briggs, Lydia; Blake, Holly

2017-11-23

supporting the health and wellbeing of healthcare employees is a national priority in the UK. to design, deliver and evaluate an educational package to promote health and wellbeing for nurses and midwives. an online training package was developed and administered in two ways: online (HAWN-online) or in a face-to-face workshop (HAWN-contact). A mixed methods evaluation was used to assess usability and acceptability of HAWN training. 316 nurses, midwives and students completed the online training package and 16 participants attended the workshop. HAWN-online significantly increased knowledge in core areas of workplace health and wellbeing. Nurses and midwives valued online and face-to-face delivery but found there were barriers to attendance at workshops. Participants advocated that training in workplace health should be mandatory for all frontline staff. employers should take steps to promote staff wellbeing through HAWN training, and address barriers to accessing workplace health training or supportive services.

Delivering digital health and well-being at scale: lessons learned during the implementation of the dallas program in the United Kingdom

PubMed Central

Devlin, Alison M; McGee-Lennon, Marilyn; O’Donnell, Catherine A; Bouamrane, Matt-Mouley; Agbakoba, Ruth; O’Connor, Siobhan; Grieve, Eleanor; Finch, Tracy; Wyke, Sally; Watson, Nicholas; Browne, Susan

2016-01-01

Objective To identify implementation lessons from the United Kingdom Delivering Assisted Living Lifestyles at Scale (dallas) program—a large-scale, national technology program that aims to deliver a broad range of digital services and products to the public to promote health and well-being. Materials and Methods Prospective, longitudinal qualitative research study investigating implementation processes. Qualitative data collected includes semi-structured e-Health Implementation Toolkit–led interviews at baseline/mid-point (n = 38), quarterly evaluation, quarterly technical and barrier and solutions reports, observational logs, quarterly evaluation alignment interviews with project leads, observational data collected during meetings, and ethnographic data from dallas events (n > 200 distinct pieces of qualitative data). Data analysis was guided by Normalization Process Theory, a sociological theory that aids conceptualization of implementation issues in complex healthcare settings. Results Five key challenges were identified: 1) The challenge of establishing and maintaining large heterogeneous, multi-agency partnerships to deliver new models of healthcare; 2) The need for resilience in the face of barriers and set-backs including the backdrop of continually changing external environments; 3) The inherent tension between embracing innovative co-design and achieving delivery at pace and at scale; 4) The effects of branding and marketing issues in consumer healthcare settings; and 5) The challenge of interoperability and information governance, when commercial proprietary models are dominant. Conclusions The magnitude and ambition of the dallas program provides a unique opportunity to investigate the macro level implementation challenges faced when designing and delivering digital health and wellness services at scale. Flexibility, adaptability, and resilience are key implementation facilitators when shifting to new digitally enabled models of care. PMID:26254480

Delivering digital health and well-being at scale: lessons learned during the implementation of the dallas program in the United Kingdom.

PubMed

Devlin, Alison M; McGee-Lennon, Marilyn; O'Donnell, Catherine A; Bouamrane, Matt-Mouley; Agbakoba, Ruth; O'Connor, Siobhan; Grieve, Eleanor; Finch, Tracy; Wyke, Sally; Watson, Nicholas; Browne, Susan; Mair, Frances S

2016-01-01

To identify implementation lessons from the United Kingdom Delivering Assisted Living Lifestyles at Scale (dallas) program-a large-scale, national technology program that aims to deliver a broad range of digital services and products to the public to promote health and well-being. Prospective, longitudinal qualitative research study investigating implementation processes. Qualitative data collected includes semi-structured e-Health Implementation Toolkit-led interviews at baseline/mid-point (n = 38), quarterly evaluation, quarterly technical and barrier and solutions reports, observational logs, quarterly evaluation alignment interviews with project leads, observational data collected during meetings, and ethnographic data from dallas events (n > 200 distinct pieces of qualitative data). Data analysis was guided by Normalization Process Theory, a sociological theory that aids conceptualization of implementation issues in complex healthcare settings. Five key challenges were identified: 1) The challenge of establishing and maintaining large heterogeneous, multi-agency partnerships to deliver new models of healthcare; 2) The need for resilience in the face of barriers and set-backs including the backdrop of continually changing external environments; 3) The inherent tension between embracing innovative co-design and achieving delivery at pace and at scale; 4) The effects of branding and marketing issues in consumer healthcare settings; and 5) The challenge of interoperability and information governance, when commercial proprietary models are dominant. The magnitude and ambition of the dallas program provides a unique opportunity to investigate the macro level implementation challenges faced when designing and delivering digital health and wellness services at scale. Flexibility, adaptability, and resilience are key implementation facilitators when shifting to new digitally enabled models of care. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

Qualitative Interviews Exploring Palliative Care Perspectives of Latinos on Dialysis.

PubMed

Cervantes, Lilia; Jones, Jacqueline; Linas, Stuart; Fischer, Stacy

2017-05-08

Compared with non-Latino whites with advanced illness, Latinos are less likely to have an advance directive or to die with hospice services. To improve palliative care disparities, international ESRD guidelines call for increased research on culturally responsive communication of advance care planning (ACP). The objective of our study was to explore the preferences of Latino patients receiving dialysis regarding symptom management and ACP. Qualitative study design using semistructured face-to-face interviews of 20 Latinos on hemodialysis between February and July of 2015. Data were analyzed using thematic analysis. Four themes were identified: Avoiding harms of medication (fear of addiction and damage to bodies, effective distractions, reliance on traditional remedies, fatalism: the sense that one's illness is deserved punishment); barriers and facilitators to ACP: faith, family, and home (family group decision-making, family reluctance to have ACP conversations, flexible decision-making conversations at home with family, ACP conversations incorporating trust and linguistic congruency, family-first and faith-driven decisions); enhancing wellbeing day-to-day (supportive relationships, improved understanding of illness leads to adherence, recognizing new self-value, maintaining a positive outlook); and distressing aspects of living with their illness (dietary restriction is culturally isolating and challenging for families, logistic challenges and socioeconomic disadvantage compounded by health literacy and language barriers, required rapid adjustments to chronic illness, demanding dialysis schedule). Latinos described unique cultural preferences such as avoidance of medications for symptom alleviation and a preference to have family group decision-making and ACP conversations at home. Understanding and integrating cultural values and preferences into palliative care offers the potential to improve disparities and achieve quality patient-centered care for Latinos with advanced illness. Copyright © 2017 by the American Society of Nephrology.

Providing Online-Based Sexual Health Outreach to Gay, Bisexual, and Queer Men in Ontario, Canada: Qualitative Interviews with Multisectoral Frontline Service Providers and Managers.

PubMed

Brennan, David J; Souleymanov, Rusty; Lachowsky, Nathan; Betancourt, Gerardo; Pugh, Daniel; McEwen, Owen

2018-06-13

The Internet is a common tool for gay, bisexual, and other men who have sex with men (MSM) to find sexual partners and sexual health information. Given persistently high human immunodeficiency virus (HIV) infection rates among MSM, it is important to examine the role of online outreach for MSM as part of HIV prevention and care. We provide an overview of the unique perspectives of online sexual health outreach, delivered through AIDS Service Organizations (ASOs) through sociosexual Internet sites and mobile applications. Data were drawn from the qualitative arm of the community-based Cruising Counts study conducted across Ontario from December 2013 to January 2014. ASO online outreach providers and managers (n = 22) were recruited to complete a 1-h in-person/telephone interview to explore in-depth their experiences with, and perspectives on, delivering online outreach services for MSM in Ontario. Thematic analyses were conducted inductively using NVivo 10. Service providers suggested a high demand for online outreach services for MSM. Strengths and advantages of online outreach over face-to-face outreach included anonymity, instant access to services, peer model, and accessing hard-to-reach populations of MSM. Barriers included consistent quality of service, collaborations between companies that own online technologies and outreach service agencies, budgetary and staff capacity issues, and uncertainty of best practices and evaluation parameters for online outreach. Findings from these interviews can inform service providers, policy makers, and researchers on how online sexual health outreach can play a greater role in HIV prevention by better acknowledging and addressing the opportunities and barriers experienced by service providers working with MSM communities online.

Qualitative Interviews Exploring Palliative Care Perspectives of Latinos on Dialysis

PubMed Central

Jones, Jacqueline; Linas, Stuart; Fischer, Stacy

2017-01-01

Background and objectives Compared with non-Latino whites with advanced illness, Latinos are less likely to have an advance directive or to die with hospice services. To improve palliative care disparities, international ESRD guidelines call for increased research on culturally responsive communication of advance care planning (ACP). The objective of our study was to explore the preferences of Latino patients receiving dialysis regarding symptom management and ACP. Design, setting, participants, & measurements Qualitative study design using semistructured face-to-face interviews of 20 Latinos on hemodialysis between February and July of 2015. Data were analyzed using thematic analysis. Results Four themes were identified: Avoiding harms of medication (fear of addiction and damage to bodies, effective distractions, reliance on traditional remedies, fatalism: the sense that one’s illness is deserved punishment); barriers and facilitators to ACP: faith, family, and home (family group decision-making, family reluctance to have ACP conversations, flexible decision-making conversations at home with family, ACP conversations incorporating trust and linguistic congruency, family-first and faith-driven decisions); enhancing wellbeing day-to-day (supportive relationships, improved understanding of illness leads to adherence, recognizing new self-value, maintaining a positive outlook); and distressing aspects of living with their illness (dietary restriction is culturally isolating and challenging for families, logistic challenges and socioeconomic disadvantage compounded by health literacy and language barriers, required rapid adjustments to chronic illness, demanding dialysis schedule). Conclusions Latinos described unique cultural preferences such as avoidance of medications for symptom alleviation and a preference to have family group decision-making and ACP conversations at home. Understanding and integrating cultural values and preferences into palliative care offers the potential to improve disparities and achieve quality patient-centered care for Latinos with advanced illness. PMID:28404600

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

Facilitators and Barriers to Participation in PrEP HIV Prevention Trials Involving Transgender Male and Female Adolescents and Emerging Adults

PubMed Central

Fisher, Celia B.; Fried, Adam L.; Desmond, Margaret; Macapagal, Kathryn; Mustanski, Brian

2018-01-01

Despite the disproportionate burden of HIV facing transgender youth, they continue to be under-represented in studies designed to provide an empirical basis for pre-exposure prophylaxis (PrEP) programs that can meet the unique needs of this population. This study examined facilitators and barriers to participation in a PrEP adherence study. Ninety transgender male (TM) and 60 transgender female (TF) 14 – 21 year olds attracted to cisgender male sexual partners completed an online survey to examine (a) gender identity, age and family disclosure; (b) sexual experience, HIV/STI testing history and perceptions of HIV risk; (c) prior health services and (d) perceived PrEP research risks and benefits (e) and the relationship of these factors to the likelihood of study participation. Approximately 50% were likely to participate in the PrEP study. Participation facilitators included prior sexual and health service experiences (i.e. number of sexual partners, STI testing history, comfort discussing sexual orientation and HIV protection with health providers) and study access to PrEP and health services (i.e. daily HIV protection, not having to rely on a partner for protection, regular health check ups). Participation barriers included lack of concern about HIV, potential medication side effects, the logistics of quarterly meetings, remembering to take PrEP daily and reluctance to discuss gender identity with study staff. Requiring guardian consent was a participation barrier for youth under 18. Results suggest that successful recruitment and retention of transgender youth in PrEP prevention studies warrant protocols designed to address youth's underestimation of HIV risk, concerns regarding medical risk and study logistics, and their need for gender and sexual orientation affirming health services. PMID:28650227

Identifying Barriers in the Use of Electronic Health Records in Hawai‘i

PubMed Central

Hamamura, Faith D; Hughes, Kira

2017-01-01

Hawai‘i faces unique challenges to Electronic Health Record (EHR) adoption due to physician shortages, a widespread distribution of Medically Underserved Areas and Populations (MUA/P), and a higher percentage of small independent practices. However, research on EHR adoption in Hawai‘i is limited. To address this gap, this article examines the current state of EHR in Hawai‘i, the barriers to adoption, and the future of Health Information Technology (HIT) initiatives to improve the health of Hawai‘i's people. Eight focus groups were conducted on Lana‘i, Maui, Hawai‘i Island, Kaua‘i, Moloka‘i, and O‘ahu. In these groups, a total of 51 diverse health professionals were asked about the functionality of EHR systems, barriers to use, facilitators of use, and what EHRs would look like in a perfect world. Responses were summarized and analyzed based on constant comparative analysis techniques. Responses were then clustered into thirteen themes: system compatibility, loss of productivity, poor interface, IT support, hardware/software, patient factors, education/training, noise in the system, safety, data quality concerns, quality metrics, workflow, and malpractice concerns. Results show that every group mentioned system compatibility. In response to these findings, the Health eNet Community Health Record initiative — which allows providers web-based access to patient health information from the patient's provider network— was developed as a step toward alleviating some of the barriers to sharing information between different EHRs. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation will introduce a new payment model in 2017 that is partially based on EHR utilization. Therefore, more research should be done to understand EHR adoption and how this ruling will affect providers in Hawai‘i. PMID:28435756

Identifying Barriers in the Use of Electronic Health Records in Hawai'i.

PubMed

Hamamura, Faith D; Withy, Kelley; Hughes, Kira

2017-03-01

Hawai'i faces unique challenges to Electronic Health Record (EHR) adoption due to physician shortages, a widespread distribution of Medically Underserved Areas and Populations (MUA/P), and a higher percentage of small independent practices. However, research on EHR adoption in Hawai'i is limited. To address this gap, this article examines the current state of EHR in Hawai'i, the barriers to adoption, and the future of Health Information Technology (HIT) initiatives to improve the health of Hawai'i's people. Eight focus groups were conducted on Lana'i, Maui, Hawai'i Island, Kaua'i, Moloka'i, and O'ahu. In these groups, a total of 51 diverse health professionals were asked about the functionality of EHR systems, barriers to use, facilitators of use, and what EHRs would look like in a perfect world. Responses were summarized and analyzed based on constant comparative analysis techniques. Responses were then clustered into thirteen themes: system compatibility, loss of productivity, poor interface, IT support, hardware/software, patient factors, education/training, noise in the system, safety, data quality concerns, quality metrics, workflow, and malpractice concerns. Results show that every group mentioned system compatibility. In response to these findings, the Health eNet Community Health Record initiative - which allows providers web-based access to patient health information from the patient's provider network- was developed as a step toward alleviating some of the barriers to sharing information between different EHRs. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) legislation will introduce a new payment model in 2017 that is partially based on EHR utilization. Therefore, more research should be done to understand EHR adoption and how this ruling will affect providers in Hawai'i.

'If an Eye Is Washed Properly, It Means It Would See Clearly': A Mixed Methods Study of Face Washing Knowledge, Attitudes, and Behaviors in Rural Ethiopia.

PubMed

Aiemjoy, Kristen; Stoller, Nicole E; Gebresillasie, Sintayehu; Shiferaw, Ayalew; Tadesse, Zerihun; Sewnet, Tegene; Ayele, Bezuayehu; Chanyalew, Melsew; Callahan, Kelly; Stewart, Aisha; Emerson, Paul M; Lietman, Thomas M; Keenan, Jeremy D; Oldenburg, Catherine E

2016-10-01

Face cleanliness is a core component of the SAFE (Surgery, Antibiotics, Facial cleanliness, and Environmental improvements) strategy for trachoma control. Understanding knowledge, attitudes, and behaviors related to face washing may be helpful for designing effective interventions for improving facial cleanliness. In April 2014, a mixed methods study including focus groups and a quantitative cross-sectional study was conducted in the East Gojjam zone of the Amhara region of Ethiopia. Participants were asked about face washing practices, motivations for face washing, use of soap (which may reduce bacterial load), and fly control strategies. Overall, both knowledge and reported practice of face washing was high. Participants reported they knew that washing their own face and their children's faces daily was important for hygiene and infection control. Although participants reported high knowledge of the importance of soap for face washing, quantitative data revealed strong variations by community in the use of soap for face washing, ranging from 4.4% to 82.2% of households reporting using soap for face washing. Cost and forgetfulness were cited as barriers to the use of soap for face washing. Keeping flies from landing on children was a commonly cited motivator for regular face washing, as was trachoma prevention. Interventions aiming to improve facial cleanliness for trachoma prevention should focus on habit formation (to address forgetfulness) and address barriers to the use of soap, such as reducing cost. Interventions that focus solely on improving knowledge may not be effective for changing face-washing behaviors.

Predictors of Attitudes toward Disability and Employment Policy Issues among Undergraduate Students at the University of Nairobi

ERIC Educational Resources Information Center

Mamboleo, George Isaboke

2009-01-01

Disability rights issues are an emerging area of discourse in Kenya. Persons with disabilities in Kenya face many barriers to integration into the larger Kenyan society possibly due to barriers such as societal negative attitudes. Research has indicated that the greatest barrier to rehabilitation of persons with disabilities is negative attitudes…

Barriers to employment for drug dependent postpartum women.

PubMed

Bowden, Kelley; Goodman, Daisy

2015-01-01

Employment represents the key to independence for women, and equal opportunity has been an elusive goal. For women with substance dependence, employment is strongly linked to the ability to sustain recovery. Unfortunately, for postpartum mothers with substance use disorders, gender-based barriers are magnified. A case analysis is provided to illustrate the interaction of multiple barriers to employment success in one postpartum woman's experience. To elucidate the complex factors involved in return to employment for postpartum women being treated for substance use disorders. A review of the current literature on employment, substance use, and the postpartum period was performed. Themes identified in the literature were applied to analyze a representative case. Postpartum women with substance use disorders face a variety of challenges to employment success. Lack of education and job skills are common barriers to successful employment of women in addiction recovery. These barriers may be complicated by emotional or logistical challenges, or related to external factors such as stigma and/or previous criminal history. Assessment of employment history, marketable skills, and barriers should be an essential component of substance abuse treatment programs. Professionals working to increase employment opportunities for postpartum women with substance use disorders should be particularly aware of the multiple barriers they face and integrate employment assessment and skills training into the early stages of treatment programs.

The Experiences of Blacks Who Obtained Doctorates from Predominantly White Institutions

ERIC Educational Resources Information Center

Nickelberry, Tressie A.

2012-01-01

Being in a doctoral program requires a substantial amount of one's time, energy, and commitment. Doctoral students face many challenges while pursuing their degrees. For example, some may be on financial aid, work full-time, and/or have a family. While doctoral students face many hurdles, Black doctoral students face additional barriers. The…

A systematic literature review of evidence-based clinical practice for rare diseases: what are the perceived and real barriers for improving the evidence and how can they be overcome?

PubMed

Rath, Ana; Salamon, Valérie; Peixoto, Sandra; Hivert, Virginie; Laville, Martine; Segrestin, Berenice; Neugebauer, Edmund A M; Eikermann, Michaela; Bertele, Vittorio; Garattini, Silvio; Wetterslev, Jørn; Banzi, Rita; Jakobsen, Janus C; Djurisic, Snezana; Kubiak, Christine; Demotes-Mainard, Jacques; Gluud, Christian

2017-11-22

Evidence-based clinical practice is challenging in all fields, but poses special barriers in the field of rare diseases. The present paper summarises the main barriers faced by clinical research in rare diseases, and highlights opportunities for improvement. Systematic literature searches without meta-analyses and internal European Clinical Research Infrastructure Network (ECRIN) communications during face-to-face meetings and telephone conferences from 2013 to 2017 within the context of the ECRIN Integrating Activity (ECRIN-IA) project. Barriers specific to rare diseases comprise the difficulty to recruit participants because of rarity, scattering of patients, limited knowledge on natural history of diseases, difficulties to achieve accurate diagnosis and identify patients in health information systems, and difficulties choosing clinically relevant outcomes. Evidence-based clinical practice for rare diseases should start by collecting clinical data in databases and registries; defining measurable patient-centred outcomes; and selecting appropriate study designs adapted to small study populations. Rare diseases constitute one of the most paradigmatic fields in which multi-stakeholder engagement, especially from patients, is needed for success. Clinical research infrastructures and expertise networks offer opportunities for establishing evidence-based clinical practice within rare diseases.

Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study.

PubMed

Iravani, Mina; Janghorbani, Mohsen; Zarean, Ellahe; Bahrami, Masod

2016-02-01

Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality.

Ethical Issues in Pediatric Face Transplantation: Should We Perform Face Transplantation in Children?

PubMed

Marchac, Alexandre; Kuschner, Tomasine; Paris, John; Picard, Arnaud; Vazquez, Marie Paule; Lantieri, Laurent

2016-08-01

In 2005, face transplantation ceased to be fiction and became a scientific reality. Today, 10 teams from six different countries have performed 32 face transplantations. Immunosuppressive treatments are similar to other solid organ transplants, and patients have experienced a significant functional improvement. The authors are logically considering expanding face transplantation to children; however, children are not simply small adults. The authors searched for pediatric patients in need of restoration of fundamental functions of the face, such as orbicularis oris or oculi muscle closure by, first, selecting cases from a pediatric plastic surgery reference center and, second, analyzing the feasibility of face transplantation in those patients. The authors then identified the specific problems that they would encounter during a pediatric face transplant. The authors identified three potential candidates for pediatric face transplantation. Children's youth imposes additional ethical and psychological considerations, such as the balance of risk to benefit when it is quality of life, not life itself, that is at stake; the process of informed consent; the selection process; and the protection of privacy against media exposure. The question becomes not whether children should be included as candidates for face transplantation but whether any ethical barriers should preclude children as candidates for a full face transplant. After careful consideration of the physical, psychological, and ethical aspects of such a procedure, the authors found no such barrier that would either disqualify such vulnerable subjects as profoundly disfigured children or conflict with their best interests.

Athletic Trainer Services in Public and Private Secondary Schools.

PubMed

Pike, Alicia M; Pryor, Riana R; Vandermark, Lesley W; Mazerolle, Stephanie M; Casa, Douglas J

2017-01-01

 The presence of athletic trainers (ATs) in secondary schools to provide medical care is crucial, especially with the rise in sports participation and resulting high volume of injuries. Previous authors have investigated the level of AT services offered, but the differences in medical care offered between the public and private sectors have not been explored.  To compare the level of AT services in public and private secondary schools.  Concurrent mixed-methods study.  Public and private secondary schools in the United States.  A total of 10 553 secondary schools responded to the survey (8509 public, 2044 private).  School administrators responded to the survey via telephone or e-mail. Descriptive statistics depict national data. Open-ended questions were evaluated through content analysis.  A greater percentage of public secondary schools than private secondary schools hired ATs. Public secondary schools provided a higher percentage of full-time, part-time, and clinic AT services than private secondary schools. Only per diem AT services were more frequent in the private sector. Regardless of the extent of services, reasons for not employing an AT were similar between sectors. Common barriers were budget, school size, and lack of awareness of the role of an AT. Unique to the public sector, remote location was identified as a challenge faced by some administrators.  Both public and private secondary schools lacked ATs, but higher percentages of total AT services and full-time services were available in the public sector. Despite differences in AT services, both settings provided a similar number of student-athletes with access to medical care. Barriers to hiring ATs were comparable between public and private secondary schools; however, remote location was a unique challenge for the public sector.

Athletic Trainer Services in Public and Private Secondary Schools

PubMed Central

Pike, Alicia M.; Pryor, Riana R.; Vandermark, Lesley W.; Mazerolle, Stephanie M.; Casa, Douglas J.

2017-01-01

Context: The presence of athletic trainers (ATs) in secondary schools to provide medical care is crucial, especially with the rise in sports participation and resulting high volume of injuries. Previous authors have investigated the level of AT services offered, but the differences in medical care offered between the public and private sectors have not been explored. Objective: To compare the level of AT services in public and private secondary schools. Design: Concurrent mixed-methods study. Setting: Public and private secondary schools in the United States. Patients or Other Participants: A total of 10 553 secondary schools responded to the survey (8509 public, 2044 private). Main Outcome Measure(s): School administrators responded to the survey via telephone or e-mail. Descriptive statistics depict national data. Open-ended questions were evaluated through content analysis. Results: A greater percentage of public secondary schools than private secondary schools hired ATs. Public secondary schools provided a higher percentage of full-time, part-time, and clinic AT services than private secondary schools. Only per diem AT services were more frequent in the private sector. Regardless of the extent of services, reasons for not employing an AT were similar between sectors. Common barriers were budget, school size, and lack of awareness of the role of an AT. Unique to the public sector, remote location was identified as a challenge faced by some administrators. Conclusions: Both public and private secondary schools lacked ATs, but higher percentages of total AT services and full-time services were available in the public sector. Despite differences in AT services, both settings provided a similar number of student-athletes with access to medical care. Barriers to hiring ATs were comparable between public and private secondary schools; however, remote location was a unique challenge for the public sector. PMID:28157403

See More, Do More, Teach More: Surgical Resident Autonomy and the Transition to Independent Practice.

PubMed

Hashimoto, Daniel A; Bynum, William E; Lillemoe, Keith D; Sachdeva, Ajit K

2016-06-01

The graduate medical education system is tasked with training competent and autonomous health care providers while also improving patient safety, delivering more efficient care, and cutting costs. Concerns about resident autonomy and preparation for independent and safe practice appear to be growing, and the field of surgery faces unique challenges in preparing graduates for independent practice. Multiple factors are contributing to an erosion of resident autonomy and decreased operative experience, including differing views of autonomy, financial forces, duty hours regulations, and diverse community health care needs. Identifying these barriers and developing solutions to overcome them are vital first steps in reversing the trend of diminishing autonomy in surgical residency training. This Commentary highlights the problem of decreasing autonomy, outlines specific threats to resident autonomy, and discusses potential solutions to mitigate their impact on the successful transition to independent practice.

Tangible resources for preparing patients for antiviral therapy for chronic hepatitis C.

PubMed

Bonner, Jason E; Barritt, A Sidney; Fried, Michael W; Evon, Donna M

2012-06-01

Chronic hepatitis C (HCV) infected patients with coexisting mental health and/or substance abuse issues face significant barriers to treatment and are often deferred. This paper sought to highlight critical pre-treatment strategies and provide tangible resources for HCV clinicians to facilitate preparation and successful treatment of these patients. Guided by the clinical experience of our liver center, a large, tertiary academic medical center, and informed by the extant literature, we summarize pre-treatment strategies and specific resources and recommendations for HCV providers. Four key pre-treatment strategies include: 1) screening for mental health/substance abuse issues using brief, reliable and validated instruments; 2) locating and establishing collaborative care with mental health and substance abuse specialists; 3) using a motivational interviewing communication style; and 4) addressing adherence-related issues. HCV clinicians are in a unique position to prepare patients with coexisting mental health and/or substance abuse issues for antiviral therapy.

Developing a Safer Conception Intervention for Men Living with HIV in South Africa.

PubMed

Khidir, Hazar; Psaros, Christina; Greener, Letitia; O'Neil, Kasey; Mathenjwa, Mxolisi; Mosery, F N; Moore, Lizzie; Harrison, Abigail; Bangsberg, David R; Smit, Jennifer A; Safren, Steven A; Matthews, Lynn T

2018-06-01

Within sexual partnerships, men make many decisions about sexual behavior, reproductive goals, and HIV prevention. There are increasing calls to involve men in reproductive health and HIV prevention. This paper describes the process of creating and evaluating the acceptability of a safer conception intervention for men living with HIV who want to have children with partners at risk for acquiring HIV in KwaZulu-Natal, South Africa. Based on formative work conducted with men and women living with HIV, their partners, and providers, we developed an intervention based on principles of cognitive-behavioral therapy to support men in the adoption of HIV risk-reduction behaviors such as HIV-serostatus disclosure and uptake of and adherence to antiretroviral therapy. Structured group discussions were used to explore intervention acceptability and feasibility. Our work demonstrates that men are eager for reproductive health services, but face unique barriers to accessing them.

Softening due to Grain Boundary Cavity Formation and its Competition with Hardening in Helium Implanted Nanocrystalline Tungsten

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

Cunningham, W. Streit; Gentile, Jonathan M.; El-Atwani, Osman

The unique ability of grain boundaries to act as effective sinks for radiation damage plays a significant role in nanocrystalline materials due to their large interfacial area per unit volume. Leveraging this mechanism in the design of tungsten as a plasma-facing material provides a potential pathway for enhancing its radiation tolerance under fusion-relevant conditions. In this study, we explore the impact of defect microstructures on the mechanical behavior of helium ion implanted nanocrystalline tungsten through nanoindentation. Softening was apparent across all implantation temperatures and attributed to bubble/cavity loaded grain boundaries suppressing the activation barrier for the onset of plasticity viamore » grain boundary mediated dislocation nucleation. An increase in fluence placed cavity induced grain boundary softening in competition with hardening from intragranular defect loop damage, thus signaling a new transition in the mechanical behavior of helium implanted nanocrystalline tungsten.« less

Softening due to Grain Boundary Cavity Formation and its Competition with Hardening in Helium Implanted Nanocrystalline Tungsten

DOE PAGES

Cunningham, W. Streit; Gentile, Jonathan M.; El-Atwani, Osman; ...

2018-02-13

The unique ability of grain boundaries to act as effective sinks for radiation damage plays a significant role in nanocrystalline materials due to their large interfacial area per unit volume. Leveraging this mechanism in the design of tungsten as a plasma-facing material provides a potential pathway for enhancing its radiation tolerance under fusion-relevant conditions. In this study, we explore the impact of defect microstructures on the mechanical behavior of helium ion implanted nanocrystalline tungsten through nanoindentation. Softening was apparent across all implantation temperatures and attributed to bubble/cavity loaded grain boundaries suppressing the activation barrier for the onset of plasticity viamore » grain boundary mediated dislocation nucleation. An increase in fluence placed cavity induced grain boundary softening in competition with hardening from intragranular defect loop damage, thus signaling a new transition in the mechanical behavior of helium implanted nanocrystalline tungsten.« less

Improving Voluntary Environmental Management Programs: Facilitating Learning and Adaptation

NASA Astrophysics Data System (ADS)

Genskow, Kenneth D.; Wood, Danielle M.

2011-05-01

Environmental planners and managers face unique challenges understanding and documenting the effectiveness of programs that rely on voluntary actions by private landowners. Programs, such as those aimed at reducing nonpoint source pollution or improving habitat, intend to reach those goals by persuading landowners to adopt behaviors and management practices consistent with environmental restoration and protection. Our purpose with this paper is to identify barriers for improving voluntary environmental management programs and ways to overcome them. We first draw upon insights regarding data, learning, and adaptation from the adaptive management and performance management literatures, describing three key issues: overcoming information constraints, structural limitations, and organizational culture. Although these lessons are applicable to a variety of voluntary environmental management programs, we then present the issues in the context of on-going research for nonpoint source water quality pollution. We end the discussion by highlighting important elements for advancing voluntary program efforts.

Patient Navigators: Agents of Creating Community-Nested Patient-Centered Medical Homes for Cancer Care

PubMed Central

Simon, Melissa A.; Samaras, Athena T.; Nonzee, Narissa J.; Hajjar, Nadia; Frankovich, Carmi; Bularzik, Charito; Murphy, Kara; Endress, Richard; Tom, Laura S.; Dong, XinQi

2016-01-01

Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients’ interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus–community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care. While the patient navigator experience has been qualitatively documented, the literature pertaining to patient navigation has largely focused on efficacy outcomes and program cost effectiveness. Here, we uniquely highlight stories of women enrolled in the DPNC, told from the perspective of patient navigators, to shed light on the myriad barriers that DPNC patients faced and document the strategies DPNC patient navigators implemented. PMID:27594792

Challenges in Expanding Access to Dialysis in South Africa-Expensive Modalities, Cost Constraints and Human Rights.

PubMed

Etheredge, Harriet; Fabian, June

2017-07-31

South Africa is a country with two distinct health sectors, which are both characterised by inequalities. Within this context, patients with end stage renal disease face unique and sometimes impenetrable barriers to accessing dialysis. There are a number of reasons for this situation. These include: the South African government's endorsement of discordant, unequal policies, which disadvantage the most vulnerable; a lack of robust national guidelines; and divisive rationing practices, which are ad hoc and place the burden of responsibility for rationing dialysis on the clinician. In this paper, we trace the socio-economic mechanisms of how we have come to be in this situation, and overlay this with a detailed examination of South African legislation. Finally, we make comprehensive practical recommendations for rectifying the situation, which include engagement with key stakeholders, public-private partnerships, and more equitable funding mechanisms.

The nursing informatics workforce: who are they and what do they do?

PubMed

Murphy, Judy

2011-01-01

Nursing informatics has evolved into an integral part of health care delivery and a differentiating factor in the selection, implementation, and evaluation of health IT that supports safe, high-quality, patient-centric care. New nursing informatics workforce data reveal changing dynamics in clinical experience, job responsibilities, applications, barriers to success, information, and compensation and benefits. In addition to the more traditional informatics nurse role, a new position has begun to emerge in the health care C-suite with the introduction of the chief nursing informatics officer (CNIO). The CNIO is the senior informatics nurse guiding the implementation and optimization of HIT systems for an organization. With their fused clinical and informatics background, informatics nurses and CNIOs are uniquely positioned to help with "meaningful use" initiatives which are so important to changing the face of health care in the United States.

Newborn screening progress in developing countries--overcoming internal barriers.

PubMed

Padilla, Carmencita D; Krotoski, Danuta; Therrell, Bradford L

2010-04-01

Newborn screening is an important public health measure aimed at early identification and management of affected newborns thereby lowering infant morbidity and mortality. It is a comprehensive system of education, screening, follow-up, diagnosis, treatment/management, and evaluation that must be institutionalized and sustained within public health systems often challenged by economic, political, and cultural considerations. As a result, developing countries face unique challenges in implementing and expanding newborn screening that can be grouped into the following categories: (1) planning, (2) leadership, (3) medical support, (4) technical support, (5) logistical support, (6) education, (7) protocol and policy development, (8) administration, (9) evaluation, and (10) sustainability. We review some of the experiences in overcoming implementation challenges in developing newborn screening programs, and discuss recent efforts to encourage increased newborn screening through support networking and information exchange activities in 2 regions-the Asia Pacific and the Middle East/North Africa. Copyright 2010 Elsevier Inc. All rights reserved.

Introduction: Linkage, engagement, and retention in HIV care: essential for optimal individual- and community-level outcomes in the era of highly active antiretroviral therapy.

PubMed

Mayer, Kenneth Hugh

2011-01-15

Engagement in medical care after a diagnosis of human immunodeficiency virus (HIV) infection is essential to initiate lifesaving antiretroviral therapy and facilitate the delivery of important prevention messages for reducing HIV transmission. Failure to engage and be retained in HIV care can be associated with negative outcomes for both the individual and the community. However, many Americans living with HIV infection are, for a variety of reasons, undiagnosed, not in medical care, or not receiving HIV treatment. The articles in this supplement describe the barriers, challenges, and successes in linking HIV-infected patients to expert care in the United States, with a focus on the unique issues faced by specific populations of men who have sex with men, heterosexual men, and women, and the role of the health care system and other structural factors in facilitating or impeding engagement in care.

Mechanically expandable annular seal

DOEpatents

Gilmore, R.F.

1983-07-19

A mechanically expandable annular reusable seal assembly to form an annular hermetic barrier between two stationary, parallel, and planar containment surfaces is described. A rotatable ring, attached to the first surface, has ring wedges resembling the saw-tooth array of a hole saw. Matching seal wedges are slidably attached to the ring wedges and have their motion restricted to be perpendicular to the second surface. Each seal wedge has a face parallel to the second surface. An annular elastomer seal has a central annular region attached to the seal wedges' parallel faces and has its inner and outer circumferences attached to the first surface. A rotation of the ring extends the elastomer seal's central region perpendicularly towards the second surface to create the fluid tight barrier. A counter rotation removes the barrier. 6 figs.

"They're younger… it's harder." Primary providers' perspectives on hypertension management in young adults: a multicenter qualitative study.

PubMed

Johnson, Heather M; Warner, Ryan C; Bartels, Christie M; LaMantia, Jamie N

2017-01-03

Young adults (18-39 year-olds) have the lowest hypertension control rates among adults with hypertension in the United States. Unique barriers to hypertension management in young adults with primary care access compared to older adults have not been evaluated. Understanding these differences will inform the development of hypertension interventions tailored to young adults. The goals of this multicenter study were to explore primary care providers' perspectives on barriers to diagnosing, treating, and controlling hypertension among young adults with regular primary care. Primary care providers (physicians and advanced practice providers) actively managing young adults with uncontrolled hypertension were recruited by the Wisconsin Research & Education Network (WREN), a statewide practice-based research network. Semi-structured qualitative interviews were conducted in three diverse Midwestern clinical practices (academic, rural, and urban clinics) using a semi-structured interview guide, and content analysis was performed. Primary care providers identified unique barriers across standard hypertension healthcare delivery practices for young adults. Altered self-identity, greater blood pressure variability, and unintended consequences of medication initiation were critical hypertension control barriers among young adults. Gender differences among young adults were also noted as barriers to hypertension follow-up and antihypertensive medication initiation. Tailored interventions addressing the unique barriers of young adults are needed to improve population hypertension control. Augmenting traditional clinic structure to support the "health identity" of young adults and self-management skills are promising next steps to improve hypertension healthcare delivery.

Translation, Cross-cultural Adaptation and Psychometric Validation of the Korean-Language Cardiac Rehabilitation Barriers Scale (CRBS-K)

PubMed Central

2017-01-01

Objective To perform a translation and cross-cultural adaptation of the Cardiac Rehabilitation Barriers Scale (CRBS) for use in Korea, followed by psychometric validation. The CRBS was developed to assess patients' perception of the degree to which patient, provider and health system-level barriers affect their cardiac rehabilitation (CR) participation. Methods The CRBS consists of 21 items (barriers to adherence) rated on a 5-point Likert scale. The first phase was to translate and cross-culturally adapt the CRBS to the Korean language. After back-translation, both versions were reviewed by a committee. The face validity was assessed in a sample of Korean patients (n=53) with history of acute myocardial infarction that did not participate in CR through semi-structured interviews. The second phase was to assess the construct and criterion validity of the Korean translation as well as internal reliability, through administration of the translated version in 104 patients, principle component analysis with varimax rotation and cross-referencing against CR use, respectively. Results The length, readability, and clarity of the questionnaire were rated well, demonstrating face validity. Analysis revealed a six-factor solution, demonstrating construct validity. Cronbach's alpha was greater than 0.65. Barriers rated highest included not knowing about CR and not being contacted by a program. The mean CRBS score was significantly higher among non-attendees (2.71±0.26) than CR attendees (2.51±0.18) (p<0.01). Conclusion The Korean version of CRBS has demonstrated face, content and criterion validity, suggesting it may be useful for assessing barriers to CR utilization in Korea. PMID:29201826

Access to health care for persons with disabilities in rural South Africa.

PubMed

Vergunst, R; Swartz, L; Hem, K-G; Eide, A H; Mannan, H; MacLachlan, M; Mji, G; Braathen, S H; Schneider, M

2017-11-17

Global research suggests that persons with disabilities face barriers when accessing health care services. Yet, information regarding the nature of these barriers, especially in low-income and middle-income countries is sparse. Rural contexts in these countries may present greater barriers than urban contexts, but little is known about access issues in such contexts. There is a paucity of research in South Africa looking at "triple vulnerability" - poverty, disability and rurality. This study explored issues of access to health care for persons with disabilities in an impoverished rural area in South Africa. The study includes a quantitative survey with interviews with 773 participants in 527 households. Comparisons in terms of access to health care between persons with disabilities and persons with no disabilities were explored. The approach to data analysis included quantitative data analysis using descriptive and inferential statistics. Frequency and cross tabulation, comparing and contrasting the frequency of different phenomena between persons with disabilities and persons with no disabilities, were used. Chi-square tests and Analysis of Variance tests were then incorporated into the analysis. Persons with disabilities have a higher rate of unmet health needs as compared to non-disabled. In rural Madwaleni in South Africa, persons with disabilities faced significantly more barriers to accessing health care compared to persons without disabilities. Barriers increased with disability severity and was reduced with increasing level of education, living in a household without disabled members and with age. This study has shown that access to health care in a rural area in South Africa for persons with disabilities is more of an issue than for persons without disabilities in that they face more barriers. Implications are that we need to look beyond the medical issues of disability and address social and inclusion issues as well.

Sensitivity to spatial frequency content is not specific to face perception

PubMed Central

Williams, N. Rankin; Willenbockel, Verena; Gauthier, Isabel

2010-01-01

Prior work using a matching task between images that were complementary in spatial frequency and orientation information suggested that the representation of faces, but not objects, retains low-level spatial frequency (SF) information (Biederman & Kalocsai. 1997). In two experiments, we reexamine the claim that faces are uniquely sensitive to changes in SF. In contrast to prior work, we used a design allowing the computation of sensitivity and response criterion for each category, and in one experiment, equalized low-level image properties across object categories. In both experiments, we find that observers are sensitive to SF changes for upright and inverted faces and nonface objects. Differential response biases across categories contributed to a larger sensitivity for faces, but even sensitivity showed a larger effect for faces, especially when faces were upright and in a front-facing view. However, when objects were inverted, or upright but shown in a three-quarter view, the matching of objects and faces was equally sensitive to SF changes. Accordingly, face perception does not appear to be uniquely affected by changes in SF content. PMID:19576237

Finding resiliency in the face of financial barriers: Development of a conceptual framework for people with cardiovascular-related chronic disease.

PubMed

Campbell, David J T; Manns, Braden J; Leblanc, Pamela; Hemmelgarn, Brenda R; Sanmartin, Claudia; King-Shier, Kathryn

2016-12-01

Patients with chronic diseases often face financial barriers to optimize their health. These financial barriers may be related to direct healthcare costs such as medications or self-monitoring supplies, or indirect costs such as transportation to medical appointments. No known framework exists to understand how financial barriers impact patients' lives or their health outcomes.We undertook a grounded theory study to develop such a framework. We used semistructured interviews with a purposive sample of participants with cardiovascular-related chronic disease (hypertension, diabetes, heart disease, or stroke) from Alberta, Canada. Interview transcripts were analyzed in triplicate, and interviews continued until saturation was reached.We interviewed 34 participants. We found that the confluence of 2 events contributed to the perception of having a financial barrier-onset of chronic disease and lack of income or health benefits. The impact of having a perceived financial barrier varied considerably. Protective, predisposing, or modifying of factors determined how impactful a financial barrier would be. An individual's particular set of factors is then shaped by their worldview. This combination of factors and lens determines one's degree of resiliency, which ultimately impacts how well they cope with their disease.The role of financial barriers is complex. How well an individual copes with their financial barriers is intimately tied to resiliency, which is related to the composite of a personal circumstances and their worldview. Our framework for understanding the experience of financial barriers can be used by both researchers and clinicians to better understand patient behavior.

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

PubMed

Hanghøj, Signe; Boisen, Kirsten A

2014-02-01

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

Exploring the potential of technology-based mental health services for homeless youth: A qualitative study.

PubMed

Adkins, Elizabeth C; Zalta, Alyson K; Boley, Randy A; Glover, Angela; Karnik, Niranjan S; Schueller, Stephen M

2017-05-01

Homelessness has serious consequences for youth that heighten the need for mental health services; however, these individuals face significant barriers to access. New models of intervention delivery are required to improve the dissemination of mental health interventions that tailor these services to the unique challenges faced by homeless youth. The purpose of this study was to better understand homeless youths' use of technology, mental health experiences and needs, and willingness to engage with technology-supported mental health interventions to help guide the development of future youth-facing technology-supported interventions. Five focus groups were conducted with 24 homeless youth (62.5% female) in an urban shelter. Youth were 18- to 20-years-old with current periods of homelessness ranging from 6 days to 4 years. Transcripts of these focus groups were coded to identify themes. Homeless youth reported using mobile phones frequently for communication, music, and social media. They indicated a lack of trust and a history of poor relationships with mental health providers despite recognizing the need for general support as well as help for specific mental health problems. Although initial feelings toward technology that share information with a provider were mixed, they reported an acceptance of tracking and sharing information under certain circumstances. Based on these results, we provide recommendations for the development of mental health interventions for this population focusing on technology-based treatment options. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

A qualitative focus group study to identify the needs of survivors of stage II and III colorectal cancer.

PubMed

Ho, Maria Y; McBride, Mary L; Gotay, Carolyn; Grunfeld, Eva; Earle, Craig C; Relova, Sharon; Tsonis, Miranda; Ruan, Jenny Y; Chang, Jennifer T; Cheung, Winson Y

2016-12-01

Prior survivorship research has largely focused on issues faced by survivors of childhood tumors, breast cancers, or hematologic malignancies. Relatively little is known about the needs of other prevalent survivor groups. Our aim was to identify the specific concerns of colorectal cancer (CRC) survivors in the key domains of physical functioning, psychological wellbeing, and social relationships. We conducted focus groups with stage II and III CRC survivors who had completed their primary active anti-cancer treatments. Patients were asked to describe how their diagnosis and treatment impacted their lives, to outline deficiencies in the care that they received, and to suggest ways of addressing any unmet needs. A content analysis was subsequently conducted to identify major themes. Thirty CRC survivors participated in six focus groups. Individuals reported some degree of dissatisfaction with the amount and type of diagnostic and treatment information they received at their initial clinic visit. Distress from toxicities, such as peripheral neuropathy, was also common among the survivors. Similarly, the majority faced challenges adjusting to their lives and daily activities, especially in caring for their colostomy. Having survived CRC, many survivors expressed an interest in advocacy and health promotion of CRC. CRC survivors face many barriers after their cancer treatment. Issues with colostomy are unique to this survivor group. Interventions to improve CRC survivorship care should also incorporate opportunities for patient advocacy. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Barriers to Participatory Extension in Egypt: Agricultural Workers' Perspectives

ERIC Educational Resources Information Center

McDonough, Chris; Nuberg, Ian K.; Pitchford, Wayne S.

2015-01-01

Purpose: This paper examines extension practises of agricultural workers within the Egyptian government and the perceived barriers they face in implementing participatory approaches, identifying improvements required in research and extension processes to meet the real needs of Egyptian farming communities. Design/Methodology/Approach: Key…

Women of Color in Academic Administration: Trends, Progress, and Barriers.

ERIC Educational Resources Information Center

Wilson, Reginald

1989-01-01

Presents historical events, legal restrictions, and traditional customs as barriers that women of color have faced in pursuit of academic administrative positions. Discusses degree attainment and fields of study for different ethnic groups. Recent changes in affirmative action policy are discussed. (JS)

A Comparison of Recruitment Methods for an mHealth Intervention Targeting Mothers: Lessons from the Growing Healthy Program.

PubMed

Laws, Rachel A; Litterbach, Eloise-Kate V; Denney-Wilson, Elizabeth A; Russell, Catherine G; Taki, Sarah; Ong, Kok-Leong; Elliott, Rosalind M; Lymer, Sharyn J; Campbell, Karen J

2016-09-15

Mobile health (mHealth) programs hold great promise for increasing the reach of public health interventions. However, mHealth is a relatively new field of research, presenting unique challenges for researchers. A key challenge is understanding the relative effectiveness and cost of various methods of recruitment to mHealth programs. The objectives of this study were to (1) compare the effectiveness of various methods of recruitment to an mHealth intervention targeting healthy infant feeding practices, and (2) explore factors influencing practitioner referral to the intervention. The Growing healthy study used a quasi-experimental design with an mHealth intervention group and a concurrent nonrandomized comparison group. Eligibility criteria included: expectant parents (>30 weeks of gestation) or parents with an infant <3 months old, ability to read and understand English, own a mobile phone, ≥18 years old, and living in Australia. Recruitment to the mHealth program consisted of: (1) practitioner-led recruitment through Maternal and Child Health nurses, midwives, and nurses in general practice; (2) face-to-face recruitment by researchers; and (3) online recruitment. Participants' baseline surveys provided information regarding how participants heard about the study, and their sociodemographic details. Costs per participant recruited were calculated by taking into account direct advertising costs and researcher time/travel costs. Practitioner feedback relating to the recruitment process was obtained through a follow-up survey and qualitative interviews. A total of 300 participants were recruited to the mHealth intervention. The cost per participant recruited was lowest for online recruitment (AUD $14) and highest for practice nurse recruitment (AUD $586). Just over half of the intervention group (50.3%, 151/300) were recruited online over a 22-week period compared to practitioner recruitment (29.3%, 88/300 over 46 weeks) and face-to-face recruitment by researchers (7.3%, 22/300 over 18 weeks). No significant differences were observed in participant sociodemographic characteristics between recruitment methods, with the exception that practitioner/face-to-face recruitment resulted in a higher proportion of first-time parents (68% versus 48%, P=.002). Less than half of the practitioners surveyed reported referring to the program often or most of the time. Key barriers to practitioner referral included lack of time, difficulty remembering to refer, staff changes, lack of parental engagement, and practitioner difficulty in accessing the app. Online recruitment using parenting-related Facebook pages was the most cost effective and timely method of recruitment to an mHealth intervention targeting parents of young infants. Consideration needs to be given to addressing practitioner barriers to referral, to further explore if this can be a viable method of recruitment.

A Comparison of Recruitment Methods for an mHealth Intervention Targeting Mothers: Lessons from the Growing Healthy Program

PubMed Central

Litterbach, Eloise-Kate V; Denney-Wilson, Elizabeth A; Russell, Catherine G; Taki, Sarah; Ong, Kok-Leong; Elliott, Rosalind M; Lymer, Sharyn J; Campbell, Karen J

2016-01-01

Background Mobile health (mHealth) programs hold great promise for increasing the reach of public health interventions. However, mHealth is a relatively new field of research, presenting unique challenges for researchers. A key challenge is understanding the relative effectiveness and cost of various methods of recruitment to mHealth programs. Objective The objectives of this study were to (1) compare the effectiveness of various methods of recruitment to an mHealth intervention targeting healthy infant feeding practices, and (2) explore factors influencing practitioner referral to the intervention. Methods The Growing healthy study used a quasi-experimental design with an mHealth intervention group and a concurrent nonrandomized comparison group. Eligibility criteria included: expectant parents (>30 weeks of gestation) or parents with an infant <3 months old, ability to read and understand English, own a mobile phone, ≥18 years old, and living in Australia. Recruitment to the mHealth program consisted of: (1) practitioner-led recruitment through Maternal and Child Health nurses, midwives, and nurses in general practice; (2) face-to-face recruitment by researchers; and (3) online recruitment. Participants’ baseline surveys provided information regarding how participants heard about the study, and their sociodemographic details. Costs per participant recruited were calculated by taking into account direct advertising costs and researcher time/travel costs. Practitioner feedback relating to the recruitment process was obtained through a follow-up survey and qualitative interviews. Results A total of 300 participants were recruited to the mHealth intervention. The cost per participant recruited was lowest for online recruitment (AUD $14) and highest for practice nurse recruitment (AUD $586). Just over half of the intervention group (50.3%, 151/300) were recruited online over a 22-week period compared to practitioner recruitment (29.3%, 88/300 over 46 weeks) and face-to-face recruitment by researchers (7.3%, 22/300 over 18 weeks). No significant differences were observed in participant sociodemographic characteristics between recruitment methods, with the exception that practitioner/face-to-face recruitment resulted in a higher proportion of first-time parents (68% versus 48%, P=.002). Less than half of the practitioners surveyed reported referring to the program often or most of the time. Key barriers to practitioner referral included lack of time, difficulty remembering to refer, staff changes, lack of parental engagement, and practitioner difficulty in accessing the app. Conclusions Online recruitment using parenting-related Facebook pages was the most cost effective and timely method of recruitment to an mHealth intervention targeting parents of young infants. Consideration needs to be given to addressing practitioner barriers to referral, to further explore if this can be a viable method of recruitment. PMID:27634633

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.

13. View of Clark Fork Vehicle Bridge facing south. Concrete ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

13. View of Clark Fork Vehicle Bridge facing south. Concrete barrier blocks access. Plaque was originally located where strioed traffic sign is posted at right. - Clark Fork Vehicle Bridge, Spanning Clark Fork River, serves Highway 200, Clark Fork, Bonner County, ID

Universities Face Wide-Ranging Changes

ERIC Educational Resources Information Center

Krieger, James H.

1976-01-01

Discusses problems facing the research university, including declining enrollments and funds, fewer opportunities for graduates, and the complexity of research problems. Recommends making more efficient use of resources, improving communications with the broader public, and reducing economic and social barriers to obtaining a higher education.…

Listeria monocytogenes InlP interacts with afadin and facilitates basement membrane crossing.

PubMed

Faralla, Cristina; Bastounis, Effie E; Ortega, Fabian E; Light, Samuel H; Rizzuto, Gabrielle; Nocadello, Salvatorre; Anderson, Wayne F; Robbins, Jennifer R; Theriot, Julie A; Bakardjiev, Anna I

2018-05-30

During pregnancy, the placenta protects the fetus against the maternal immune response, as well as bacterial and viral pathogens. Bacterial pathogens that have evolved specific mechanisms of breaching this barrier, such as Listeria monocytogenes, present a unique opportunity for learning how the placenta carries out its protective function. We previously identified the L. monocytogenes protein Internalin P (InlP) as a secreted virulence factor critical for placental infection. Here, we show that InlP, but not the highly similar L. monocytogenes internalin Lmo2027, binds to human afadin (encoded by AF-6), a protein associated with cell-cell junctions. A crystal structure of InlP reveals several unique features, including an extended leucine-rich repeat (LRR) domain with a distinctive Ca2+-binding site. Despite afadin's involvement in the formation of cell-cell junctions, MDCK epithelial cells expressing InlP displayed a decrease in the magnitude of the traction stresses they could exert on deformable substrates, similar to the decrease in traction exhibited by AF-6 knock-out MDCK cells. L. monocytogenes ΔinlP mutants were deficient in their ability to form actin-rich protrusions from the basal face of polarized epithelial monolayers, a necessary step in the crossing of such monolayers (transcytosis). A similar phenotype was observed for bacteria expressing an internal in-frame deletion in inlP (inlP ΔLRR5) that specifically disrupts its interaction with afadin. However, afadin deletion in the host cells did not rescue the transcytosis defect. We conclude that secreted InlP targets cytosolic afadin to specifically promote L. monocytogenes transcytosis across the basal face of epithelial monolayers, which may contribute to the crossing of the basement membrane during placental infection.

Health, equity and the post-2015 agenda: raising the voices of marginalized communities.

PubMed

Ruano, Ana Lorena; Friedman, Eric A; Hill, Peter S

2014-10-10

In September 2012 the United Nations (UN) initiated a process that would extend and enhance the unfinished agenda of the Millennium Development Goals (MDGs), integrating a new vision for sustainable development beyond the year 2015. The initial consultation phase has been completed, with the UN and partner organizations undertaking eleven thematic consultations, including one on health. It is in this context that the European Commission (EC) has tasked the research consortium Goals and Governance for Global Health (Go4Health) with providing recommendations for the post-2015 health-related development goals and including voices that are routinely excluded from health-related decision-making processes. This has not been an easy task. It has led us to question how to define marginalization, how to access marginalized communities, as well as how community members could provide informed consent. The context of the communities we worked with was far removed from the reality of the post-2015 debates, where the MDGs and the new goals are remote and abstract, and where the promise of immediate benefit from participation could not be assured. Given the social, historical, cultural, ethnic and geographical diversity of our chosen community partners, and the diversity of their lived experiences, could their unique situations be generalized in ways that could influence the global debate? In this special issue, we have tried to explore the uniqueness and the commonalities of the issues and barriers that marginalized communities face all over the globe, and present them in individual papers that, together, provide a nuanced and complex picture of the challenges that face the post-2015 health-related agenda setting-process.

Online social networks that connect users to physical activity partners: a review and descriptive analysis.

PubMed

Nakhasi, Atul; Shen, Album Xiaotian; Passarella, Ralph Joseph; Appel, Lawrence J; Anderson, Cheryl Am

2014-06-16

The US Centers for Disease Control and Prevention have identified a lack of encouragement, support, or companionship from family and friends as a major barrier to physical activity. To overcome this barrier, online social networks are now actively leveraging principles of companion social support in novel ways. The aim was to evaluate the functionality, features, and usability of existing online social networks which seek to increase physical activity and fitness among users by connecting them to physical activity partners, not just online, but also face-to-face. In September 2012, we used 3 major databases to identify the website addresses for relevant online social networks. We conducted a Google search using 8 unique keyword combinations: the common keyword "find" coupled with 1 of 4 prefix terms "health," "fitness," "workout," or "physical" coupled with 1 of 2 stem terms "activity partners" or "activity buddies." We also searched 2 prominent technology start-up news sites, TechCrunch and Y Combinator, using 2 unique keyword combinations: the common keyword "find" coupled with 1 of 2 stem terms "activity partners" and "activity buddies." Sites were defined as online social health activity networks if they had the ability to (1) actively find physical activity partners or activities for the user, (2) offer dynamic, real-time tracking or sharing of social activities, and (3) provide virtual profiles to users. We excluded from our analysis sites that were not Web-based, publicly available, in English, or free. Of the 360 initial search results, we identified 13 websites that met our complete criteria of an online social health activity network. Features such as physical activity creation (13/13, 100%) and private messaging (12/13, 92%) appeared almost universally among these websites. However, integration with Web 2.0 technologies such as Facebook and Twitter (9/13, 69%) and the option of direct event joining (8/13, 62%) were not as universally present. Largely absent were more sophisticated features that would enable greater usability, such as interactive engagement prompts (3/13, 23%) and system-created best fit activities (3/13, 23%). Several major online social networks that connect users to physical activity partners currently exist and use standardized features to achieve their goals. Future research is needed to better understand how users utilize these features and how helpful they truly are.

Challenges faced by health-care providers offering infant-feeding counseling to HIV-positive women in sub-Saharan Africa: a review of current research.

PubMed

Tuthill, Emily L; Chan, Jessica; Butler, Lisa M

2015-01-01

Exclusive breastfeeding (EBF) has been identified as the optimal nutrition and critical behavior in attaining human immunodeficiency virus (HIV)-free infant survival in resource-limited settings. Health-care providers (HCPs) in clinic- and community-settings throughout sub-Saharan Africa (sSA) provide infant-feeding counseling. However, rates of EBF at 6 months of age are suboptimal. HCPs are uniquely positioned to educate HIV-positive mothers and provide support by addressing known barriers to EBF. However, limited evidence exists on the experiences faced by HCPs in providing counseling on infant feeding to HIV-positive women. Our objective is to describe experiences faced by HCPs when delivering infant-feeding counseling in the context of HIV in program settings in sSA. We searched a range of electronic databases, including PubMed, CINAHL, and PsycINFO from January 1990 to February 2013, in addition to hand-searching, cross-reference searching, and personal communications. The search was limited to publications in English. Empirical studies of HCP experiences providing infant-feeding counseling in the prevention of mother-to-child transmission (PMTCT) of HIV programs in sSA were selected. We identified 10 peer-reviewed articles reporting HCP challenges in infant-feeding counseling that met inclusion criteria. Articles included qualitative, cross-sectional and mixed-method studies, and cumulatively reported 31 challenges faced by HCPs. Among the challenges identified, the most commonly reported were personal beliefs held by the HCPs toward infant feeding in the context of HIV, contradictory messages, staff workload, directive counseling styles, and a lack of practical strategies to offer mothers, often leading to improvised counseling approaches. Counseling strategies need to be developed that are relevant, meaningful, and responsive to the needs of both HCPs and mothers.

Technology Implementation in Education--Identifying Barriers to Fidelity

ERIC Educational Resources Information Center

Dennis, William J.; Johnson, Daniel L.; Monroe, Arla K.

2012-01-01

This report describes a problem-based learning project focused on determining the barriers to the implementation of technological innovations. Research findings offered evidence that properly executed technology implementation is an instructional variable related to student achievement; yet, school district leaders are faced with the problem of…

Technology Implementation in Education--Identifying Barriers to Fidelity

ERIC Educational Resources Information Center

Monroe, Arla K.; Dennis, William J.; Johnson, Daniel L.

2012-01-01

This report describes a problem-based learning project focused on determining the barriers to the implementation of technological innovations. that properly executed technology implementation is an instructional variable related to student achievement; yet, school district leaders are faced with the problem of recognizing and identifying the…

Assessment of Barriers to Changing Practice as CME Outcomes

ERIC Educational Resources Information Center

Price, David W.; Miller, Elaine K.; Rahm, Alanna Kulchak; Brace, Nancy E.; Larson, R. Sam

2010-01-01

Introduction: Continuing medical education (CME) is meant to drive and support improvements in practice. To achieve this goal, CME activities must move beyond simply purveying knowledge, instead helping attendees to contextualize information and to develop strategies for implementing new learning. CME attendees face different barriers to…

Barriers to global health development: An international quantitative survey.

PubMed

Weiss, Bahr; Pollack, Amie Alley

2017-01-01

Global health's goal of reducing low-and-middle-income country versus high-income country health disparities faces complex challenges. Although there have been discussions of barriers, there has not been a broad-based, quantitative survey of such barriers. 432 global health professionals were invited via email to participate in an online survey, with 268 (62%) participating. The survey assessed participants' (A) demographic and global health background, (B) perceptions regarding 66 barriers' seriousness, (C) detailed ratings of barriers designated most serious, (D) potential solutions. Thirty-four (of 66) barriers were seen as moderately or more serious, highlighting the widespread, significant challenges global health development faces. Perceived barrier seriousness differed significantly across domains: Resource Limitations mean = 2.47 (0-4 Likert scale), Priority Selection mean = 2.20, Corruption, Lack of Competence mean = 1.87, Social and Cultural Barriers mean = 1.68. Some system-level predictors showed significant but relatively limited relations. For instance, for Global Health Domain, HIV and Mental Health had higher levels of perceived Social and Cultural Barriers than other GH Domains. Individual-level global health experience predictors had small but significant effects, with seriousness of (a) Corruption, Lack of Competence, and (b) Priority Selection barriers positively correlated with respondents' level of LMIC-oriented (e.g., weeks/year spent in LMIC) but Academic Global Health Achievement (e.g., number of global health publications) negatively correlated with overall barrier seriousness. That comparatively few system-level predictors (e.g., Organization Type) were significant suggests these barriers may be relatively fundamental at the system-level. Individual-level and system-level effects do have policy implications; e.g., Priority Selection barriers were among the most serious, yet effects on seriousness of how LMIC-oriented a professional was versus level of academic global health achievement ran in opposite directions, suggesting increased discussion of priorities between LMIC-based and other professionals may be useful. It is hoped the 22 suggested solutions will provide useful ideas for addressing global health barriers.

"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…

Exploring low-income families' financial barriers to food allergy management and treatment.

PubMed

Minaker, Leia M; Elliott, Susan J; Clarke, Ann

2014-01-01

Objectives. Low-income families may face financial barriers to management and treatment of chronic illnesses. No studies have explored how low-income individuals and families with anaphylactic food allergies cope with financial barriers to anaphylaxis management and/or treatment. This study explores qualitatively assessed direct, indirect, and intangible costs of anaphylaxis management and treatment faced by low-income families. Methods. In-depth, semistructured interviews with 23 participants were conducted to gain insight into income-related barriers to managing and treating anaphylactic food allergies. Results. Perceived direct costs included the cost of allergen-free foods and allergy medication and costs incurred as a result of misinformation about social support programs. Perceived indirect costs included those associated with lack of continuity of health care. Perceived intangible costs included the stress related to the difficulty of obtaining allergen-free foods at the food bank and feeling unsafe at discount grocery stores. These perceived costs represented barriers that were perceived as especially salient for the working poor, immigrants, youth living in poverty, and food bank users. Discussion. Low-income families report significant financial barriers to food allergy management and anaphylaxis preparedness. Clinicians, advocacy groups, and EAI manufacturers all have a role to play in ensuring equitable access to medication for low-income individuals with allergies.

Reorientation of health services: enablers and barriers faced by organisations when increasing health promotion capacity.

PubMed

McFarlane, K; Judd, J; Devine, S; Watt, K

2016-08-01

Issue addressed Primary healthcare settings are important providers of health promotion approaches. However, organisational challenges can affect their capacity to deliver these approaches. This review identified the common enablers and barriers health organisations faced and it aimed to explore the experiences health organisations, in particular Aboriginal organisations, had when increasing their health promotion capacity. Methods A systematic search of peer-reviewed literature was conducted. Articles published between 1990-2014 that focused on a health care-settings approach and discussed factors that facilitated or hindered an organisation's ability to increase health promotion capacity were included. Results Twenty-five articles met the inclusion criteria. Qualitative (n=18) and quantitative (n=7) study designs were included. Only one article described the experiences of an Aboriginal health organisation. Enablers included: management support, skilled staff, provision of external support to the organisation, committed staffing and financial resources, leadership and the availability of external partners to work with. Barriers included: lack of management support, lack of dedicated health promotion staff, staff lacking skills or confidence, competing priorities and a lack of time and resources allocated to health promotion activities. Conclusions While the literature highlighted the importance of health promotion work, barriers can limit the delivery of health promotion approaches within primary healthcare organisations. A gap in the literature exists about how Aboriginal health organisations face these challenges. So what? Primary healthcare organisations wanting to increase their health promotion capacity can pre-empt the common barriers and strengthen identified enablers through the shared learnings outlined in this review.

Understanding barriers to fruit and vegetable intake in the Australian Longitudinal Study of Indigenous Children: a mixed-methods approach.

PubMed

Thurber, Katherine Ann; Banwell, Cathy; Neeman, Teresa; Dobbins, Timothy; Pescud, Melanie; Lovett, Raymond; Banks, Emily

2017-04-01

To identify barriers to fruit and vegetable intake for Indigenous Australian children and quantify factors related to these barriers, to help understand why children do not meet recommendations for fruit and vegetable intake. We examined factors related to carer-reported barriers using multilevel Poisson models (robust variance); a key informant focus group guided our interpretation of findings. Eleven diverse sites across Australia. Australian Indigenous children and their carers (N 1230) participating in the Longitudinal Study of Indigenous Children. Almost half (45 %; n 555/1230) of carers reported barriers to their children's fruit and vegetable intake. Dislike of fruit and vegetables was the most common barrier, reported by 32·9 % of carers; however, we identified few factors associated with dislike. Carers were more than ten times less likely to report barriers to accessing fruit and vegetables if they lived large cities v. very remote areas. Within urban and inner regional areas, child and carer well-being, financial security, suitable housing and community cohesion promoted access to fruit and vegetables. In this national Indigenous Australian sample, almost half of carers faced barriers to providing their children with a healthy diet. Both remote/outer regional carers and disadvantaged urban/inner regional carers faced problems accessing fruit and vegetables for their children. Where vegetables were accessible, children's dislike was a substantial barrier. Nutrition promotion must address the broader family, community, environmental and cultural contexts that impact nutrition, and should draw on the strengths of Indigenous families and communities.

Women's expectations and experiences regarding e-health treatment: A systematic review.

PubMed

Verhoeks, Carmen; Teunissen, Doreth; van der Stelt-Steenbergen, Anke; Lagro-Janssen, Antoine

2017-08-01

There is a gap in knowledge of women's perceptions of e-health treatment. This review aims to investigate women's expectations and experiences regarding e-health. A search was conducted in MEDLINE, EMBASE, CINAHL and PsycInfo in March 2016. We included articles published between 2000 and March 2016, reporting on e-health interventions. The initial search yielded 2987 articles. Eventually, 16 articles reporting on 16 studies were included. Barriers to e-health treatment were lower for women than barriers to face-to-face treatment, such as feelings of shame and time constraints. Women were able to develop an online therapeutic relationship. As reduced feelings of obligation and lack of motivation were women's greatest challenges in completing e-health treatment, they expressed a wish for more support during e-health treatment, preferably blended care. e-Health lowers the threshold for women to seek healthcare. Combining e-health interventions with face-to-face sessions may enhance women's motivation to complete treatment.

Specific barriers to the conduct of randomised clinical trials on medical devices.

PubMed

Neugebauer, Edmund A M; Rath, Ana; Antoine, Sunya-Lee; Eikermann, Michaela; Seidel, Doerthe; Koenen, Carsten; Jacobs, Esther; Pieper, Dawid; Laville, Martine; Pitel, Séverine; Martinho, Cecilia; Djurisic, Snezana; Demotes-Mainard, Jacques; Kubiak, Christine; Bertele, Vittorio; Jakobsen, Janus C; Garattini, Silvio; Gluud, Christian

2017-09-13

Medical devices play an important role in the diagnosis, prevention, treatment and care of diseases. However, compared to pharmaceuticals, there is no rigorous formal regulation for demonstration of benefits and exclusion of harms to patients. The medical device industry argues that the classical evidence hierarchy cannot be applied for medical devices, as randomised clinical trials are impossible to perform. This article aims to identify the barriers for randomised clinical trials on medical devices. Systematic literature searches without meta-analysis and internal European Clinical Research Infrastructure Network (ECRIN) communications taking place during face-to-face meetings and telephone conferences from 2013 to 2017 within the context of the ECRIN Integrating Activity (ECRIN-IA) project. In addition to the barriers that exist for all trials, we identified three major barriers for randomised clinical trials on medical devices, namely: (1) randomisation, including timing of assessment, acceptability, blinding, choice of the comparator group and considerations on the learning curve; (2) difficulties in determining appropriate outcomes; and (3) the lack of scientific advice, regulations and transparency. The present review offers potential solutions to break down the barriers identified, and argues for applying the randomised clinical trial design when assessing the benefits and harms of medical devices.

Barriers to Implementing Evidence-Based Intrapartum Care: A Descriptive Exploratory Qualitative Study

PubMed Central

Iravani, Mina; Janghorbani, Mohsen; Zarean, Ellahe; Bahrami, Masod

2016-01-01

Background: Evidence based practice is an effective strategy to improve the quality of obstetric care. Identification of barriers to adaptation of evidence-based intrapartum care is necessary and crucial to deliver high quality care to parturient women. Objectives: The current study aimed to explore barriers to adaptation of evidence-based intrapartum care from the perspective of clinical groups that provide obstetric care in Iran. Materials and Methods: This descriptive exploratory qualitative research was conducted from 2013 to 2014 in fourteen state medical training centers in Iran. Participants were selected from midwives, specialists, and residents of obstetrics and gynecology, with a purposive sample and snowball method. Data were collected through face-to-face semi-structured in-depth interviews and analyzed according to conventional content analysis. Results: Data analysis identified twenty subcategories and four main categories. Main categories included barriers were related to laboring women, persons providing care, the organization environment and health system. Conclusions: The adoption of evidence based intrapartum care is a complex process. In this regard, identifying potential barriers is the first step to determine and apply effective strategies to encourage the compliance evidence based obstetric care and improves maternity care quality. PMID:27175303

Facilitators and Barriers to Implementing Clinical Governance: A Qualitative Study among Senior Managers in Iran.

PubMed

Ravaghi, Hamid; Rafiei, Sima; Heidarpour, Peigham; Mohseni, Maryam

2014-09-01

Health care systems should assign quality improvement as their main mission. Clinical governance (CG) is a key strategy to improve quality of health care services. The Iranian Ministry of Health and Medical Education (MOHME) has promoted CG as a framework for safeguarding quality and safety in all hospitals since 2009. The purpose of this study was to explore perceived facilitators and barriers to implementing CG by deputies for curative affairs of Iranian medical universities. A qualitative study was conducted using face to face interviews with a purposeful sample of 43 deputies for curative affairs of Iranian Medical Universities and documents review. Thematic analysis was used to analyze the data. Five themes were explored including: knowledge and attitude toward CG, culture, organizational factors, managerial factors and barriers. The main perceived facilitating factors were adequate knowledge and positive attitude toward CG, supporting culture, managers' commitment, effective communication and well designed incentives. Pe rceived barriers were the reverse of facilitators noted above in addition to insufficient resources, legal challenges, workload and parallel quality programs. Successful implementation of CG in Iran will require identifying barriers and challenges existing in the way of CG implementation and try to mitigate them by using appropriate facilitators.

Barriers to Physician Identification and Treatment of Family Violence: Lessons from Five Communities.

ERIC Educational Resources Information Center

Cohen, Stu; And Others

1997-01-01

A study involving over 480 interviews in five diverse communities (Atlanta, Georgia; Duluth, Minnesota; Providence, Rhode Island; Riverside, California; Roswell, New Mexico) identified barriers facing physicians and other health care providers in identifying, treating, and referring victims of family violence, and illuminated the relationships of…

Overcoming Barriers to Engaging in College Academics

ERIC Educational Resources Information Center

Hensley, Lauren; Shaulskiy, Stephanie; Zircher, Andrew; Sanders, Megan

2015-01-01

Underprepared college students face transition issues that prevent full academic engagement. The written responses of 176 students in a learning-strategies course were used to develop a grounded model of overcoming barriers to academic engagement. Findings revealed contexts in which academic engagement involved high costs (i.e., effort, trade-off,…

Do Children's Behavior Problems Limit Poor Women's Labor Market Success?

ERIC Educational Resources Information Center

Coley, Rebekah Levine; Ribar, David; Votruba-Drzal, Elizabeth

2011-01-01

Economically disadvantaged mothers face numerous barriers to stable, quality employment opportunities. One barrier that has received limited attention in previous research is having a child with significant psychological or behavioral problems. Using a representative sample of low-income mothers and early adolescent children from the Three-City…

The Stumbling Campaign for Free-Access Buildings

ERIC Educational Resources Information Center

Building Design and Construction, 1974

1974-01-01

Although a concerted effort has been made during the past 15 years to knock down the architectural barriers facing the handicapped, the existence of over 400,000 wheelchair handicapped and more than two million people wearing leg braces or with artificial legs makes it imperative that architectural designs produce completely barrier-free…

Overcoming Barriers to the Sexual Expression of Women with Developmental Disabilities.

ERIC Educational Resources Information Center

Stinson, Jennifer; Christian, LeeAnn; Dotson, Lori Ann

2002-01-01

This article discusses barriers to sexual fulfillment faced by women with developmental disabilities, including: access to gynecological healthcare, limited choices regarding reproductive issues, lack of sex education, and prevailing negative stereotypes that affect the way women are viewed by others and the way they view themselves.…

Laboratory Barriers in Science, Engineering, and Mathematics for Students with Disabilities.

ERIC Educational Resources Information Center

Heidari, Farzin

This report addresses the barriers college students with disabilities face in the laboratory setting. In engineering, mathematics, and science education most courses require laboratory work which may pose challenges to those with disabilities. Instructors should be aware of the individual needs of students with disabilities and make necessary…

Perceived Parental Barriers to and Strategies for Supporting Physical Activity and Healthy Eating among Head Start Children.

PubMed

Ling, Jiying; B Robbins, Lorraine; Hines-Martin, Vicki

2016-06-01

Despite the need for parents to support their children's healthy behaviors, knowledge of factors preventing parents from doing so is still rudimentary. This study primarily aimed to explore perceived parental barriers to and strategies for supporting physical activity and healthy eating among Head Start children. A semi-structured interview format was used with four focus groups conducted at two urban Head Start centers in the Midwestern U.S. A qualitative content analysis of audio-recorded sessions was facilitated using ATLAS.ti7. A convenience sample of 32 parents (Mage = 34.97 years) participated. Over half were female (78.1 %), African Americans (65.6 %), and single (65.6 %). About 61.3 % reported an annual family income <$20,000, and 43.8 % were unemployed. Three themes reflected the barriers: (1) intrapersonal (child): short attention span and limited eating preferences; (2) interpersonal (parent): lack of time and cooking skills and a tight family budget; and (3) environmental: inaccessible programs, lack of age-appropriate education, electronic media use, and unsafe environment. Parents across all groups expressed high interest in enrolling in a program with their children. Recommendations included: parents' support team; family outings at parks; taking a walk or enrolling in a class with children; and planting a garden. Many parents showed their preference for face-to-face meetings and a support group, but repulsion of counseling. To promote parental support in future interventions with Head Start children, their perceived intrapersonal, interpersonal, and environmental barriers should be considered as intervention targets. Involving parents through a support group and face-to-face meetings is recommended.

Perceptions of Approved Clinical Instructors: Barriers in the Implementation of Evidence-Based Practice

PubMed Central

Hankemeier, Dorice A.; Van Lunen, Bonnie L.

2013-01-01

Context: As evidence-based practice (EBP) becomes prevalent in athletic training education, the barriers that Approved Clinical Instructors (ACIs) experience in implementing it with students need to be understood. Objective: To investigate barriers ACIs face when implementing EBP concepts in clinical practice and in teaching EBP to professional athletic training students and to investigate the educational emphases to improve the barriers. Design: Qualitative study. Setting: Telephone interviews. Patients or Other Participants: Sixteen ACIs (11 men, 5 women; experience as an athletic trainer = 10 ± 4.7 years, experience as an ACI = 6.81 ± 3.9 years) were interviewed. Data Collection and Analysis: We interviewed each participant by telephone. Interview data were analyzed and coded for common themes and subthemes regarding barriers and educational emphases. Themes were triangulated through multiple-analyst triangulation and interpretive verification. Results: Barriers to EBP incorporation and educational emphasis placed on EBP were the main themes reported. Resources, personnel, and student characteristics were subthemes identified as barriers. Resource barriers included time, equipment, access to current literature, and knowledge. Coworkers, clinicians, and coaches who were unwilling to accept evidence regarding advancements in treatment were identified as personnel barriers. Programmatic improvement and communication improvement were subthemes of the educational emphasis placed on EBP theme. The ACIs reported the need for better integration between the clinical setting and the classroom and expressed the need for EBP to be integrated throughout the athletic training education program. Conclusions: Integration of the classroom and clinical experience is important in advancing ACIs' use of EBP with their students. Collaborative efforts within the clinical and academic program could help address the barriers ACIs face when implementing EBP. This collaboration could positively affect the ability of ACIs to implement EBP within their clinical practices. PMID:23675798

Barriers to global health development: An international quantitative survey

PubMed Central

2017-01-01

Background Global health’s goal of reducing low-and-middle-income country versus high-income country health disparities faces complex challenges. Although there have been discussions of barriers, there has not been a broad-based, quantitative survey of such barriers. Methods 432 global health professionals were invited via email to participate in an online survey, with 268 (62%) participating. The survey assessed participants’ (A) demographic and global health background, (B) perceptions regarding 66 barriers’ seriousness, (C) detailed ratings of barriers designated most serious, (D) potential solutions. Results Thirty-four (of 66) barriers were seen as moderately or more serious, highlighting the widespread, significant challenges global health development faces. Perceived barrier seriousness differed significantly across domains: Resource Limitations mean = 2.47 (0–4 Likert scale), Priority Selection mean = 2.20, Corruption, Lack of Competence mean = 1.87, Social and Cultural Barriers mean = 1.68. Some system-level predictors showed significant but relatively limited relations. For instance, for Global Health Domain, HIV and Mental Health had higher levels of perceived Social and Cultural Barriers than other GH Domains. Individual–level global health experience predictors had small but significant effects, with seriousness of (a) Corruption, Lack of Competence, and (b) Priority Selection barriers positively correlated with respondents’ level of LMIC-oriented (e.g., weeks/year spent in LMIC) but Academic Global Health Achievement (e.g., number of global health publications) negatively correlated with overall barrier seriousness. Conclusions That comparatively few system-level predictors (e.g., Organization Type) were significant suggests these barriers may be relatively fundamental at the system-level. Individual-level and system-level effects do have policy implications; e.g., Priority Selection barriers were among the most serious, yet effects on seriousness of how LMIC-oriented a professional was versus level of academic global health achievement ran in opposite directions, suggesting increased discussion of priorities between LMIC-based and other professionals may be useful. It is hoped the 22 suggested solutions will provide useful ideas for addressing global health barriers. PMID:28972971

Identifying trial recruitment uncertainties using a James Lind Alliance Priority Setting Partnership - the PRioRiTy (Prioritising Recruitment in Randomised Trials) study.

PubMed

Healy, Patricia; Galvin, Sandra; Williamson, Paula R; Treweek, Shaun; Whiting, Caroline; Maeso, Beccy; Bray, Christopher; Brocklehurst, Peter; Moloney, Mary Clarke; Douiri, Abdel; Gamble, Carrol; Gardner, Heidi R; Mitchell, Derick; Stewart, Derek; Jordan, Joan; O'Donnell, Martin; Clarke, Mike; Pavitt, Sue H; Guegan, Eleanor Woodford; Blatch-Jones, Amanda; Smith, Valerie; Reay, Hannah; Devane, Declan

2018-03-01

Despite the problem of inadequate recruitment to randomised trials, there is little evidence to guide researchers on decisions about how people are effectively recruited to take part in trials. The PRioRiTy study aimed to identify and prioritise important unanswered trial recruitment questions for research. The PRioRiTy study - Priority Setting Partnership (PSP) included members of the public approached to take part in a randomised trial or who have represented participants on randomised trial steering committees, health professionals and research staff with experience of recruiting to randomised trials, people who have designed, conducted, analysed or reported on randomised trials and people with experience of randomised trials methodology. This partnership was aided by the James Lind Alliance and involved eight stages: (i) identifying a unique, relevant prioritisation area within trial methodology; (ii) establishing a steering group (iii) identifying and engaging with partners and stakeholders; (iv) formulating an initial list of uncertainties; (v) collating the uncertainties into research questions; (vi) confirming that the questions for research are a current recruitment challenge; (vii) shortlisting questions and (viii) final prioritisation through a face-to-face workshop. A total of 790 survey respondents yielded 1693 open-text answers to 6 questions, from which 1880 potential questions for research were identified. After merging duplicates, the number of questions was reduced to 496. Questions were combined further, and those that were submitted by fewer than 15 people and/or fewer than 6 of the 7 stakeholder groups were excluded from the next round of prioritisation resulting in 31 unique questions for research. All 31 questions were confirmed as being unanswered after checking relevant, up-to-date research evidence. The 10 highest priority questions were ranked at a face-to-face workshop. The number 1 ranked question was "How can randomised trials become part of routine care and best utilise current clinical care pathways?" The top 10 research questions can be viewed at www.priorityresearch.ie . The prioritised questions call for a collective focus on normalising trials as part of clinical care, enhancing communication, addressing barriers, enablers and motivators around participation and exploring greater public involvement in the research process.

Overcoming Workplace Barriers: A Focus Group Study Exploring African American Mothers' Needs for Workplace Breastfeeding Support.

PubMed

Johnson, Angela Marie; Kirk, Rosalind; Muzik, Maria

2015-08-01

Persistent racial disparities in breastfeeding show that African American women breastfeed at the lowest rates. Return to work is a critical breastfeeding barrier for African American women who return to work sooner than other ethnic groups and more often encounter unsupportive work environments. They also face psychosocial burdens that make breastfeeding at work uniquely challenging. Participants share personal struggles with combining paid employment and breastfeeding and suggest workplace and personal support strategies that they believe will help continue breastfeeding after a return to work. To explore current perspectives on ways to support African American mothers' workplace breastfeeding behavior. Pregnant African American women (n = 8), African American mothers of infants (n = 21), and lactation support providers (n = 9) participated in 1 of 6 focus groups in the Greater Detroit area. Each focus group audiotape was transcribed verbatim. Thematic analysis was used to inductively analyze focus group transcripts and field notes. Focus groups explored thoughts, perceptions, and behavior on interventions to support African American women's breastfeeding. Participants indicate that they generally believed breastfeeding was a healthy option for the baby; however, paid employment is a critical barrier to successful breastfeeding for which mothers receive little help. Participants felt breastfeeding interventions that support working African American mothers should include education and training for health care professionals, regulation and enforcement of workplace breastfeeding support policies, and support from peers who act as breastfeeding role models. Culturally appropriate interventions are needed to support breastfeeding among working African American women. © The Author(s) 2015.

Overcoming Workplace Barriers: A Focus Group Study Exploring African American Mothers' Needs for Workplace Breastfeeding Support

PubMed Central

Johnson, Angela Marie; Kirk, Rosalind; Muzik, Maria

2015-01-01

Background Persistent racial disparities in breastfeeding show that African American women breastfeed at the lowest rates. Return to work is a critical breastfeeding barrier for African American women who return to work sooner than other ethnic groups and more often encounter unsupportive work environments. They also face psychosocial burdens that make breastfeeding at work uniquely challenging. Participants share personal struggles with combining paid employment and breastfeeding and suggest workplace and personal support strategies that they believe will help continue breastfeeding after a return to work. Objective To explore current perspectives on ways to support African American mothers' workplace breastfeeding behavior. Methods Pregnant African American women (n = 8), African American mothers of infants (n = 21), and lactation support providers (n = 9) participated in 1 of 6 focus groups in the Greater Detroit area. Each focus group audiotape was transcribed verbatim. Thematic analysis was used to inductively analyze focus group transcripts and field notes. Focus groups explored thoughts, perceptions, and behavior on interventions to support African American women's breastfeeding. Results Participants indicate that they generally believed breastfeeding was a healthy option for the baby; however, paid employment is a critical barrier to successful breastfeeding for which mothers receive little help. Participants felt breastfeeding interventions that support working African American mothers should include education and training for health care professionals, regulation and enforcement of workplace breastfeeding support policies, and support from peers who act as breastfeeding role models. Conclusion Culturally appropriate interventions are needed to support breastfeeding among working African American women. PMID:25714345

“Do You Expect Me to Receive PTSD Care in a Setting Where Most of the Other Patients Remind Me of the Perpetrator?”: Home-Based Telemedicine to Address Barriers to Care Unique to Military Sexual Trauma and Veterans Affairs Hospitals

PubMed Central

Gilmore, Amanda K.; Davis, Margaret T.; Grubaugh, Anouk; Resnick, Heidi; Birks, Anna; Denier, Carol; Muzzy, Wendy; Tuerk, Peter; Acierno, Ron

2016-01-01

Home-based telemedicine (HBT) is a validated method of evidence-based treatment delivery for posttraumatic stress disorder (PTSD), and justification for its use has centered on closing gaps related to provider availability and distance to treatment centers. However, another potential use of HBT may be to overcome barriers to care that are inherent to the treatment environment, such as with female veterans who have experienced military sexual trauma (MST) and who must present to VA Medical Centers where the majority of patients share features with perpetrator (e.g. gender, clothing) and may function as reminders of the trauma. Delivering evidence-based therapies to female veterans with MST-related PTSD via HBT can provide needed treatment to this population. This manuscript describes an ongoing federally funded randomized controlled trial comparing Prolonged Exposure (PE) delivered in-person to PE delivered via HBT. Outcomes include session attendance, satisfaction with services, and clinical and quality of life indices. It is hypothesized that based on intent-to-treat analyses, HBT delivery of PE will be more effective than SD at improving both clinical and quality of life outcomes at post, 3-, and 6-month follow-up. This is because ‘dose received’, that is fewer sessions missed, and lower attrition, will be observed in the HBT group. Although the current manuscript focuses on female veterans with MST-related PTSD, implications for other populations facing systemic barriers are discussed. PMID:26992740

"Do you expect me to receive PTSD care in a setting where most of the other patients remind me of the perpetrator?": Home-based telemedicine to address barriers to care unique to military sexual trauma and veterans affairs hospitals.

PubMed

Gilmore, Amanda K; Davis, Margaret T; Grubaugh, Anouk; Resnick, Heidi; Birks, Anna; Denier, Carol; Muzzy, Wendy; Tuerk, Peter; Acierno, Ron

2016-05-01

Home-based telemedicine (HBT) is a validated method of evidence-based treatment delivery for posttraumatic stress disorder (PTSD), and justification for its use has centered on closing gaps related to provider availability and distance to treatment centers. However, another potential use of HBT may be to overcome barriers to care that are inherent to the treatment environment, such as with female veterans who have experienced military sexual trauma (MST) and who must present to VA Medical Centers where the majority of patients share features with perpetrator (e.g. gender, clothing) and may function as reminders of the trauma. Delivering evidence-based therapies to female veterans with MST-related PTSD via HBT can provide needed treatment to this population. This manuscript describes an ongoing federally funded randomized controlled trial comparing Prolonged Exposure (PE) delivered in-person to PE delivered via HBT. Outcomes include session attendance, satisfaction with services, and clinical and quality of life indices. It is hypothesized that based on intent-to-treat analyses, HBT delivery of PE will be more effective than SD at improving both clinical and quality of life outcomes at post, 3-, and 6-month follow-up. This is because 'dose received', that is fewer sessions missed, and lower attrition, will be observed in the HBT group. Although the current manuscript focuses on female veterans with MST-related PTSD, implications for other populations facing systemic barriers are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

Changing An Electrical Safety Culture - The Importance of Understanding Why.

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

Waters, Richard Thomas

2015-12-01

Abstract – Electrical workers, regardless of experience, are faced with a major barrier when first introduced to NFPA 70E, “The Standard for Electrical Safety in the Workplace,” and an erroneous electrical safety culture pre-exists. This paper describes, from the author’s point of view, the barrier that he and other electrical workers have experienced and his insight into overcoming the barrier. The author in conclusion will present a series of techniques that can be used to assist other electrical workers in overcoming the barrier.

The Need for More Research on Language Barriers in Health Care: A Proposed Research Agenda

PubMed Central

Jacobs, Elizabeth; Chen, Alice HM; Karliner, Leah S; Agger-Gupta, Niels; Mutha, Sunita

2006-01-01

Many U.S. residents who speak little English may face language barriers when seeking health care. This article describes what is currently known about language barriers in health care and outlines a research agenda based on mismatches between the current state of knowledge of language barriers and what health care stakeholders need to know. Three broad areas needing more research are discussed: the ways in which language barriers affect health and health care, the efficacy of linguistic access service interventions, and the costs of language barriers and efforts to overcome them. In each of these areas, we outline specific research questions and recommendations. PMID:16529570

14. View of Clark Fork Vehicle Bridge facing north. Approach ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

14. View of Clark Fork Vehicle Bridge facing north. Approach from the south. Concrete barrier blocks access. Plaque was originally located where striped traffic sign is posted at right. - Clark Fork Vehicle Bridge, Spanning Clark Fork River, serves Highway 200, Clark Fork, Bonner County, ID

Canadian Chefs' Workplace Learning

ERIC Educational Resources Information Center

Cormier-MacBurnie, Paulette; Doyle, Wendy; Mombourquette, Peter; Young, Jeffrey D.

2015-01-01

Purpose: This paper aims to examine the formal and informal workplace learning of professional chefs. In particular, it considers chefs' learning strategies and outcomes as well as the barriers to and facilitators of their workplace learning. Design/methodology/approach: The methodology is based on in-depth, face-to-face, semi-structured…

Perceived barriers to smoking cessation in selected vulnerable groups: a systematic review of the qualitative and quantitative literature

PubMed Central

Twyman, Laura; Bonevski, Billie; Paul, Christine; Bryant, Jamie

2014-01-01

Objectives To identify barriers that are common and unique to six selected vulnerable groups: low socioeconomic status; Indigenous; mental illness and substance abuse; homeless; prisoners; and at-risk youth. Design A systematic review was carried out to identify the perceived barriers to smoking cessation within six vulnerable groups. Data sources MEDLINE, EMBASE, CINAHL and PsycInfo were searched using keywords and MeSH terms from each database's inception published prior to March 2014. Study selection Studies that provided either qualitative or quantitative (ie, longitudinal, cross-sectional or cohort surveys) descriptions of self-reported perceived barriers to quitting smoking in one of the six aforementioned vulnerable groups were included. Data extraction Two authors independently assessed studies for inclusion and extracted data. Results 65 eligible papers were identified: 24 with low socioeconomic groups, 16 with Indigenous groups, 18 involving people with a mental illness, 3 with homeless groups, 2 involving prisoners and 1 involving at-risk youth. One study identified was carried out with participants who were homeless and addicted to alcohol and/or other drugs. Barriers common to all vulnerable groups included: smoking for stress management, lack of support from health and other service providers, and the high prevalence and acceptability of smoking in vulnerable communities. Unique barriers were identified for people with a mental illness (eg, maintenance of mental health), Indigenous groups (eg, cultural and historical norms), prisoners (eg, living conditions), people who are homeless (eg, competing priorities) and at-risk youth (eg, high accessibility of tobacco). Conclusions Vulnerable groups experience common barriers to smoking cessation, in addition to barriers that are unique to specific vulnerable groups. Individual-level, community-level and social network-level interventions are priority areas for future smoking cessation interventions within vulnerable groups. Trial registration number: A protocol for this review has been registered with PROSPERO International Prospective Register of Systematic Reviews (Identifier: CRD42013005761). PMID:25534212

An examination of how women and underrepresented racial/ethnic minorities experience barriers in biomedical research and medical programs

NASA Astrophysics Data System (ADS)

Chakraverty, Devasmita

Women in medicine and biomedical research often face challenges to their retention, promotion, and advancement to leadership positions (McPhillips et al., 2007); they take longer to advance their careers, tend to serve at less research-intensive institutions and have shorter tenures compared to their male colleagues (White, McDade, Yamagata, & Morahan, 2012). Additionally, Blacks and Hispanics are the two largest minority groups that are vastly underrepresented in medicine and biomedical research in the United States (AAMC, 2012; NSF, 2011). The purpose of this study is to examine specific barriers reported by students and post-degree professionals in the field through the following questions: 1. How do women who are either currently enrolled or graduated from biomedical research or medical programs define and make meaning of gender-roles as academic barriers? 2. How do underrepresented groups in medical schools and biomedical research institutions define and make meaning of the academic barriers they face and the challenges these barriers pose to their success as individuals in the program? These questions were qualitatively analyzed using 146 interviews from Project TrEMUR applying grounded theory. Reported gender-role barriers were explained using the "Condition-Process-Outcome" theoretical framework. About one-third of the females (across all three programs; majority White or Black between 25-35 years of age) reported gender-role barriers, mostly due to poor mentoring, time constraints, set expectations and institutional barriers. Certain barriers act as conditions, causing gender-role issues, and gender-role issues influence certain barriers that act as outcomes. Strategies to overcome barriers included interventions mostly at the institutional level (mentor support, proper specialty selection, selecting academia over medicine). Barrier analysis for the two largest URM groups indicated that, while Blacks most frequently reported racism, gender barriers, mentoring, and personal barriers, Hispanics most frequently reported economic barriers, language barriers, institutional and workplace environment barriers, and gender-role barriers. Examining barriers using the "Individual-Institutional" theoretical framework indicated that barriers do not occur in isolation, but due to an interaction between the individual and its institution. Additionally, the barriers of the two groups are qualitatively different and the "one size fits all" approach may not be suitable for interventions. Implications and recommendations were stated.

Deconstructing barriers: perceptions of students labeled with learning disabilities in higher education.

PubMed

Denhart, Hazel

2008-01-01

This phenomenological study investigated barriers to higher education faced by 11 college students labeled with learning disabilities (LD) using their voice as the primary data. Data were analyzed and interpreted through a disability theory perspective revealing barriers stemmed largely from external social causes rather than individual pathology. Barriers included being misunderstood by faculty, being reluctant to request accommodations for fear of invoking stigma, and having to work considerably longer hours than nonlabeled peers. Findings indicated barriers could be overcome through raising faculty awareness about LD issues, engaging the assistance of the college LD specialist, and participation in a LD democratic empowerment community on campus.

Reaction mechanisms at 4H-SiC/SiO2 interface during wet SiC oxidation

NASA Astrophysics Data System (ADS)

Akiyama, Toru; Hori, Shinsuke; Nakamura, Kohji; Ito, Tomonori; Kageshima, Hiroyuki; Uematsu, Masashi; Shiraishi, Kenji

2018-04-01

The reaction processes at the interface between SiC with 4H structure (4H-SiC) and SiO2 during wet oxidation are investigated by electronic structure calculations within the density functional theory. Our calculations for 4H-SiC/SiO2 interfaces with various orientations demonstrate characteristic features of the reaction depending on the crystal orientation of SiC: On the Si-face, the H2O molecule is stable in SiO2 and hardly reacts with the SiC substrate, while the O atom of H2O can form Si-O bonds at the C-face interface. Two OH groups are found to be at least necessary for forming new Si-O bonds at the Si-face interface, indicating that the oxidation rate on the Si-face is very low compared with that on the C-face. On the other hand, both the H2O molecule and the OH group are incorporated into the C-face interface, and the energy barrier for OH is similar to that for H2O. By comparing the calculated energy barriers for these reactants with the activation energies of oxide growth rate, we suggest the orientation-dependent rate-limiting processes during wet SiC oxidation.

Stay Connected: Using Technology to Enhance Professional Learning Communities

ERIC Educational Resources Information Center

Bates, Celeste C.; Huber, Rachael; McClure, Erin

2016-01-01

Professional Learning Communities (PLCs) offer opportunities for educators to collaboratively inquire and study innovative literacy practices. However, scheduling conflicts and other challenges often interrupt or create barriers for PLCs. This article provides suggestions for integrating technology into a face-to-face PLC as a means of supporting…

Factors That Affect Faculty Attitudes toward Adoption of Technology-Rich Blended Learning

ERIC Educational Resources Information Center

Moukali, Khalid Hussain

2012-01-01

Universities worldwide are transitioning to blended learning where technology is used to enhance and augment traditional face-to-face instruction. Investigation of how well blended learning strategies are accepted and adopted in multicultural settings is needed to facilitate this transition. This study investigated factors and barriers that…

Increasing Student Success and Retention: A Multidimensional Approach

ERIC Educational Resources Information Center

Fowler, Paul R.; Boylan, Hunter R.

2010-01-01

Students who are seriously academically deficient, those who are underprepared in all subjects, face many academic challenges as they begin their coursework in higher education. However, students also face nonacademic and personal issues that create additional barriers to success. The results of this study suggest that increases in student success…

Interdisciplinary Team Training for Prospective Middle Grades Teachers.

ERIC Educational Resources Information Center

Warner, Mark

2001-01-01

Describes how face-to-face meetings, field trips, and Internet technology with team planning helped a teacher educator at Augusta State University in Georgia overcome barriers to preparing prospective middle school teachers as effective team members. Illustrates impact on small-group decision making, expectations for team functioning, and…

Managing menstruation in the workplace: an overlooked issue in low- and middle-income countries.

PubMed

Sommer, Marni; Chandraratna, Sahani; Cavill, Sue; Mahon, Therese; Phillips-Howard, Penelope

2016-06-06

The potential menstrual hygiene management barriers faced by adolescent girls and women in workplace environments in low- and middle-income countries has been under addressed in research, programming and policy. Despite global efforts to reduce poverty among women in such contexts, there has been insufficient attention to the water and sanitation related barriers, specifically in relation to managing monthly menstruation, that may hinder girls' and women's contributions to the workplace, and their health and wellbeing. There is an urgent need to document the specific social and environmental barriers they may be facing in relation to menstrual management, to conduct a costing of the implications of inadequate supportive workplace environments for menstrual hygiene management, and to understand the implications for girls' and women's health and wellbeing. This will provide essential evidence for guiding national policy makers, the private sector, donors and activists focused on advancing girls' and women's rights.

Rural Trends in Diagnosis and Services for Autism Spectrum Disorder

PubMed Central

Antezana, Ligia; Scarpa, Angela; Valdespino, Andrew; Albright, Jordan; Richey, John A.

2017-01-01

Rural communities face significant challenges regarding the adequate availability of diagnostic-, treatment-, and support-services for individuals with autism spectrum disorder (ASD). Specifically, a variety of factors, including geographic distance between families and service providers, low reliance on health care professionals, and cultural characteristics, contribute to the diminished availability and utilization of services. Together, these factors lead to risks for delayed ASD screening and diagnosis, yielding lower educational and functional outcomes. The purpose of this review is to outline the specific diagnosis and treatment barriers that affect individuals with ASD and their families in rural settings. Telehealth feasibility and efficacy research is also reviewed, suggesting that telecommunication services may offer an inroad for addressing the specific service barriers faced by rural communities. Together, the current review identifies specific needs for both research and support services that address the specific access barriers characteristic of rural settings. PMID:28473784

Holistic face representation is highly orientation-specific.

PubMed

Rosenthal, Gideon; Levakov, Gidon; Avidan, Galia

2017-09-29

It has long been argued that face processing requires disproportionate reliance on holistic processing (HP), relative to that required for nonface object recognition. Nevertheless, whether the holistic nature of face perception is achieved via a unique internal representation or by the employment of an automated attention mechanism is still debated. Previous studies had used the face inversion effect (FIE), a unique face-processing marker, or the face composite task, a gold standard paradigm measuring holistic processing, to examine the validity of these two different hypotheses, with some studies combining the two paradigms. However, the results of such studies remain inconclusive, particularly pertaining to the issue of the two proposed HP mechanisms-an internal representation as opposed to an automated attention mechanism. Here, using the complete composite paradigm design, we aimed to examine whether face rotation yields a nonlinear or a linear drop in HP, thus supporting an account that face processing is based either on an orientation-dependent internal representation or on automated attention. Our results reveal that even a relatively small perturbation in face orientation (30 deg away from upright) already causes a sharp decline in HP. These findings support the face internal representation hypothesis and the notion that the holistic processing of faces is highly orientation-specific.

Supporting patients with mental illness: Deconstructing barriers to community pharmacist access.

PubMed

Calogero, Samantha; Caley, Charles F

To discuss the barriers faced by individuals with mental health conditions attempting to access their community pharmacists and to propose solutions toward deconstructing those barriers. Given the prevalence of mental illness and the frequency at which psychotropic medications are dispensed, community pharmacists have a daily opportunity to engage patients with mental illness and be active participants in community-based mental health care. Yet multiple barriers affect patient access to community pharmacists. Some barriers, such as heavy dispensing workload, can be considered as "external" to the pharmacist. Other barriers, such as negative attitudes about mental illness, are considered to be "internal." Research about mental illness stigma in pharmacy often reports that community pharmacists are uncomfortable with, or have little time for, mental health patients. Patients also report experiencing stigma from pharmacists and pharmacy staff. Expanded efforts are needed by the pharmacy profession to deconstruct barriers that patients with mental illness are faced with in community pharmacy, especially related to stigma. Specifically, these efforts should include critically evaluating and addressing the quality of didactic and experiential opportunities in psychiatric pharmacotherapy for pharmacy students, transforming the physical layout of community pharmacies to offer true counseling privacy, educating community pharmacists and pharmacy staff about mental illness, and educating patients about what to expect from community pharmacists. There are opportunities for community pharmacy to improve its impact on mental health treatment outcomes by resolving mental illness stigma and other barriers that prevent patients with mental illness from accessing their community pharmacist. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Avoiding Communication Barriers in the Classroom: The APEINTA Project

ERIC Educational Resources Information Center

Iglesias, Ana; Jiménez, Javier; Revuelta, Pablo; Moreno, Lourdes

2016-01-01

Education is a fundamental human right, however unfortunately not everybody has the same learning opportunities. For instance, if a student has hearing impairments, s/he could face communications barriers in the classroom, which could affect his/her learning process. APEINTA is a Spanish educational project that aims for inclusive education for…

Barriers and Perceptions of Natural Resource Careers by Minority Students

ERIC Educational Resources Information Center

Haynes, Nia A.; Jacobson, Susan

2015-01-01

Using a framework based on social cognitive career theory, we conducted 38 interviews and four focus groups with college students to identify motivations and barriers faced by underrepresented groups to natural resource careers. Interviews revealed career satisfaction as the most important goal for both natural resource and a comparison of liberal…

Accessing Science Courses in Rural BC: A Cultural Border-Crossing Metaphor

ERIC Educational Resources Information Center

Nielsen, Wendy S.; Nashon, Samson Madera

2007-01-01

Students in small rural schools in British Columbia face barriers to accessing senior science courses. A case study employing questionnaire and interview methods sought the perspectives of principals, teachers, and students in the affected schools on this issue. Interpretive data analysis revealed the following barriers as key factors that affect…

Broadening Extension's Capacity--Comparing Extension Agents' and Environmental Educators' Perceptions of Needs and Barriers

ERIC Educational Resources Information Center

Smaldone, Dave; Boone, Deborah A.; Selin, Steve; See, Amanda

2011-01-01

Conservation and environmental education share similar goals with Extension and thus holds partnership potential for Extension. The study reported here compared the needs and barriers faced by environmental educators and Extension agents in West Virginia using a mail survey. Results indicated there were both similarities and differences in the…

Participatory Action Research with College Students with Disabilities: Photovoice for an Inclusive Campus

ERIC Educational Resources Information Center

Agarwal, Neelam; Moya, Eva M.; Yasui, Naoko Yura; Seymour, Corene

2015-01-01

College students with disabilities face various barriers to academic and social engagement. The present project was conducted based on principles of participatory action research (PAR) using Photovoice method with six students, gathering images representing such barriers, and developing narratives to describe the problems as well as possible ways…

Access Barriers to Distance Education Perceived by Inservice and Preservice Career and Technical Education Majors.

ERIC Educational Resources Information Center

Zirkle, Chris

The access barriers to distance education faced by inservice and preservice career and technical education (CTE) majors were examined through a survey of 76 students enrolled in undergraduate- and graduate-level CTE education programs. Completed questionnaires were received from 60 students (response rate, 78.9%). Forty respondents worked…

Barriers to Conducting a Community Mobilization Intervention among Youth in a Rural South African Community

ERIC Educational Resources Information Center

Whitehead, Kevin A.; Kriel, Anita J.; Richter, Linda M.

2005-01-01

In the face of extreme poverty and inequality in South Africa, community mobilization interventions represent an important way in which people can be empowered to improve their life. Successfully conducting community mobilization interventions in rural South African communities requires anticipating and addressing a number of potential barriers in…

Beyond Bias and Barriers: Fulfilling the Potential of Women in Academic Science and Engineering

ERIC Educational Resources Information Center

National Academies Press, 2007

2007-01-01

The United States economy relies on the productivity, entrepreneurship, and creativity of its people. To maintain its scientific and engineering leadership amid increasing economic and educational globalization, the United States must aggressively pursue the innovative capacity of all its people--women and men. However, women face barriers to…

Barriers Experienced by Mexican Immigrants: Implications for Educational Achievement and Mental Health

ERIC Educational Resources Information Center

Consoli, Melissa L. Morgan; Consoli, Andres J.; Orozco, Graciela Leon; Gonzales, Rufus R.; Vera, Elizabeth M.

2012-01-01

The adversities faced by Latina/o individuals and their families in the U.S. negatively impact educational outcomes as well as their mental and physical health. These adversities are often related to immigration status and acculturation and include difficulties with immigration, language barriers, and discrimination. Given that recent immigrants…

Prevalence of, and Factors Associated with, Unemployment among Graduates: Evidence from Tanzania

ERIC Educational Resources Information Center

Amani, Jaquiline

2017-01-01

Unemployment in Tanzania and many other sub-Saharan African countries has remained one of the daunting challenges in these nascent economies. Drawing on secondary sources, this article reviews and analyses the employment barriers Tanzanian graduates face, with a view to discussing possible counter-strategies. The article reveals barriers to…

Love and Literacy: What Happens in Couples when the Woman Learns to Read

ERIC Educational Resources Information Center

Garland, Rebecca J.

2009-01-01

Approximately fourteen percent of English-speaking Americans are functionally illiterate. Given this high figure, it is important to understand the barriers that undereducated adults face when they decide to return to school to improve their literacy skills. This qualitative study examines spousal support as one of these barriers. Through…

Play and Recreational Habits of Youths Who Are Deaf-Blind

ERIC Educational Resources Information Center

Lieberman, Lauren J.; MacVicar, Janet M.

2003-01-01

This study analyzed the current recreational practices and the barriers faced by 54 youths who are deaf-blind. The most common recreational activities were swimming, swinging, walking, climbing, and biking, and the greatest perceived barriers were the disability itself, lack of knowledge, lack of programming, lack of staff, and inadequate…

Barriers to Antiretroviral Medication Adherence in Young HIV-Infected Children

ERIC Educational Resources Information Center

Roberts, Kathleen Johnston

2005-01-01

The purpose of this exploratory study was to examine, from the perspectives of both HIV-infected children and such children's primary guardians, the barriers children face in adhering to combination antiretroviral therapies. Nine HIV-infected young children and 14 guardians of HIV-positive children were interviewed about what the children's lives…

Teaching English Language Learners: Strategies for Overcoming Barriers

ERIC Educational Resources Information Center

Helfrich, Sara R.; Bosh, Amy J.

2011-01-01

The number of English language learners (ELLs) in today's classrooms is increasing. In this article, the authors identify four perceived barriers beginning and veteran teachers face in teaching literacy to ELLs: the lack of understanding of the role of literacy in other cultures, the teacher's inability to differentiate instruction to meet the…

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

ERIC Educational Resources Information Center

Anczweski, Julian; Anczewska, Marta

2015-01-01

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

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.…

School-based service delivery for homeless students: relevant laws and overcoming access barriers.

PubMed

Sulkowski, Michael L; Joyce-Beaulieu, Diana K

2014-11-01

Schools in the United States are facing a record number of homeless students. These students are highly at-risk for experiencing negative life outcomes, and they face considerable academic and social-emotional functional impairments. To help address the complex needs of homeless students, this article reviews the intersection of laws and practices that impact homeless students, as well as contemporary school-based service delivery efforts to support the academic and social-emotional needs of these students. In addition, this article also reviews several barriers to school-based service delivery for homeless students and ways to overcome these barriers. These barriers include confusion regarding consent and record-sharing procedures, ineffectively utilizing homeless liaisons, and misapplying tenants of Multitiered Systems of Support (MTSS), which is a school-based service-delivery framework that has been adopted by and implemented in many U.S. schools. Ultimately, this article aims to provide members of school communities with practical information that they can use to support the homeless youth they encounter and serve. (c) 2014 APA, all rights reserved.

Why Physicians Don’t Ask: Interpersonal and Intrapersonal Barriers to HIV Testing—Making a Case for a Patient-Initiated Campaign

PubMed Central

Arya, Monisha; Patel, Sajani; Kumar, Disha; Zheng, Micha Yin; Amspoker, Amber Bush; Kallen, Michael Anthony; Street, Richard Lewis; Viswanath, Kasisomayajula; Giordano, Thomas Peter

2014-01-01

In 2006, the US Centers for Disease Control and Prevention recommended HIV testing for all adolescents and adults aged 13 to 64 in health care settings with a HIV prevalence of at least 0.1%. However, 55% of US adults have never been tested and therefore do not know their HIV status. To understand suboptimal HIV testing rates, this study sought to illuminate interpersonal and intrapersonal physician barriers to HIV testing. One hundred and eighty physicians from health centers in Houston completed a survey based on Cabana’s Knowledge, Attitudes and Behaviors model. One-third of the physicians faced at least 1 interpersonal barrier to HIV testing, such as a difference in age or language. Many (41%) physicians faced at least 1 intrapersonal barrier, such as believing their patients would be feeling uncomfortable discussing HIV. Notably, 71% of physicians would prefer their patients ask for the test. A patient-engaging campaign may be an innovative solution to increasing HIV testing and reducing the number of undiagnosed persons. PMID:25421929

Evidence-based practice within nutrition: what are the barriers for improving the evidence and how can they be dealt with?

PubMed

Laville, Martine; Segrestin, Berenice; Alligier, Maud; Ruano-Rodríguez, Cristina; Serra-Majem, Lluis; Hiesmayr, Michael; Schols, Annemie; La Vecchia, Carlo; Boirie, Yves; Rath, Ana; Neugebauer, Edmund A M; Garattini, Silvio; Bertele, Vittorio; Kubiak, Christine; Demotes-Mainard, Jacques; Jakobsen, Janus C; Djurisic, Snezana; Gluud, Christian

2017-09-11

Evidence-based clinical research poses special barriers in the field of nutrition. The present review summarises the main barriers to research in the field of nutrition that are not common to all randomised clinical trials or trials on rare diseases and highlights opportunities for improvements. Systematic academic literature searches and internal European Clinical Research Infrastructure Network (ECRIN) communications during face-to-face meetings and telephone conferences from 2013 to 2017 within the context of the ECRIN Integrating Activity (ECRIN-IA) project. Many nutrients occur in multiple forms that differ in biological activity, and several factors can alter their bioavailability which raises barriers to their assessment. These include specific difficulties with blinding procedures, with assessments of dietary intake, and with selecting appropriate outcomes as patient-centred outcomes may occur decennia into the future. The methodologies and regulations for drug trials are, however, applicable to nutrition trials. Research on clinical nutrition should start by collecting clinical data systematically in databases and registries. Measurable patient-centred outcomes and appropriate study designs are needed. International cooperation and multistakeholder engagement are key for success.

Why Physicians Don't Ask: Interpersonal and Intrapersonal Barriers to HIV Testing-Making a Case for a Patient-Initiated Campaign.

PubMed

Arya, Monisha; Patel, Sajani; Kumar, Disha; Zheng, Micha Yin; Kallen, Michael A; Street, Richard L; Viswanath, Kasisomayajula; Giordano, Thomas P

2016-07-01

In 2006, the US Centers for Disease Control and Prevention recommended HIV testing for all adolescents and adults aged 13 to 64 in health care settings with a HIV prevalence of at least 0.1%. However, 55% of US adults have never been tested and therefore do not know their HIV status. To understand suboptimal HIV testing rates, this study sought to illuminate interpersonal and intrapersonal physician barriers to HIV testing. One hundred and eighty physicians from health centers in Houston completed a survey based on Cabana's Knowledge, Attitudes and Behaviors model. One-third of the physicians faced at least 1 interpersonal barrier to HIV testing, such as a difference in age or language. Many (41%) physicians faced at least 1 intrapersonal barrier, such as believing their patients would be feeling uncomfortable discussing HIV. Notably, 71% of physicians would prefer their patients ask for the test. A patient-engaging campaign may be an innovative solution to increasing HIV testing and reducing the number of undiagnosed persons. © The Author(s) 2014.

An adult learning perspective on disability and microfinance: The case of Katureebe.

PubMed

Nuwagaba, Ephraim L; Rule, Peter N

2016-01-01

Despite Uganda's progress in promoting affirmative action for persons with disabilities and its strategy of using microfinance to fight poverty, access to microfinance services by persons with disabilities is still problematic due to barriers, characterised by discrepancies between policies and practices. Regarding education, the affirmative action in favour of learners with disabilities has not translated into actual learning opportunities due to personal and environmental barriers. The study on which this article is based investigated the non-formal and informal adult learning practices regarding microfinance that persons with disabilities engaged in. This article seeks to illuminate the barriers that a person with a visual impairment encountered while learning about and engaging with microfinance and the strategies that he developed to overcome them. This was a case study, framed within the social model of disability and critical research paradigm. Data were collected through in-depth interviews of a person with visual impairment and observations of the environment in which adult learning and engagement with Savings and Credit Cooperative Organisations (SACCOs) occurred. Findings indicate that the person with a visual disability faced barriers to learning about microfinance services. He experienced barriers in an integrated manner and developed strategies to overcome these barriers. The barriers and strategies are theorised using the social model of disability. The case of a person with visual impairment suggests that persons with disabilities face multiple barriers regarding microfinance, including social, psychological and educational. However, his own agency and attitudes were also of importance as they influenced his learning. Viewing these barriers as blockades can lead to non-participation in learning and engagement with microfinance whereas viewing them as surmountable hurdles can potentially motivate participants to succeed in learning about and engaging with microfinance.

An adult learning perspective on disability and microfinance: The case of Katureebe

PubMed Central

Nuwagaba, Ephraim L.

2016-01-01

Background Despite Uganda’s progress in promoting affirmative action for persons with disabilities and its strategy of using microfinance to fight poverty, access to microfinance services by persons with disabilities is still problematic due to barriers, characterised by discrepancies between policies and practices. Regarding education, the affirmative action in favour of learners with disabilities has not translated into actual learning opportunities due to personal and environmental barriers. Objectives The study on which this article is based investigated the non-formal and informal adult learning practices regarding microfinance that persons with disabilities engaged in. This article seeks to illuminate the barriers that a person with a visual impairment encountered while learning about and engaging with microfinance and the strategies that he developed to overcome them. Methods This was a case study, framed within the social model of disability and critical research paradigm. Data were collected through in-depth interviews of a person with visual impairment and observations of the environment in which adult learning and engagement with Savings and Credit Cooperative Organisations (SACCOs) occurred. Results Findings indicate that the person with a visual disability faced barriers to learning about microfinance services. He experienced barriers in an integrated manner and developed strategies to overcome these barriers. The barriers and strategies are theorised using the social model of disability. Conclusion The case of a person with visual impairment suggests that persons with disabilities face multiple barriers regarding microfinance, including social, psychological and educational. However, his own agency and attitudes were also of importance as they influenced his learning. Viewing these barriers as blockades can lead to non-participation in learning and engagement with microfinance whereas viewing them as surmountable hurdles can potentially motivate participants to succeed in learning about and engaging with microfinance. PMID:28730047

78 FR 47699 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-06

... barriers to use such as relevant educational materials, knowledge, costs, availability; and (4) develop strategies to overcome key barriers to compliance. The Organization for Safety, Asepsis and Prevention (OSAP... public through quality education and information dissemination. OSAP's unique membership includes the...

Green FR Cotton Barrier Nonwovens: Progress Report

USDA-ARS?s Scientific Manuscript database

This green barrier fabric is unique in sense that it is from a renewable resource, biodegradable, economical, employing greige (unbleached) cotton, thus, increasing its marketability. The recent open-flame standard (effective since July, 2007) for residential mattresses 16 CFR 1633 from CPSC has l...

Overcoming barriers to exercise among parents: A social cognitive theory perspective

PubMed Central

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

2017-01-01

Parents face numerous barriers to exercise and exhibit high levels of inactivity. Examining theory-based determinants of exercise among parents may inform interventions for this population. The purpose of this study was to test a social-cognitive model of parental exercise participation over a 12-month period. Mothers (n=226) and fathers (n=70) of children <16 completed measures of exercise, barriers self-efficacy, perceived barriers, and exercise planning at baseline and one year later. Panel analyses were used to test the hypothesized relationships. Barriers self-efficacy was related to exercise directly and indirectly through perceived barriers and prioritization/planning. Prioritization and planning also mediated the relationship between perceived barriers and exercise. These paths remained significant at 12 months. These results suggest efforts to increase exercise in parents should focus on improving confidence to overcome exercise barriers, reducing perceptions of barriers, and helping parents make specific plans for prioritizing and engaging in exercise. PMID:27108160

Effect of study context on item recollection.

PubMed

Skinner, Erin I; Fernandes, Myra A

2010-07-01

We examined how visual context information provided during encoding, and unrelated to the target word, affected later recollection for words presented alone using a remember-know paradigm. Experiments 1A and 1B showed that participants had better overall memory-specifically, recollection-for words studied with pictures of intact faces than for words studied with pictures of scrambled or inverted faces. Experiment 2 replicated these results and showed that recollection was higher for words studied with pictures of faces than when no image accompanied the study word. In Experiment 3 participants showed equivalent memory for words studied with unique faces as for those studied with a repeatedly presented face. Results suggest that recollection benefits when visual context information high in meaningful content accompanies study words and that this benefit is not related to the uniqueness of the context. We suggest that participants use elaborative processes to integrate item and meaningful contexts into ensemble information, improving subsequent item recollection.

New twinning route in face-centered cubic nanocrystalline metals.

PubMed

Wang, Lihua; Guan, Pengfei; Teng, Jiao; Liu, Pan; Chen, Dengke; Xie, Weiyu; Kong, Deli; Zhang, Shengbai; Zhu, Ting; Zhang, Ze; Ma, Evan; Chen, Mingwei; Han, Xiaodong

2017-12-15

Twin nucleation in a face-centered cubic crystal is believed to be accomplished through the formation of twinning partial dislocations on consecutive atomic planes. Twinning should thus be highly unfavorable in face-centered cubic metals with high twin-fault energy barriers, such as Al, Ni, and Pt, but instead is often observed. Here, we report an in situ atomic-scale observation of twin nucleation in nanocrystalline Pt. Unlike the classical twinning route, deformation twinning initiated through the formation of two stacking faults separated by a single atomic layer, and proceeded with the emission of a partial dislocation in between these two stacking faults. Through this route, a three-layer twin was nucleated without a mandatory layer-by-layer twinning process. This route is facilitated by grain boundaries, abundant in nanocrystalline metals, that promote the nucleation of separated but closely spaced partial dislocations, thus enabling an effective bypassing of the high twin-fault energy barrier.

Parent opinions about use of text messaging for immunization reminders.

PubMed

Ahlers-Schmidt, Carolyn Rose; Chesser, Amy K; Paschal, Angelia M; Hart, Traci A; Williams, Katherine S; Yaghmai, Beryl; Shah-Haque, Sapna

2012-06-06

Adherence to childhood immunization schedules is a function of various factors. Given the increased use of technology as a strategy to increase immunization coverage, it is important to investigate how parents perceive different forms of communication, including traditional means and text-message reminders. To examine current forms of communication about immunization information, parents' satisfaction levels with these communication modes, perceived barriers and benefits to using text messaging, and the ideal content of text messages for immunization reminders. Structured interviews were developed and approved by two Institutional Review Boards. A convenience sample of 50 parents was recruited from two local pediatric clinics. The study included a demographics questionnaire, the shortened form of the Test of Functional Health Literacy for Adults (S-TOFHLA), questions regarding benefits and barriers of text communication from immunization providers, and preferred content for immunization reminders. Content analyses were performed on responses to barriers, benefits, and preferred content (all Cohen's kappas > 0.70). Respondents were mostly female (45/50, 90%), white non-Hispanic (31/50, 62%), between 20-41 years (mean = 29, SD 5), with one or two children (range 1-9). Nearly all (48/50, 96%) had an S-TOFHLA score in the "adequate" range. All parents (50/50, 100%) engaged in face-to-face contact with their child's physician at appointments, 74% (37/50) had contact via telephone, and none of the parents (0/50, 0%) used email or text messages. Most parents were satisfied with the face-to-face (48/50, 96%) and telephone (28/50, 75%) communication. Forty-nine of the 50 participants (98%) were interested in receiving immunization reminders by text message, and all parents (50/50, 100%) were willing to receive general appointment reminders by text message. Parents made 200 comments regarding text-message reminders. Benefits accounted for 63.5% of comments (127/200). The remaining 37.5% (73/200) regarded barriers; however, no barriers could be identified by 26% of participants (13/50). Parents made 172 comments regarding preferred content of text-message immunization reminders. The most frequently discussed topics were date due (50/172, 29%), general reminder (26/172, 26%), and child's name (21/172, 12%). Most parents were satisfied with traditional communication; however, few had experienced any alternative forms of communication regarding immunizations. Benefits of receiving text messages for immunization reminders far outweighed the barriers identified by parents. Few barriers identified were text specific. Those that were, centered on cost if parents did not have unlimited texting plans.

System and method for representing and manipulating three-dimensional objects on massively parallel architectures

DOEpatents

Karasick, Michael S.; Strip, David R.

1996-01-01

A parallel computing system is described that comprises a plurality of uniquely labeled, parallel processors, each processor capable of modelling a three-dimensional object that includes a plurality of vertices, faces and edges. The system comprises a front-end processor for issuing a modelling command to the parallel processors, relating to a three-dimensional object. Each parallel processor, in response to the command and through the use of its own unique label, creates a directed-edge (d-edge) data structure that uniquely relates an edge of the three-dimensional object to one face of the object. Each d-edge data structure at least includes vertex descriptions of the edge and a description of the one face. As a result, each processor, in response to the modelling command, operates upon a small component of the model and generates results, in parallel with all other processors, without the need for processor-to-processor intercommunication.

Revisiting the Birth of 7YSZ Thermal Barrier Coatings: Steve Stecura

NASA Technical Reports Server (NTRS)

Smialek, James L.; Miller, Robert A.

2017-01-01

Thermal barrier coatings are widely used in all turbine engines, typically using a 7 wt% Y2O3-ZrO2 formulation. Extensive research and development over many decades have refined the processing and structure of these coatings for increased durability and reliability. New compositions demonstrate some unique advantages and are gaining in application. However, the "7YSZ" formulation predominates and is still in widespread use. This special composition has been universally found to produce nanoscale precipitates of metastable t' tetragonal phase, giving rise to a unique toughening mechanism via ferro-elastic switching under stress. This note recalls the original study that identified superior properties of 6 to 8 wt% YSZ plasma sprayed thermal barrier coatings, published in 1978. The impact of this discovery, arguably, continues in some form to this day. At one point, 7YSZ thermal barrier coatings were used in every new aircraft and ground power turbine engine produced worldwide. It is a tribute to its inventor, Dr. Stephan J. Stecura, NASA retiree.

Veterans and Military Family Health

MedlinePlus

Service members and veterans face some different health issues from civilians. Their families also face some unique challenges. Families may have to cope with Separation from their loved ones Anxiety over ...

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

PubMed

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

2016-01-01

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

Access to, Use of, and Attitudes toward Telecommunication among Rural VR Clients

ERIC Educational Resources Information Center

Ipsen, Catherine; Rigles, Bethany; Arnold, Nancy; Seekins, Tom

2013-01-01

Telecommunication offers rural vocational rehabilitation (VR) clients a method of communicating with their VR counselor between face-to-face visits. Unfortunately, certain telecommunication methods may not be available to many rural VR clients or may pose barriers in the rehabilitation process. This article describes findings from an exploratory…

DACA-Lamented? Spared Deportation, Immigrant Students Still Face Higher Ed Barriers

ERIC Educational Resources Information Center

Burke, Lauren A.

2014-01-01

In this brief article, immigration lawyer and executive director of Atlas: DIY Lauren Burke describes the challenges faced by "DACA-mented" students--those who have received deportation reprieve through President Obama's 2012 memorandum. Atlas: DIY (www.atlasdiy.org) is a cooperative center for undocumented youth and their allies in…

Food for Thought. The Changing Face of CTE

ERIC Educational Resources Information Center

Mischel, Susan

2005-01-01

As a former career and technical education teacher, this author was often faced with the issue of students segregating themselves by culture. This article describes how she managed to break down cultural barriers and prejudice through teamwork, cooking, and class goals set with high expectations. The course she offered included student "ownership"…

Understanding Knowledge-Sharing Breakdowns: A Meeting of the Quantitative and Qualitative Minds

ERIC Educational Resources Information Center

Soller, Amy

2004-01-01

The rapid advance of distance learning and networking technology has enabled universities and corporations to reach out and educate students across time and space barriers. Although this technology enables structured collaborative learning activities, online groups often do not enjoy the same benefits as face-to-face learners, and their…

Shallow Roots Require Constant Watering: The Challenge of Sustained Impact in Educational Programs

ERIC Educational Resources Information Center

Rosen, Yigal; Perkins, David

2013-01-01

Socially-oriented educational programs often face societal barriers. Peace education in a region of prolonged conflict faces a negative socio-political environment that works against its effects. The media, leadership, educational system and other societal institutions continue to express a culture of conflict. Recent studies show that the effects…

Barriers to Considering Ethical and Societal Implications of Research: Perceptions of Life Scientists.

PubMed

McCormick, Jennifer Blair; Boyce, Angie M; Ladd, Jennifer M; Cho, Mildred

2012-01-01

BACKGROUND: As part of an empirical study investigating how life scientists think about ethical and societal implications of their work, and about life science research in general, we sought to elucidate barriers that scientists might face in considering such implications. METHOD: Between 2005 and 2007, we conducted a study consisting of phone interviews, focus groups, and a national survey of life scientists at biomedical research institutions. The study population included graduate students, postdoctoral fellows, faculty, clinical instructors, and research staff. We analyzed data through qualitative and quantitative methods. RESULTS: In analyzing the data, we found that life scientists do, in fact, face barriers to considering ethical and societal implications of research. We categorized these barriers as falling into four broad domains: (1) lack of awareness of ethical and societal implications; (2) lack of relevance of such concerns to their specific research; (3) self-confidence in their ability to resolve such concerns; and (4) aspects of the daily practice of science itself. CONCLUSIONS: Life science researchers experience elements inherent in their training and in the conduct of science as barriers to thinking about ethical and societal implications related to their work. These findings suggest areas in which research ethics educators, bioethicists, and the scientific community can focus their efforts to improve social and ethical accountability in research.

Facilitators and Barriers to Implementing Clinical Governance: A Qualitative Study among Senior Managers in Iran

PubMed Central

RAVAGHI, Hamid; RAFIEI, Sima; HEIDARPOUR, Peigham; MOHSENI, Maryam

2014-01-01

Abstract Background Health care systems should assign quality improvement as their main mission. Clinical governance (CG) is a key strategy to improve quality of health care services. The Iranian Ministry of Health and Medical Education (MOHME) has promoted CG as a framework for safeguarding quality and safety in all hospitals since 2009. The purpose of this study was to explore perceived facilitators and barriers to implementing CG by deputies for curative affairs of Iranian medical universities. Methods A qualitative study was conducted using face to face interviews with a purposeful sample of 43 deputies for curative affairs of Iranian Medical Universities and documents review. Thematic analysis was used to analyze the data Results Five themes were explored including: knowledge and attitude toward CG, culture, organizational factors, managerial factors and barriers. The main perceived facilitating factors were adequate knowledge and positive attitude toward CG, supporting culture, managers’ commitment, effective communication and well designed incentives. Pe rceived barriers were the reverse of facilitators noted above in addition to insufficient resources, legal challenges, workload and parallel quality programs. Conclusions Successful implementation of CG in Iran will require identifying barriers and challenges existing in the way of CG implementation and try to mitigate them by using appropriate facilitators. PMID:26175981

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.

Direct control and characterization of a Schottky barrier by scanning tunneling microscopy

NASA Technical Reports Server (NTRS)

Bell, L. D.; Kaiser, W. J.; Hecht, M. H.; Grunthaner, F. J.

1988-01-01

Scanning tunneling microscopy (STM) methods are used to directly control the barrier height of a metal tunnel tip-semiconductor tunnel junction. Barrier behavior is measured by tunnel current-voltage spectroscopy and compared to theory. A unique surface preparation method is used to prepare a low surface state density Si surface. Control of band bending with this method enables STM investigation of semiconductor subsurface properties.

Origin of the Energy Barrier to Chemical Reactions of O2 on Al(111): Evidence for Charge Transfer, Not Spin Selection

DTIC Science & Technology

2012-11-08

change of O2 spin, at the barrier [Fig. 3]; i.e., the corresponding diabatic surfaces cross. Far from the Al surface, the triplet state is...previous theoretical models, in particular nonadiabatic [17] or diabatic [16] approaches, which also find an energy barrier consistent with experiment...crossings of different diabatic O2 spin configuration sur- faces are accommodated by small spin fluctuations within the metal surface. For parallel

Technology Integration Barriers: Urban School Mathematics Teachers Perspectives

NASA Astrophysics Data System (ADS)

Wachira, Patrick; Keengwe, Jared

2011-02-01

Despite the promise of technology in education, many practicing teachers face several challenges when trying to effectively integrate technology into their classroom instruction. Additionally, while national statistics cite a remarkable improvement in access to computer technology tools in schools, teacher surveys show consistent declines in the use and integration of computer technology to enhance student learning. This article reports on primary technology integration barriers that mathematics teachers identified when using technology in their classrooms. Suggestions to overcome some of these barriers are also provided.

Anode composite for molten carbonate fuel cell

DOEpatents

Iacovangelo, Charles D.; Zarnoch, Kenneth P.

1983-01-01

An anode composite useful for a molten carbonate fuel cell comprised of a porous sintered metallic anode component having a porous bubble pressure barrier integrally sintered to one face thereof, said barrier being comprised of metal coated ceramic particles sintered together and to said anode by means of said metal coating, said metal coating enveloping said ceramic particle and being selected from the group consisting of nickel, copper and alloys thereof, the median pore size of the barrier being significantly smaller than that of the anode.

Innovation in Data-Driven Decision Making within SWPBIS Systems: Welcome to the Gallery Walk

ERIC Educational Resources Information Center

Kennedy, Michael J.; Mimmack, Jody; Flannery, K. Brigid

2012-01-01

Schools implementing school-wide positive behavioral interventions and supports (SWPBIS) at the high school level face the same challenges as elementary and middle schools, but also encounter an additional set of barriers all their own. To name but a few, these barriers include the need to focus on dropout prevention, postsecondary outcomes,…

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

ERIC Educational Resources Information Center

Neeley, Alexander B.

2017-01-01

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

Communication Barriers: A Study of Eastern Mediterranean University Students' and Teachers' of Online Program and Courses

ERIC Educational Resources Information Center

Isman, Aytekin; Altinay, Fahriye

2005-01-01

This research study defines communication barriers in online programs and courses by determining the perceptions of students and teachers at Eastern Mediterranean University. It aims to get the answers to the questions of what sorts of problems students and teachers face while being involved in online courses and online programs. Distance…

WorldSkills UK Training Managers: Midas Touch or Fool's Gold?

ERIC Educational Resources Information Center

Wilde, Stephanie; Relly, Susan James

2015-01-01

This article focuses on the role of training managers (TMs) in UK participation in WorldSkills Competitions (WSC). The TM role is outlined, according to the perceptions of the TMs, and there is analysis of the benefits to them of participation, as well as the barriers they face, and the benefits and barriers available to participating further…

DREAMing Big: Understanding the Current Context of Academic and Career Decision-Making for Undocumented Students

ERIC Educational Resources Information Center

Kantamneni, Neeta; Dharmalingam, Kavitha; Tate, Jessica M.; Perlman, Beth L.; Majmudar, Chaitasi R.; Shada, Nichole

2016-01-01

Undocumented student immigrants in the United States face substantial challenges in higher education including systemic, institutional, and cultural barriers that often impede access to and success in higher education. These barriers directly influence academic and work opportunities. The purpose of this article is to discuss the myriad of factors…

Exploring the Development of Existing Sex Education Programmes for People with Intellectual Disabilities: An Intervention Mapping Approach

ERIC Educational Resources Information Center

Schaafsma, Dilana; Stoffelen, Joke M. T.; Kok, Gerjo; Curfs, Leopold M. G.

2013-01-01

Background: People with intellectual disabilities face barriers that affect their sexual health. Sex education programmes have been developed by professionals working in the field of intellectual disabilities with the aim to overcome these barriers. The aim of this study was to explore the development of these programmes. Methods: Sex education…

Barriers to Dance Training for Young People with Disabilities

ERIC Educational Resources Information Center

Aujla, Imogen J.; Redding, Emma

2013-01-01

Dance is a viable and enjoyable activity -- and potential career -- for young people with disabilities, yet they face several barriers to participation and training. The aim of this article, by Imogen J. Aujla of the University of Bedfordshire and Emma Redding of Trinity Laban Conservatoire of Music and Dance, is to review the literature on…

Pre-Service Teachers' Uses of and Barriers from Adopting Computer-Assisted Language Learning (CALL) Programs

ERIC Educational Resources Information Center

Samani, Ebrahim; Baki, Roselan; Razali, Abu Bakar

2014-01-01

Success in implementation of computer-assisted language learning (CALL) programs depends on the teachers' understanding of the roles of CALL programs in education. Consequently, it is also important to understand the barriers teachers face in the use of computer-assisted language learning (CALL) programs. The current study was conducted on 14…

Service Delivery to Young Handicapped Children in Rural Areas: A Review of Issues and Practices.

ERIC Educational Resources Information Center

Nash, Tina Eaton; And Others

The paper examines barriers faced by educators and administrators in serving young handicapped children in rural areas and suggests approaches to overcoming these barriers. Among problems identified are transportation; funding shortages due to a lower tax base and higher levels of poverty; unemployment, and seasonal employment; staff shortages;…

Health Care among the Kumiai Indians of Baja California, Mexico: Structural and Social Barriers

ERIC Educational Resources Information Center

Fleuriet, K. Jill

2009-01-01

In this article, the author documents the illness and health care problems facing indigenous communities in Baja California, Mexico, by using ethnographic data from research she conducted from 1999 to 2001 with rural, indigenous Kumiai and with their primary health care providers in urban Ensenada. The author contends that barriers to care are…

Postsecondary Education Transition: A Summary of the Findings from Two Literature Reviews

ERIC Educational Resources Information Center

Office of Vocational and Adult Education, US Department of Education, 2010

2010-01-01

Some segments of the United States population, such as adults with low literacy skills and disadvantaged youths, face barriers in making the transition into and through postsecondary education, including community college and career training, and these barriers can keep them locked in low-wage jobs. Can transition assistance help them enter and…

Idiosyncratic Patterns of Representational Similarity in Prefrontal Cortex Predict Attentional Performance.

PubMed

Lee, Jeongmi; Geng, Joy J

2017-02-01

The efficiency of finding an object in a crowded environment depends largely on the similarity of nontargets to the search target. Models of attention theorize that the similarity is determined by representations stored within an "attentional template" held in working memory. However, the degree to which the contents of the attentional template are individually unique and where those idiosyncratic representations are encoded in the brain are unknown. We investigated this problem using representational similarity analysis of human fMRI data to measure the common and idiosyncratic representations of famous face morphs during an identity categorization task; data from the categorization task were then used to predict performance on a separate identity search task. We hypothesized that the idiosyncratic categorical representations of the continuous face morphs would predict their distractability when searching for each target identity. The results identified that patterns of activation in the lateral prefrontal cortex (LPFC) as well as in face-selective areas in the ventral temporal cortex were highly correlated with the patterns of behavioral categorization of face morphs and search performance that were common across subjects. However, the individually unique components of the categorization behavior were reliably decoded only in right LPFC. Moreover, the neural pattern in right LPFC successfully predicted idiosyncratic variability in search performance, such that reaction times were longer when distractors had a higher probability of being categorized as the target identity. These results suggest that the prefrontal cortex encodes individually unique components of categorical representations that are also present in attentional templates for target search. Everyone's perception of the world is uniquely shaped by personal experiences and preferences. Using functional MRI, we show that individual differences in the categorization of face morphs between two identities could be decoded from the prefrontal cortex and the ventral temporal cortex. Moreover, the individually unique representations in prefrontal cortex predicted idiosyncratic variability in attentional performance when looking for each identity in the "crowd" of another morphed face in a separate search task. Our results reveal that the representation of task-related information in prefrontal cortex is individually unique and preserved across categorization and search performance. This demonstrates the possibility of predicting individual behaviors across tasks with patterns of brain activity. Copyright © 2017 the authors 0270-6474/17/371257-12$15.00/0.

Socialization characteristics in persons with epilepsy.

PubMed

Myers, Lorna; Lancman, Marcelo; Laban-Grant, Olgica; Lancman, Martin; Jones, Jace

2017-07-01

The purpose of this report was to describe social behaviors and preferences in adults with epilepsy, including self-reported use of various socialization media (face-to-face and indirect communication) as well as perceived social barriers. 1320 consecutive persons with epilepsy (PWEs) confirmed through inpatient video-EEG monitoring were administered a questionnaire on the day of their first appointment. The questionnaire was designed to assess preferences in socialization practices, frequency of interpersonal contact, use of social media, and perceived barriers to socialization. The survey was developed to gain a better understanding of the socialization behaviors and preferences of our patients for the future development of customized activities in our wellness program. Our sample revealed higher rates of unemployment and single status as compared to the US Census of 2012. With regard socialization however, many were quite social (86% reported daily/weekly communication with friends and family via telephone, 71% saw relatives in person weekly, 68% saw friends weekly, and 65% reported using the computer daily/weekly to socialize). Facebook® was the preferred on-line social media. Indoor/solitary activities were most common with 63% stating they watch TV/read/use the computer followed by physical exercise and spending time outdoors (36%). The frequency of socialization with friends, relatives, and coworkers decreased with the respondents' age and the longer the respondent had carried the diagnosis of epilepsy. Respondents who were taking a greater number of AEDs or were considered refractory were less likely to consider participating in socialization-enhancing activities. The primary barriers to socialization that respondents endorsed were driving prohibition and medication side-effects. Respondents expressed the greatest interest in online support groups or educational programs (31%), office-based support groups (25%), and volunteering (19%). Although the respondents indicate that they do face barriers to socialization, a majority report frequent communication with relatives and friends via phone, in-person and social media. When designing wellness interventions with this group of patients in the future, online, as well as face to face options for support appear to be desired by a number of PWEs. Copyright © 2017 Elsevier Inc. All rights reserved.

Differential predictors of ART adherence among HIV-monoinfected versus HIV/HCV-coinfected individuals.

PubMed

Shuper, Paul A; Joharchi, Narges; Irving, Hyacinth; Fletcher, David; Kovacs, Colin; Loutfy, Mona; Walmsley, Sharon L; Wong, David K H; Rehm, Jürgen

2016-08-01

Although adherence is an important key to the efficacy of antiretroviral therapy (ART), many people living with HIV (PLWH) fail to maintain optimal levels of ART adherence over time. PLWH with the added burden of Hepatitis C virus (HCV) coinfection possess unique challenges that potentially impact their motivation and ability to adhere to ART. The present investigation sought to (1) compare ART adherence levels among a sample of HIV/HCV-coinfected versus HIV-monoinfected patients, and (2) identify whether ART-related clinical and psychosocial correlates differ by HCV status. PLWH receiving ART (N = 215: 105 HIV/HCV-coinfected, 110 HIV-monoinfected) completed a comprehensive survey assessing ART adherence and its potential correlates. Medical chart extraction identified clinical factors, including liver enzymes. Results demonstrated that ART adherence did not differ by HCV status, with 83.7% of coinfected patients and 82.4% of monoinfected patients reporting optimal (i.e., ≥95%) adherence during a four-day recall period (p = .809). Multivariable logistic regression demonstrated that regardless of HCV status, optimal ART adherence was associated with experiencing fewer adherence-related behavioral skills barriers (AOR = 0.56; 95%CI = 0.43-0.73), lower likelihood of problematic drinking (AOR = 0.15; 95%CI = 0.04-0.67), and lower likelihood of methamphetamine use (AOR = 0.14; 95%CI = 0.03-0.69). However, among HIV/HCV-coinfected patients, optimal adherence was additionally associated with experiencing fewer ART adherence-related motivational barriers (AOR = 0.23; 95%CI = 0.08-0.62) and lower likelihood of depression (AOR = 0.06; 95%CI = 0.00-0.84). Findings suggest that although HIV/HCV-coinfected patients may face additional, distinct barriers to ART adherence, levels of adherence commensurate with those demonstrated by HIV-monoinfected patients might be achievable if these barriers are addressed.

Barriers and Promoters to Participation in the Era of Shared Treatment Decision-Making.

PubMed

McCarter, Sarah P; Tariman, Joseph D; Spawn, Nadia; Mehmeti, Enisa; Bishop-Royse, Jessica; Garcia, Ima; Hartle, Lisa; Szubski, Katharine

2016-10-01

This study aimed to identify the barriers and promoters for participation in cancer treatment decision in the era of shared decision-making (SDM) process. A qualitative design was utilized. Nineteen nurses and 11 nurse practitioners from oncology inpatient and outpatient settings participated in semi-structured interviews. Data were analyzed using directed content analysis. The findings include practice barrier, patient barrier, institutional policy barrier, professional barrier, scope of practice barrier, insurance coverage barrier, and administrative barrier. Multidisciplinary team approach, having a nursing voice during SDM, high level of knowledge of the disease and treatment, and personal valuation of SDM participation were perceived as promoters. Oncology nurses and nurse practitioners face many barriers to their participation during SDM. Organizational support and system-wide culture of SDM are essential to achieve better cancer treatment decisions outcome. Additional studies are needed to determine the factors that can promote more participation among nurses and nurse practitioners. © The Author(s) 2016.

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.

Fruit and vegetable intake among older adults: a scoping review

PubMed Central

Kadell, Andria R.

2013-01-01

Older adults are the fastest growing segment of the world population. Older adults are also at heightened risk of chronic conditions (such as diabetes, heart disease, and cancer) and specific geriatric conditions (such as cognitive impairment, frailty, and falls). Research studies have examined the relationship between fruit and vegetable intake and subsequent health outcomes and the correlates of fruit and vegetable intake in the U.S. population. However, relatively few studies have specifically examined health impacts and correlates of fruit and vegetable intake among older adults, who have unique biophysical and socioeconomic circumstances. Evidence is reviewed to (1) describe findings related to consumption and chronic, geriatric, and other health outcomes among older adults and (2) describe patterns in fruit and vegetable consumption among older adults and how these patterns vary within and among populations. This review addresses specific barriers faced by older adults in obtaining and consuming fruits and vegetables in community settings. Recommendations for practice and policy are discussed. PMID:23769545

Cognitive Impairment, Alzheimer's Disease, and Other Dementias in the Lives of Lesbian, Gay, Bisexual and Transgender (LGBT) Older Adults and Their Caregivers: Needs and Competencies.

PubMed

Fredriksen-Goldsen, Karen I; Jen, Sarah; Bryan, Amanda E B; Goldsen, Jayn

2018-05-01

Cognitive impairment, Alzheimer's disease, and other dementias are important health concerns for older adults. As a marginalized and growing segment of the older adult population, lesbian, gay, bisexual, and transgender (LGBT) older adults face distinct risk factors related to cognitive impairment and dementias, including social isolation, discrimination, barriers to health care access, limited availability of and support for caregivers, and higher rates of certain chronic illnesses. We examine cognitive impairment and dementias among LGBT older adults, describe their unique risk factors, and outline key competencies for health care and human service providers to ensure culturally relevant care for LGBT older adults experiencing cognitive impairment, Alzheimer's disease, or other dementias, as well as their caregivers, families, and communities. Implications include developing an awareness of the context of LGBT older adults' lives and relationships, the importance of early detection and support, and the development of policies and practices that promote community-level advocacy and education.

Small-grants programs: lessons from community-based approaches to changing nutrition environments.

PubMed

Johnson, Donna B; Smith, Lynne T; Bruemmer, Barbara

2007-02-01

Providing small grants to community organizations can be an effective way to encourage changes in the environment that support better nutrition. This is effective because these organizations can provide insights into their communities, ready-made relationships with community members, and the trust of the community. Small-grants programs are more likely to be successful when they are tailored to the needs of individual communities, led by organizations that have established reputations with the community, fully supported by the lead community organization, and engage local partners that complement the skills and resources of the lead organization. An evaluation of a small-grants program, Grants for Healthy Youth, found that grantees developed unique approaches to improving their community nutrition environments, gained experience and skills in program development, built partnerships, and received recognition for their project work. Grantees faced some common barriers, especially with program evaluation. Small-grants programs can be an effective way to improve community nutrition environments, but granting agencies need to provide effective technical assistance to communities throughout the process.

Sampling bias in an international internet survey of diversion programs in the criminal justice system.

PubMed

Hartford, Kathleen; Carey, Robert; Mendonca, James

2007-03-01

Despite advances in the storage and retrieval of information within health care systems, health researchers conducting surveys for evaluations still face technical barriers that may lead to sampling bias. The authors describe their experience in administering a Web-based, international survey to English-speaking countries. Identifying the sample was a multistage effort involving (a) searching for published e-mail addresses, (b) conducting Web searches for publicly funded agencies, and (c) performing literature searches, personal contacts, and extensive Internet searches for individuals. After pretesting, the survey was converted into an electronic format accessible by multiple Web browsers. Sampling bias arose from (a) system incompatibility, which did not allow potential respondents to open the survey, (b) varying institutional gate-keeping policies that "recognized" the unsolicited survey as spam, (c) culturally unique program terminology, which confused some respondents, and (d) incomplete sampling frames. Solutions are offered to the first three problems, and the authors note that sampling bias remains a crucial problem.

Parent–Adolescent Communication About Sexual Pressure, Maternal Norms About Relationship Power, and STI/HIV Protective Behaviors of Minority Urban Girls

PubMed Central

Teitelman, Anne M.; Ratcliffe, Sarah J.; Cederbaum, Julie A.

2011-01-01

Racial/ethnic minority adolescent girls bear a disproportionate risk for HIV and face barriers to autonomous sexual decision making, but parental messages may help protect against sexual risk taking. The authors examined African American and Hispanic girls’ sexually transmitted infection (STI) and HIV prevention practices, parent–adolescent communication about sexual pressure, and maternal gender norms (N = 118). Teens were more likely to practice consistent STI/HIV prevention when mothers talked about partner sexual pressure (p = .017) and fathers talked about resisting partner sexual pressure (p = .034). Sexually active girls who perceived that their mothers held egalitarian beliefs about partner decision making had more consistent condom use (p = .029). Given the context of increased STI/HIV risk, it is critical that parents discuss partner dynamics with daughters. Nurses play a unique role in facilitating these conversations; they provide parents with age-appropriate resources and assist in normalizing fears, which can help increase parent–child sexual-risk communication. PMID:21672881

Cognitive Impairment, Alzheimer’s Disease, and Other Dementias in the Lives of Lesbian, Gay, Bisexual and Transgender (LGBT) Older Adults and Their Caregivers: Needs and Competencies

PubMed Central

Fredriksen-Goldsen, Karen I.; Jen, Sarah; Bryan, Amanda E. B.; Goldsen, Jayn

2017-01-01

Cognitive impairment, Alzheimer’s disease, and other dementias are important health concerns for older adults. As a marginalized and growing segment of the older adult population, lesbian, gay, bisexual, and transgender (LGBT) older adults face distinct risk factors related to cognitive impairment and dementias, including social isolation, discrimination, barriers to health care access, limited availability of and support for caregivers, and higher rates of certain chronic illnesses. We examine cognitive impairment and dementias among LGBT older adults, describe their unique risk factors, and outline key competencies for health care and human service providers to ensure culturally relevant care for LGBT older adults experiencing cognitive impairment, Alzheimer’s disease, or other dementias, as well as their caregivers, families, and communities. Implications include developing an awareness of the context of LGBT older adults’ lives and relationships, the importance of early detection and support, and the development of policies and practices that promote community-level advocacy and education. PMID:27729400

Ambulatory anesthesia for cosmetic surgery in Brazil.

PubMed

May, Diego Marcelo

2016-08-01

Outpatient plastic surgery is growing around the world. This industry faces unique challenges in terms of patient selection and standards of practice to ensure safety and cost-effectiveness. This review will highlight information about anesthesia practice for outpatient cosmetic surgery in Brazil, especially regarding regulation, legislation, and medical tourism. Medical tourism is growing worldwide, with a flow of patients traveling from developed to developing countries where procedures can be done at a fraction of the cost as in the patient's home country. Though generally well tolerated, there are concerns about incomplete data on outcomes of office-based surgeries and lack of safety standards. Brazil is one of the world's leaders in cosmetic surgery. Strong legislation governing outpatient facilities and continued development of accrediting standards for healthcare facilities are indications of a commitment to patient safety and high quality of care. Although the market for medical tourism in this country is high, there are still barriers to overcome before Brazil reaches its full potential in this industry.

The NxStage System One.

PubMed

Clark, William R; Turk, Joseph E

2004-01-01

Given the results of recent randomized controlled trials as well as staffing and budget challenges that today face many institutions across North America, a novel therapeutic approach is likely necessary to enable improvements in clinical outcomes for renal failure patients. The NxStage System One was developed to address these challenges. The system is an innovative, flexible device that delivers hemodialysis, hemofiltration, and/or ultrafiltration therapies to patients with renal failure or fluid overload. The unique characteristics of this system include a highly automated system design with a drop-in cartridge to facilitate training and simple operation; portable size and independence from dedicated infrastructure to minimize practical barriers to where therapy may be administered; use of high-quality premixed treatment fluids to enable capture of the potential clinical benefits of fluid purity without the hassles of local water treatment; and wide operating ranges to allow clinician flexibility in patient therapy prescriptions. In both the chronic and acute care environments, the System One presents clinicians with a new platform for delivering patient therapy improvements within real-world constraints.

LGBTQ+ Young Adults on the Street and on Campus: Identity as a Product of Social Context.

PubMed

Schmitz, Rachel M; Tyler, Kimberly A

2018-01-01

Lesbian, gay, bisexual, queer, and other sexual and gender minority (LGBTQ+) young adults face unique identity-related experiences based on their immersion in distinctive social contexts. The predominant framework of performing separate analyses on samples of LGBTQ+ young people by their primary social status obfuscates more holistic understandings of the role of social context. Using 46 in-depth interviews with LGBTQ+ college students and LGBTQ+ homeless young adults, we ask: How are LGBTQ+ young adults' capacities for "doing" their gender and sexual identities shaped by their distinctive social contexts? In developing their identities, both groups of LGBTQ+ young adults navigated their social environments to seek out resources and support. Most college students described their educational contexts as conducive to helping them develop their identities, or "undo" rigid norms of gender and sexuality. Homeless young adults' social environments, meanwhile, imposed complex barriers to self-expression that reinforced more normative expectations of "doing" gender and sexual identities.

Barriers faced by healthcare professionals when managing falls in older people in Kuala Lumpur, Malaysia: a qualitative study

PubMed Central

Loganathan, Annaletchumy; Ng, Chirk Jenn; Tan, Maw Pin; Low, Wah Yun

2015-01-01

Objective To explore the barriers faced by healthcare professionals (HCPs) in managing falls among older people (aged above 60 years) who have a high risk of falling. Research design The study used a qualitative methodology, comprising 10 in-depth interviews and two focus group discussions. A semistructured topic guide was used to facilitate the interviews, which were audio recorded, transcribed verbatim and checked for accuracy. Data were analysed thematically using WeftQDA software. Participants 20 HCPs who managed falls in older people. Setting This study was conducted at the Primary Care Clinic in the University Malaya Medical Centre (UMMC), Malaysia. Results Four categories of barriers emerged—these were related to perceived barriers for older people, HCPs’ barriers, lack of caregiver support and healthcare system barriers. HCPs perceived that older people normalised falls, felt stigmatised, were fatalistic, as well as in denial regarding falls-related advice. HCPs themselves trivialised falls and lacked the skills to manage falls. Rehabilitation was impeded by premature decisions to admit older people to nursing homes. Lastly, there was a lack of healthcare providers as well as a dearth of fall education and training on fall prevention for HCPs. Conclusions This study identified barriers that explain poor fall management in older people with a high risk of falls. The lack of structured fall prevention guidelines and insufficient training in fall management made HCPs unable to advise patients on how to prevent falls. The findings of this study warrant evidence-based structured fall prevention intervention targeted to patients as well as to HCPs. PMID:26546140

Small Wastewater Systems Research

EPA Pesticide Factsheets

Small communities face barriers to building and maintaining effective wastewater treatment services, challenges include financial/economic limitations, lack of managerial training and geographic isolation/remoteness.

Access 3 project protocol: young people and health system navigation in the digital age: a multifaceted, mixed methods study

PubMed Central

Kang, Melissa; Robards, Fiona; Sanci, Lena; Steinbeck, Katharine; Jan, Stephen; Hawke, Catherine; Kong, Marlene; Usherwood, Tim

2017-01-01

Background The integration of digital technology into everyday lives of young people has become widespread. It is not known whether and how technology influences barriers and facilitators to healthcare, and whether and how young people navigate between face-to-face and virtual healthcare. To provide new knowledge essential to policy and practice, we designed a study that would explore health system access and navigation in the digital age. The study objectives are to: (1) describe experiences of young people accessing and navigating the health system in New South Wales (NSW), Australia; (2) identify barriers and facilitators to healthcare for young people and how these vary between groups; (3) describe health system inefficiencies, particularly for young people who are marginalised; (4) provide policy-relevant knowledge translation of the research data. Methods and analysis This mixed methods study has four parts, including: (1) a cross-sectional survey of young people (12–24 years) residing in NSW, Australia; (2) a longitudinal, qualitative study of a subsample of marginalised young people (defined as young people who: identify as Aboriginal and/or Torres Strait Islander; are experiencing homelessness; identify as sexuality and/or gender diverse; are of refugee or vulnerable migrant background; and/or live in rural or remote NSW); (3) interviews with professionals; (4) a knowledge translation forum. Ethics and dissemination Ethics approvals were sought and granted. Data collection commenced in March 2016 and will continue until June 2017. This study will gather practice and policy-relevant intelligence about contemporary experiences of young people and health services, with a unique focus on five different groups of marginalised young people, documenting their experiences over time. Access 3 will explore navigation around all levels of the health system, determine whether digital technology is integrated into this, and if so how, and will translate findings into policy-relevant recommendations. PMID:28790044

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

Cheng, Liwen, E-mail: lwcheng@yzu.edu.cn; Wu, Shudong; Xia, Changquan

In this work, graded barrier InGaN light-emitting diodes with increasing indium composition barriers are proposed and investigated numerically. When the conventional GaN barriers are replaced by this unique graded InGaN barrier design, the forward voltage at 100 mA is reduced from 3.32 V to 3.27 V, and the efficiency droop is improved from 46.6% to 7.5%. The simulation results observed in this work indicate that these improvements can be attributed to increased electron confinement and enhanced hole injection efficiency caused by the modified energy band diagram.

Barriers to HIV testing among male clients of female sex workers in Indonesia.

PubMed

Fauk, Nelsensius Klau; Sukmawati, Anastasia Suci; Berek, Pius Almindu Leki; Ernawati; Kristanti, Elisabeth; Wardojo, Sri Sunaringsih Ika; Cahaya, Isaias Budi; Mwanri, Lillian

2018-05-30

Frequent engagement of men in sexual encounters with female sex workers (FSWs) without using condoms places them at a high risk for HIV infection. HIV testing has been noted to be among important strategies to prevent HIV transmission and acquisition. However, it is known that not all men willingly undertake an HIV test as a way to prevent HIV transmission and/or acquisition. This study aimed to identify barriers to accessing HIV testing services among men who are clients of FSWs (clients) in Belu and Malaka districts, Indonesia. A qualitative inquiry employing face to face open ended interviews was conducted from January to April 2017. The participants (n = 42) were clients of FSWs recruited using purposive and snowball sampling techniques. Data were analysed using a qualitative data analysis framework. Findings indicated three main barriers of accessing HIV testing services by clients. These included: (1) personal barriers (lack of knowledge of HIV/AIDS and HIV testing availability, and unwillingness to undergo HIV testing due to low self-perceived risk of HIV and fear of the test result); (2) health care service provision barriers (lack of trust in health professionals and limited availability of medication including antiretroviral (ARV)); and (3) social barriers (stigma and discrimination, and the lack of social supports). These findings indicated multilevelled barriers to accessing HIV testing services among participants, who are known to be among key population groups in HIV care. Actions to improve HIV/AIDS-related health services accessibility are required. The dissemination of the knowledge and information on HIV/AIDS and improved available of HIV/AIDS-related services are necessary actions to improve the personal levelled barriers. System wide barriers will need improved practices and health policies to provide patients friendly and accessible services. The societal levelled barriers will need a more broad societal approach including raising awareness in the community and enhanced discussions about HIV/AIDS issues in order to normalise HIV in the society.

Intercultural Communication Barriers and Management Education in Developing Nations: Problems and Prospects.

ERIC Educational Resources Information Center

Abraham, Yohannan T.; Cunningham, William K.

Education and training of management personnel in developing nations have been patterned after the American system. Unfortunately, efforts at transplanting such knowledge has neglected the cultural nuances unique to the various nations, resulting in incomplete success. Intercultural communication barriers can be posed by such cultural features as…

Vocal Fold Epithelial Barrier in Health and Injury: A Research Review

ERIC Educational Resources Information Center

Levendoski, Elizabeth Erickson; Leydon, Ciara; Thibeault, Susan L.

2014-01-01

Purpose: Vocal fold epithelium is composed of layers of individual epithelial cells joined by junctional complexes constituting a unique interface with the external environment. This barrier provides structural stability to the vocal folds and protects underlying connective tissue from injury while being nearly continuously exposed to potentially…

Reconsidering racial/ethnic differences in sterilization in the United States.

PubMed

White, Kari; Potter, Joseph E

2014-06-01

Cross-sectional studies have found that low-income and racial/ethnic minority women are more likely to use female sterilization and less likely to rely on a partner's vasectomy than women with higher incomes and whites. However, studies of pregnant and postpartum women report that racial/ethnic minorities, particularly low-income minority women, face greater barriers in obtaining a sterilization than do whites and those with higher incomes. In this paper, we address this apparent contradiction by examining the likelihood a woman gets a sterilization following each delivery, which removes from the comparison any difference in the number of births she has experienced. Using the 2006-2010 National Survey of Family Growth, we fit multivariable-adjusted logistic and Cox regression models to estimate odds ratios and hazard ratios for getting a postpartum or interval sterilization, respectively, according to race/ethnicity and insurance status. Women's chances of obtaining a sterilization varied by both race/ethnicity and insurance. Among women with Medicaid, whites were more likely to use female sterilization than African Americans and Latinas. Privately insured whites were more likely to rely on vasectomy than African Americans and Latinas, but among women with Medicaid-paid deliveries reliance on vasectomy was low for all racial/ethnic groups. Low-income racial/ethnic minority women are less likely to undergo sterilization following delivery compared to low-income whites and privately insured women of similar parities. This could result from unique barriers to obtaining permanent contraception and could expose women to the risk of future unintended pregnancies. Low-income minorities are less likely to undergo sterilization than low-income whites and privately insured minorities, which may result from barriers to obtaining permanent contraception, and exposes women to unintended pregnancies. Copyright © 2014 Elsevier Inc. All rights reserved.

Rural Doctors' Views on and Experiences with Evidence-Based Medicine: The FrEEDoM Qualitative Study.

PubMed

Hisham, Ranita; Liew, Su May; Ng, Chirk Jenn; Mohd Nor, Kamaliah; Osman, Iskandar Firzada; Ho, Gah Juan; Hamzah, Nurazira; Glasziou, Paul

2016-01-01

Evidence-based medicine is the integration of individual clinical expertise, best external evidence and patient values which was introduced more than two decades ago. Yet, primary care physicians in Malaysia face unique barriers in accessing scientific literature and applying it to their clinical practice. This study aimed to explore the views and experiences of rural doctors' about evidence-based medicine in their daily clinical practice in a rural primary care setting. Qualitative methodology was used. The interviews were conducted in June 2013 in two rural health clinics in Malaysia. The participants were recruited using purposive sampling. Four focus group discussions with 15 medical officers and three individual in-depth interviews with family medicine specialists were carried out. All interviews were conducted using a topic guide and were audio-recorded, transcribed verbatim, checked and analyzed using a thematic approach. Key themes identified were: (1) doctors viewed evidence-based medicine mainly as statistics, research and guidelines, (2) reactions to evidence-based medicine were largely negative, (3) doctors relied on specialists, peers, guidelines and non-evidence based internet sources for information, (4) information sources were accessed using novel methods such as mobile applications and (5) there are several barriers to evidence-based practice, including doctor-, evidence-based medicine-, patient- and system-related factors. These included inadequacies in knowledge, attitude, management support, time and access to evidence-based information sources. Participants recommended the use of online services to support evidence-based practice in the rural settings. The level of evidence-based practice is low in the rural setting due to poor awareness, knowledge, attitude and resources. Doctors use non-evidence based sources and access them through new methods such as messaging applications. Further research is recommended to develop and evaluate interventions to overcome the identified barriers.

Barriers to gender-equitable HIV testing: going beyond routine screening for pregnant women in Nova Scotia, Canada.

PubMed

Gahagan, Jacqueline C; Fuller, Janice L; Proctor-Simms, E Michelle; Hatchette, Todd F; Baxter, Larry N

2011-05-11

Women and men face different gender-based health inequities in relation to HIV, including HIV testing as well as different challenges in accessing HIV care, treatment and support programs and services when testing HIV-positive. In this article, we discuss the findings of a mixed methods study exploring the various individual and structural barriers and facilitators to HIV counselling and testing experienced among a sample of adult women and men living in Nova Scotia, Canada. Drawing from testing demographics, qualitative interview data and a review of existing testing policies and research, this paper focuses on understanding the gendered health inequities and their implications for HIV testing rates and behaviours in Nova Scotia. The findings of this research serve as the basis to further our understanding of gender as a key determinant of health in relation to HIV testing. Recognizing gender as a key determinant of health in terms of both vulnerability to HIV and access to testing, this paper explores how gender intersects with health equity issues such as access to HIV testing, stigma and discrimination, and sexual behaviours and relationships. Drawing on the current gender and HIV literatures, in conjunction with our data, we argue that an enhanced, gender-based, context-dependent approach to HIV counselling and testing service provision is required in order to address the health equity needs of diverse groups of women and men living in various settings. Further, we argue that enhanced HIV testing efforts must be inclusive of both men and women, addressing uniquely gendered barriers to accessing HIV counselling and testing services and in the process moving beyond routine HIV testing for pregnant women.

Issues in access to safe drinking water and basic hygiene for persons with physical disabilities in rural Cambodia.

PubMed

MacLeod, Marin; Pann, Mala; Cantwell, Ray; Moore, Spencer

2014-12-01

An estimated 1.6 million people die from diarrheal diseases each year due to lack of access to safe water and sanitation, and persons with physical disabilities face additional barriers. In Cambodia, approximately 5% of the population is disabled, presenting substantial obstacles in accessing these basic services. The purpose of this study was twofold: first, to identify the challenges facing persons with physical disabilities in accessing safe household water and basic hygiene in rural Cambodia; and, second, to use these results to generate policy and practice recommendations for the water and sanitation hygiene sector implementing water treatment system interventions in rural settings. Fifteen field interviews were conducted with persons with physical disabilities. Thematic analysis was used to identify six main themes. The results indicated that environmental barriers to access were greater in the workplace than household settings and those persons with disabilities had greater awareness about safe drinking water compared to basic hygiene. Additionally, lack of physical strength, distance to water, and lack of financial means were noted as common access barriers. The findings support ongoing research and offer insight into the particular challenges facing persons with physical disabilities in rural areas in accessing safe drinking water and basic hygiene.

"I'll look it up on the Web first": Barriers and overcoming barriers to consult for sexual dysfunction among young men.

PubMed

Akre, Christina; Michaud, Pierre-André; Suris, Joan-Carles

2010-06-12

Our aim was to identify the barriers young men face to consult a health professional when they encounter sexual dysfunctions and where they turn to, if so, for answers. We conducted an exploratory qualitative research including 12 young men aged 16-20 years old seen in two focus groups. Discussions were triggered through vignettes about sexual dysfunction. Young men preferred not to talk about sexual dysfunction problems with anyone and to solve them alone as it is considered an intimate and embarrassing subject which can negatively impact their masculinity. Confidentiality appeared to be the most important criterion in disclosing an intimate subject to a health professional. Participants raised the problem of males' accessibility to services and lack of reason to consult. Two criteria to address the problem were if it was long-lasting or considered as physical. The Internet was unanimously considered as an initial solution to solve a problem, which could guide them to a face-to-face consultation if necessary. Results suggest that Internet-based tools should be developed to become an easy access door to sexual health services for young men. Wherever they consult and for whatever problem, sexual health must be on the agenda.

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

ERIC Educational Resources Information Center

Romerhausen, Nick J.

2013-01-01

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

The Student Homelessness Crisis and the Role of School Psychology: Missed Opportunities, Room for Improvement, and Future Directions

ERIC Educational Resources Information Center

Sulkowski, Michael L.

2016-01-01

Affecting more than 1 million youth, student homelessness is growing at an unprecedented rate in the United States. This is alarming because homeless students face significant barriers to their academic success and positive life outcomes. Unfortunately, despite the significant risks and challenges they face, homeless students often are overlooked…

Inclusion of Students with Disabilities in South African Higher Education

ERIC Educational Resources Information Center

Mutanga, Oliver

2018-01-01

Globally, few students with disabilities progress to higher education. This is mostly due to avoidable barriers they face as they navigate different educational structures from lower levels. Even for those few students who make it to higher education, they continue to face challenges. A qualitative study was carried out at the University of the…

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

ERIC Educational Resources Information Center

Nix, J. Vincent; Michalak, Megan B.

2012-01-01

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

Predictors of Teacher Satisfaction with Online Professional Development: Evidence from the USA's e-Learning for Educators Initiative

ERIC Educational Resources Information Center

Reeves, Todd D.; Pedulla, Joseph J.

2011-01-01

Online professional development (OPD) is proliferating in an effort to eliminate barriers to high-quality in-service teacher training. Using the Internet as a vehicle for continuing professional development, however, introduces new concerns largely absent in its face-to-face counterpart. For example, evidence from the USA's e-Learning for…

Challenges of Adopting the Use of Technology in Less Developed Countries: The Case of Cambodia

ERIC Educational Resources Information Center

Richardson, Jayson W.

2011-01-01

Drawing on Everett Rogers's theory of the diffusion of innovations, this article identifies the barriers, challenges, and successes in the adoption of technology training by teacher trainers in Cambodia. The analysis was based on data collected from an open-ended survey, face-to-face interviews, and document analysis. Findings reveal that the…

Single Black Working Mothers' Perceptions: The Journey to Achieve Leadership Positions

ERIC Educational Resources Information Center

Raglin, Sherrell

2017-01-01

Single Black working mothers faced significant challenges in achieving high-level or senior-level leadership positions. The purpose of this qualitative narrative study was to collect, analyze and code the stories told by 10 participants to understand the perceptions and insights of the challenges and barriers single Black working mothers faced in…

Advocacy Week: A Model to Prepare Clinical Social Workers for Lobby Day

ERIC Educational Resources Information Center

Kilbane, Teresa; Pryce, Julia; Hong, Philip Young P.

2013-01-01

Legislative advocacy is an important and long-standing skill in social work. However, this role cannot be left solely to social workers who specialize in macro and policy practice. Rather, clinical social workers who assist clients as they face "private" troubles (Mills, 1959) also need to face the structural barriers that contribute to…

Effective e-learning for health professionals and students--barriers and their solutions. A systematic review of the literature--findings from the HeXL project.

PubMed

Childs, Sue; Blenkinsopp, Elizabeth; Hall, Amanda; Walton, Graham

2005-12-01

In 2003/4 the Information Management Research Institute, Northumbria University, conducted a research project to identify the barriers to e-learning for health professionals and students. The project also established possible ways to overcome these barriers. The North of England Workforce Development Confederation funded the project. The project comprised a systematic review of the literature on barriers to and solutions/critical success factors for e-learning in the health field. Fifty-seven references were suitable for analysis. This review was supplemented by a questionnaire survey of learners and an interview study of learning providers to ensure that data identified from the literature were grounded in reality. The main barriers are: requirement for change; costs; poorly designed packages; inadequate technology; lack of skills; need for a component of face-to-face teaching; time intensive nature of e-learning; computer anxiety. A range of solutions can solve these barriers. The main solutions are: standardization; strategies; funding; integration of e-learning into the curriculum; blended teaching; user friendly packages; access to technology; skills training; support; employers paying e-learning costs; dedicated work time for e-learning. The authors argue that librarians can play an important role in e-learning: providing support and support materials; teaching information skills; managing and providing access to online information resources; producing their own e-learning packages; assisting in the development of other packages.

Radiation Insulation

NASA Technical Reports Server (NTRS)

1993-01-01

An aluminized polymer film is a highly effective radiation barrier for both manned and unmanned spacecraft. Variations of this space-devised material are also used as an energy conservation technique for homes and offices. One commercial company, Tech 2000 (formerly Buckeye Radiant Barrier), markets 'Super R' Radiant Barrier, which finds its origins in the Apollo Mission programs. The material is placed between wall studs and exterior facing before siding or in new roof installation, between roof support and roof sheathing. Successful retrofit installations have included schools and shrink wrap ovens. The radiant barrier blocks 95 percent of radiant energy, thus retaining summer heat and blocking winter cold. Suppliers claim utility bill reductions of 20 percent or more.

An Action Research Study of Barriers to Differentiated Instruction in Reading for Georgia Middle School Students in the Inclusive Classroom

ERIC Educational Resources Information Center

Boston, Alicia

2017-01-01

The purpose of this qualitative action research study was to explore middle school inclusion teacher perceptions to overcome barriers to successful DI implementation in reading for students with special needs. Inclusion reading teachers are faced with the challenge of providing classroom instruction to students with varying abilities, levels, and…

Career Counseling as an Environmental Support: Exploring Influences on Career Choice, Career Decision-Making Self-Efficacy, and Career Barriers

ERIC Educational Resources Information Center

Makela, Julia Panke

2011-01-01

This study was motivated by concerns regarding the difficult academic and career choices facing today's college students as they navigate higher education and encounter career barriers along their paths. Using Social Cognitive Career Theory (SCCT; Lent, Brown, & Hackett, 1994) as a primary framework, the study sought to understand the role that…

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

ERIC Educational Resources Information Center

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

2007-01-01

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

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…

Oral Health Knowledge, Past Oral Health Behaviors, and Barriers to Preventive Oral Care of Head Start Parents

ERIC Educational Resources Information Center

Knowlden, Adam P.; Hill, Lawrence F.; Alles-White, Monica L.; Cottrell, Randall R.

2012-01-01

Tooth decay remains the most common chronic disease of childhood. The CincySmiles Foundation (CSF) developed an instrument to evaluate Head Start parents' knowledge of oral health care practices and to identify barriers Head Start parents face when seeking dental treatment for their children. Data from Head Start parents (n = 675) across 3…

Lowering the Cost Barrier to Higher Education for Undocumented Students: A Promising University-Level Intervention

ERIC Educational Resources Information Center

Thangasamy, Andrew; Horan, Deborah

2016-01-01

Undocumented students, many of Hispanic origin, face among the strictest cost barriers to higher education in the United States. Lack of legal status excludes them from most state and all federal financial aid programs. Furthermore, most states require them to pay out-of-state tuition rates at publicly supported institutions. In a new direction,…

Girls Getting to Secondary School Safely: Combating Gender-Based Violence in the Transportation Sector in Tanzania

ERIC Educational Resources Information Center

Mack, Laura

2009-01-01

While increasing girls' access to education is a global priority, there are numerous barriers that impede significant progress in achieving gender parity in schools. While enrollment of girl students is up in Tanzania, especially at the primary and secondary levels, AED has become concerned about the barriers girls face, including gender-based…

Insights into the Experiences of Older Workers and Change: Through the Lens of Selection, Optimization, and Compensation

ERIC Educational Resources Information Center

Unson, Christine; Richardson, Margaret

2013-01-01

Purpose: The study examined the barriers faced, the goals selected, and the optimization and compensation strategies of older workers in relation to career change. Method: Thirty open-ended interviews, 12 in the United States and 18 in New Zealand, were conducted, recorded, transcribed verbatim, and analyzed for themes. Results: Barriers to…

Beginning to Understand Why New Hampshire's Rural Educators Chose Not to Join New Hampshire's Newly Developed On-Line Professional Learning Communities: A Quantitative and Qualitative Study

ERIC Educational Resources Information Center

Baker, Cheryl B.

2011-01-01

Rural educators face many barriers when trying to participate in high quality professional development, including isolation, funding issues, distance, and lack of temporary replacements. Technological solutions can assist rural educators in overcoming these barriers. Participating in on-line professional learning communities can provide New…

Barriers and Opportunities: Helping Smaller Immigrant Communities Access the Illinois Preschool for All Program. Summary Findings from Three Studies

ERIC Educational Resources Information Center

Adams, Gina; McDaniel, Marla

2012-01-01

State prekindergarten initiatives can only succeed if they actually reach at-risk children. This brief summarizes findings from three studies conducted by the Urban Institute. Two studies supported by the McCormick and Joyce Foundations focused on whether smaller immigrant communities in metro Chicago face access barriers to enrolling their…

Breaking Down Cultural Barriers to Military Entry into Higher Education

ERIC Educational Resources Information Center

Hollis, Michael J.

2009-01-01

The purpose of this paper was to identify a problem in higher education that needed a new solution and draft a viable proposal for how to resolve it. I chose the problem of cultural barriers that veterans often face when attempting to return to many universities following military service. The method used was a combination of existing literature…

Female and Male Juvenile Offenders with Disabilities: Differences in the Barriers to Their Transition to the Community

ERIC Educational Resources Information Center

Unruh, Deanne; Bullis, Michael

2005-01-01

This article examined differences between young women and men who were incarcerated juvenile offenders with disabilities in Oregon in terms of the barriers they faced in their transition from the correctional system back into the community. Data were gathered on 72 females and 276 males, all of whom presented disabilities and who were…

Barriers to women engaging in collective action to overcome sexism.

PubMed

Radke, Helena R M; Hornsey, Matthew J; Barlow, Fiona Kate

2016-12-01

Over centuries women have fought hard to obtain increasing gender equality, but despite these successes absolute equality remains an elusive goal. Theoretically, women's numerical strength makes them well-placed to take effective collective action, and millions of women engage in feminist collective action every day. In this article, however, we argue that women also face barriers to engaging in feminist collective action; barriers that are associated with the social construction and experience of what it means to be a woman. Our review synthesizes sexism research under a contemporary collective action framework to clarify our current understanding of the literature and to offer novel theoretical explanations for why women might be discouraged from engaging in feminist collective action. Using the antecedents of collective action identified by van Zomeren, Postmes, and Spears' (2008) meta-analysis, we critically review the sexism literature to argue that women face challenges when it comes to (a) identifying with other women and feminists, (b) perceiving sexism and expressing group-based anger, and (c) recognizing the efficacy of collective action. We then outline a research agenda with a view to investigating ways of overcoming these barriers. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Understanding Barriers for Communicating Injury Prevention Messages and Strategies Moving Forward: Perspectives from Community Stakeholders.

PubMed

Mack, Diane E; Aymar, Matt; Cosby, Jarold; Wilson, Philip M; Bradley, Christina; Walters Gray, Casey

2016-01-01

The primary objective of this study was to elicit the perspectives of direct care providers on barriers and facilitators to communicating injury prevention messages to parents/caregivers of children under 4 years of age. The secondary objective was to examine characteristics of an injury prevention messaging strategy preferred by direct care providers. This qualitative study was conducted across four regions in Ontario Canada. Fifty-nine direct care providers were purposefully sampled and data interpreted using focus group analysis. Transcripts were analyzed verbatim using content and discourse analysis. Several barriers to communicating injury prevention messages were identified encompassing (a) role, (b) parental, (c) social determinants, and (d) evidence impediments. In an effort to offset some of these barriers, participants endorsed the development of a tailored multicomponent injury prevention strategy adopting action-based messages. The results of this study provide an in-depth exploration of direct care providers perceptions that can inform the design of materials and dissemination strategies to help increase and optimize access to injury prevention information. Injury prevention messages should be action-oriented, specifically tailored to the stage of child development, and disseminated through both face-to-face interactions and mobile technology. © 2015 Wiley Periodicals, Inc.

Barriers to health service access among female migrant Ugandan sex workers in Guangzhou, China.

PubMed

Davis, Alissa; Meyerson, Beth E; Aghaulor, Blessing; Brown, Katherine; Watson, Adisyn; Muessig, Kathryn E; Yang, Ligang; Tucker, Joseph D

2016-10-14

Increased trade between China and Uganda has fueled trafficking of female Ugandans into China. These women may face challenges accessing health services. This study focused on examining barriers to health care access among female Ugandan sex workers in China. In 2014, we undertook in-depth interviews with 19 female Ugandan sex workers in Guangzhou, China. Interviews focused on barriers to health service access and were analyzed using an a priori coding framework followed by open-coding to capture emergent themes. Out of 19 women, 12 women reported a history of being trafficked into China. None of the women had a valid Chinese visa. Fear of being arrested for lack of documentation discouraged women in this sample from accessing hospital services. Low pay, housing exploitation, and remittances contributed to participants' lack of financial resources, which further inhibited their ability to access health services. Participants expressed feeling social isolation from the local community and reported mistrust of local individuals and organizations, including hospitals. Ugandan sex workers in China faced substantial structural barriers that limited health service access. Policy changes and the development of new programs are urgently needed to ensure these women have improved access to health services.

A novel continuous colour mapping approach for visualization of facial skin hydration and transepidermal water loss for four ethnic groups.

PubMed

Voegeli, R; Rawlings, A V; Seroul, P; Summers, B

2015-12-01

The aim of this exploratory study was to develop a novel colour mapping approach to visualize and interpret the complexity of facial skin hydration and barrier properties of four ethnic groups (Caucasians, Indians, Chinese and Black Africans) living in Pretoria, South Africa. We measured transepidermal water loss (TEWL) and skin capacitance on 30 pre-defined sites on the forehead, cheek, jaw and eye areas of sixteen women (four per ethnic group) and took digital images of their faces. Continuous colour maps were generated by interpolating between each measured value and superimposing the values on the digital images. The complexity of facial skin hydration and skin barrier properties is revealed by these measurements and visualized by the continuous colour maps of the digital images. Overall, the Caucasian subjects had the better barrier properties followed by the Black African subjects, Chinese subjects and Indian subjects. Nevertheless, the two more darkly pigmented ethnic groups had superior skin hydration properties. Subtle differences were seen when examining the different facial sites. There exists remarkable skin capacitance and TEWL gradients within short distances on selected areas of the face. These gradients are distinctive in the different ethnic groups. In contrast to other reports, we found that darkly pigmented skin does not always have a superior barrier function and differences in skin hydration values are complex on the different parts of the face among the different ethnic groups. © 2015 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

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

PubMed

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

2016-08-01

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

Facing the Maze: Young Cancer Survivors' Return to Education and Work-A Professional Expert Key Informant Study.

PubMed

Pedersen, Kaspar Jessen; Boisen, Kirsten Arntz; Midtgaard, Julie; Elsbernd, Abbey; Larsen, Hanne Baekgaard

2018-03-13

An insufficient transition to normal life after cancer treatment in adolescent and young adults (AYAs) may lead to decreased occupational and educational opportunities throughout a survivor's lifespan. Key informant interviews were used to access unique knowledge of the healthcare, educational, and social systems. We used key informant interviews with professionals representing disciplines from healthcare, educational, and social systems (n = 15). Informants were recruited through purposive sampling and snowball sampling. Interviews were analyzed thematically using Malterud's Systematic Text Condensation and verified by member checking. We found four major themes: the impact of late effects, navigating the system, social reintegration, and the drive of youth. Although legal frameworks are often in place to assist AYA cancer survivors, navigating the public, educational, and social systems is a complex task and many AYAs do not have the required skill set or energy. Furthermore, AYA survivors often feel different from their peers and misunderstood by their surroundings, which may hinder reintegration into normal social life. In Scandinavia, healthcare and education are free of charge with equal access for all, primarily funded by government taxes. Therefore, insurance status and tuition fees should not constitute barriers for returning to education and work. However, this study finds that the public and educational systems are complex to navigate, and that AYAs face trouble mobilizing the energy to receive needed support.

Sustaining Scientist-Community Partnerships that are Just, Equitable, and Trustworthy

NASA Astrophysics Data System (ADS)

Sheats, N.

2016-12-01

Communities of color, indigenous people, and low income communities throughout the United States are on the front lines of environmental and health impacts from polluting sources, and yet don't fully benefit from public policies that are intended to reduce or prevent those impacts. Many of the challenges faced by environmental justice communities can and should be addressed, in part, through science-based public policies. Community-relevant scientific information and equal access to this information is needed to protect people from public health and environmental hazards. Too often, however, the scientific community has failed to work collaboratively with environmental justice communities. This session will explore the challenges and opportunities faced by environmental justice advocates and scientists in working with one another. This talk will share findings from a recently-held forum, specifically discussing a formal set of principles and best practices for community-scientist partnerships to guide future collaborations between scientists and communities. When community members and scientists collaborate, they bring together unique strengths and types of knowledge that can help address our most pressing challenges, inform decision making, and develop solutions that benefit all people. The speaker will address institutional and historic barriers that hinder such collaboration, potential pitfalls to avoid, and share how institutional systems of scientific research can incorporate equity analyses into their work to ensure solutions that are truly effective.

Face Time: Educating Face Transplant Candidates

PubMed Central

Lamparello, Brooke M.; Bueno, Ericka M.; Diaz-Siso, Jesus Rodrigo; Sisk, Geoffroy C.; Pomahac, Bohdan

2013-01-01

Objective: Face transplantation is the innovative application of microsurgery and immunology to restore appearance and function to those with severe facial disfigurements. Our group aims to establish a multidisciplinary education program that can facilitate informed consent and build a strong knowledge base in patients to enhance adherence to medication regimes, recovery, and quality of life. Methods: We analyzed handbooks from our institution's solid organ transplant programs to identify topics applicable to face transplant patients. The team identified unique features of face transplantation that warrant comprehensive patient education. Results: We created a 181-page handbook to provide subjects interested in pursuing transplantation with a written source of information on the process and team members and to address concerns they may have. While the handbook covers a wide range of topics, it is easy to understand and visually appealing. Conclusions: Face transplantation has many unique aspects that must be relayed to the patients pursuing this novel therapy. Since candidates lack third-party support groups and programs, the transplant team must provide an extensive educational component to enhance this complex process. Practice Implications: As face transplantation continues to develop, programs must create sound education programs that address patients’ needs and concerns to facilitate optimal care. PMID:23861990

Face time: educating face transplant candidates.

PubMed

Lamparello, Brooke M; Bueno, Ericka M; Diaz-Siso, Jesus Rodrigo; Sisk, Geoffroy C; Pomahac, Bohdan

2013-01-01

Face transplantation is the innovative application of microsurgery and immunology to restore appearance and function to those with severe facial disfigurements. Our group aims to establish a multidisciplinary education program that can facilitate informed consent and build a strong knowledge base in patients to enhance adherence to medication regimes, recovery, and quality of life. We analyzed handbooks from our institution's solid organ transplant programs to identify topics applicable to face transplant patients. The team identified unique features of face transplantation that warrant comprehensive patient education. We created a 181-page handbook to provide subjects interested in pursuing transplantation with a written source of information on the process and team members and to address concerns they may have. While the handbook covers a wide range of topics, it is easy to understand and visually appealing. Face transplantation has many unique aspects that must be relayed to the patients pursuing this novel therapy. Since candidates lack third-party support groups and programs, the transplant team must provide an extensive educational component to enhance this complex process. As face transplantation continues to develop, programs must create sound education programs that address patients' needs and concerns to facilitate optimal care.

Determination of Urea Permeability in Red Cells by Minimum Method

PubMed Central

Sha'afi, R. I.; Rich, G. T.; Mikulecky, D. C.; Solomon, A. K.

1970-01-01

A new method has been developed for measuring the permeability coefficient, ω, of small nonelectrolytes. The method depends upon a mathematical analysis of the time course of cell volume changes in the neighborhood of the minimum volume following addition of a permeating solute to an isosmolal buffer. Coefficients determined by the minimum volume method agree with those obtained using radioactive tracers. ω for urea in human red cells was found to decrease as the volume flow, Jv, into the cell increased. Such behavior is entirely unexpected for a single uniform rate-limiting barrier on the basis of the linear phenomenological equations derived from irreversible thermodynamics. However, the present findings are consonant with a complex membrane system consisting of a tight barrier on the outer face of the human red cell membrane and a somewhat less restrictive barrier behind it closer to the inner membrane face. A theoretical analysis of such a series model has been made which makes predictions consistent with the experimental findings. PMID:5435779

Barriers and Opportunities to Advancing Women in Leadership Roles in Vector Control: Perspectives from a Stakeholder Survey.

PubMed

Hayden, Mary H; Barrett, Erika; Bernard, Guyah; Toko, Eunice N; Agawo, Maurice; Okello, Amanda M; Gunn, Jayleen K L; Ernst, Kacey C

2018-05-01

Increasing the active participation of professional women in vector control (VC) activities may help promote greater gender equity in the workplace and reduce the burden of vector-borne diseases. This stakeholder survey examined the current roles and perspective of professionals employed in the VC sector in Kenya, Indonesia, India, and other countries. The largest barriers that women face in pursuing leadership roles in the VC sector include lack of awareness of career opportunities, limitations based on cultural norms, and the belief that VC is men's work. These barriers could be addressed through improving education and recruitment campaigns, as well as supporting higher education and mentoring programs. Females were almost six times more likely to be encouraged to pursue leadership positions in their organization compared with male respondents (odds ratio = 5.9, P > 0.03, 95% confidence interval: 1.19, 29.42). These findings suggest that once women are recruited into the VC workforce, they face minimal discrimination and have increased leadership opportunities.

Barriers to self-care in women of reproductive age with HIV/AIDS in Iran: a qualitative study.

PubMed

Oskouie, Fatemeh; Kashefi, Farzaneh; Rafii, Forough; Gouya, Mohammad Mehdi

2017-01-01

Although increasing attention is paid to HIV/AIDS, patients with HIV still experience several barriers to self-care. These barriers have been previously identified in small quantitative studies on women with HIV, but qualitative studies are required to clarify barriers to self-care. We conducted our study using the grounded theory methodological approach. A total of 28 women with HIV and their family members, were interviewed. The data were analyzed with the Corbin and Strauss method (1998). The key barriers to self-care in women with HIV/AIDS included social stigma, addiction, psychological problems, medication side-effects and financial problems. Women with HIV/AIDS face several barriers to self-care. Therefore, when designing self-care models for these women, social and financial barriers should be identified. Mental health treatment should also be incorporated into such models and patients' access to health care services should be facilitated.

Breastfeeding: What are the Barriers? Why Women Struggle to Achieve Their Goals.

PubMed

Sriraman, Natasha K; Kellams, Ann

2016-07-01

Despite recognized health benefits for both mothers and infants, significant disparities still exist in the rates of breastfeeding in the United States. Major organizations representing the health of women and children (including the Centers for Disease Control and Prevention [CDC], American Academy of Pediatrics [AAP], American Congress of Obstetrics and Gynecology [ACOG], American Academy of Family Physicians [AAFP], United Nations International Children's Emergency Fund (UNICEF), the World Health Organization [WHO], and the United States Public Health Service [PHS]) recommend exclusive breastfeeding, but statistics show that although many women initiate breastfeeding, few meet the recommended goals for duration and exclusivity. This article reviews the evidence related to barriers (prenatal, medical, societal, hospital, and sociocultural) that many mothers face, and explore the known barriers and the impact they have on a woman's ability to breastfeed her infant. Strategies will be discussed to address (and potentially overcome) some of the most common barriers women face along with a list of resources that can be useful in this effort. Gaps in care and areas that need further research will be noted. This article is targeted toward physicians and other healthcare providers who work with women and who can assist with and advocate for the removal of barriers and thereby improve the health of women and children by increasing the rates of breastfeeding initiation, duration, and exclusivity in the United States.

Barriers to and enablers of evidence-based practice in perinatal care in the SEA-ORCHID project.

PubMed

Turner, Tari; Short, Jacki

2013-08-01

The South-East Asia Optimising Reproductive and Child Health in Developing Countries (SEA-ORCHID) project aimed to improve health outcomes for mothers and babies in nine hospitals in South-East Asia by supporting evidence-based perinatal health care. In this research, we aimed to identify and explore the factors that may have acted as barriers to or enablers of evidence-based practice change at each of the hospitals. During the final 6 months of the intervention phase of the project, semi-structured, face-to-face interviews were undertaken with 179 nurses, midwives and doctors from the maternal and neonatal departments at each of the nine participating South-East Asian hospitals. The interviews identified several factors that participants believed had a substantial impact on the effectiveness of the SEA-ORCHID intervention. These included knowledge, skills, hierarchy, multidisciplinarity and leadership, beliefs about consequences, resources, and the nature of the behaviours. The success of the SEA-ORCHID intervention in improving practice may reflect the extent to which tailored strategies were effective in overcoming these barriers. Effective interventions to align practice with evidence rely on identifying and addressing barriers to practice change. The barriers identified in this study may be useful for those designing similar clinical practice improvement projects, as well as for continued efforts to improve practice in the SEA-ORCHID hospitals. © 2011 John Wiley & Sons Ltd.

Transgender Patients: What Radiologists Need to Know.

PubMed

Sowinski, John S; Gunderman, Richard B

2018-05-01

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

Sputter deposition of indium tin oxide onto zinc pthalocyanine: Chemical and electronic properties of the interface studied by photoelectron spectroscopy

NASA Astrophysics Data System (ADS)

Gassmann, Jürgen; Brötz, Joachim; Klein, Andreas

2012-02-01

The interface chemistry and the energy band alignment at the interface formed during sputter deposition of transparent conducting indium tin oxide (ITO) onto the organic semiconductor zinc phtalocyanine (ZnPc), which is important for inverted, transparent, and stacked organic light emitting diodes, is studied by in situ photoelectron spectroscopy (XPS and UPS). ITO was sputtered at room temperature and a low power density with a face to face arrangement of the target and substrate. With these deposition conditions, no chemical reaction and a low barrier height for charge injection at this interface are observed. The barrier height is comparable to those observed for the reverse deposition sequence, which also confirms the absence of sputter damage.

Access to healthcare by psychiatrists, psychiatric trainees and overseas trained psychiatrists: findings from the RANZCP welfare study.

PubMed

Jenkins, Kym

2017-04-01

To understand the challenges faced by psychiatrists and psychiatry trainees in accessing healthcare. An online survey was distributed to all members (fellows, associates and affiliates) of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and a number of focus groups were held across Australia and New Zealand. A total of 1051 members responded to the survey and nine focus groups were held. Almost all respondents indicated they had a personal general practitioner. However, there were varying factors affecting access to healthcare and the ability to take leave when unwell. There are numerous barriers facing RANZCP members in looking after their own health. Addressing these barriers will require action at multiple points in the system.

System and method for representing and manipulating three-dimensional objects on massively parallel architectures

DOEpatents

Karasick, M.S.; Strip, D.R.

1996-01-30

A parallel computing system is described that comprises a plurality of uniquely labeled, parallel processors, each processor capable of modeling a three-dimensional object that includes a plurality of vertices, faces and edges. The system comprises a front-end processor for issuing a modeling command to the parallel processors, relating to a three-dimensional object. Each parallel processor, in response to the command and through the use of its own unique label, creates a directed-edge (d-edge) data structure that uniquely relates an edge of the three-dimensional object to one face of the object. Each d-edge data structure at least includes vertex descriptions of the edge and a description of the one face. As a result, each processor, in response to the modeling command, operates upon a small component of the model and generates results, in parallel with all other processors, without the need for processor-to-processor intercommunication. 8 figs.

Traditional & Socio-Cultural Barriers to EFL Learning: A Case Study

ERIC Educational Resources Information Center

Ahmad, Jameel

2015-01-01

This research tends to ascertain several traditional and socio-cultural barriers to English language learning in Saudi Arabia and to explore more ways than before for making teaching and learning more effective. The findings of four quantitative and qualitative surveys conducted in this regard reveal a unique traditional and socio-cultural milieu,…

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

ERIC Educational Resources Information Center

Foster, Elaine; Appleby, Karen M.

2015-01-01

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

How Does Service Learning Increase and Sustain Interest in Engineering Education for Underrepresented Pre-Engineering College Students?

ERIC Educational Resources Information Center

Bosman, Lisa; Chelberg, Kelli; Winn, Ryan

2017-01-01

Many barriers exist for American Indian students pursuing STEM degree programs. However, federally recognized Tribal Colleges and Universities (TCUs) are uniquely suited to overcome these barriers because of their shared mission to provide 21st Century educational opportunities for American Indian students. Qualitative and quantitative findings…

Nurse practitioners in Taiwan: today and tomorrow.

PubMed

Wei, Ching-Wen; Tung, Heng-Hsin; Tsay, Shiow-Luan; Lin, Che-Wei

2012-03-01

To describe the barriers that nurse practitioners (NPs) face and their hopes for the future. The study used a qualitative research design, with 10 certified NPs who were recruited through convenience sampling. Data were collected through a face-to-face semi-structured interview, and content analysis was used to analyze the data. NPs in Taiwan are challenged by a number of barriers; however, they remain positive that their circumstances will improve. The results of this study suggest that there is a need for better communication between policymakers and NPs. Additionally, as recommended by the International Council of Nursing, there is a need for NPs to earn a master's degree and to have formal training prior to beginning work as an NP. Furthermore, to evaluate the NPs' performance, outcome studies need to be conducted. Implementing such recommendations should enable NPs to earn the respect and support of healthcare professionals and administrators. ©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.

An Evaluation of Anxiety Sensitivity, Emotional Dysregulation, and Negative Affectivity among Daily Cigarette Smokers: Relation to Smoking Motives and Barriers to Quitting

PubMed Central

Gonzalez, Adam; Zvolensky, Michael J.; Vujanovic, Anka A.; Leyro, Teresa M.; Marshall, Erin C.

2008-01-01

The present investigation evaluated the relations between anxiety sensitivity and motivational bases of cigarette smoking, as well as barriers to quitting smoking, above and beyond concurrent substance use, negative affectivity, and emotional dysregulation among a community sample of 189 daily cigarette smokers (46% women; Mage = 24.97 years, SD = 9.78). Results indicated that anxiety sensitivity was significantly related to coping, addictive, and habitual smoking motives, as well as greater perceived barriers to quitting. These effects were evident above and beyond the variance accounted for by concurrent tobacco, alcohol, and marijuana use and discernable from shared variance with negative affectivity and emotional dysregulation. Emotional dysregulation was significantly related to stimulation, habitual, and sensorimotor smoking motives and greater perceived barriers to quitting, whereas negative affectivity was only significantly related to smoking for relaxation. These findings uniquely add to a growing literature suggesting anxiety sensitivity is an important and unique cognitive factor for better understanding clinically-relevant psychological processes related to cigarette smoking. PMID:18417153

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

NASA Astrophysics Data System (ADS)

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

2010-05-01

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

Preliminary Testing of an Asthma Distance Education Program (ADEP) for School Nurses in Appalachia

ERIC Educational Resources Information Center

Putman-Casdorph, Heidi; Pinto, Susan

2011-01-01

Asthma remains one of the most challenging chronic illnesses faced by school nurses both nationally and in the State of West Virginia. There is a clear need to provide ongoing continuing asthma education to school nurses. However, nurses face many barriers to receiving this education. The purpose of this pilot project was to develop and evaluate…

Experiences of Incivility and Ageism in Currently Enrolled RN to BS Nursing Students and Their Intent to Quit

ERIC Educational Resources Information Center

Balko, Kimberly A.

2013-01-01

Student registered nurses face barriers to successful completion of a bachelor's of science degree program when faced with memories of incivility within their basic nursing program and their current experiences of incivility and ageism in the classroom, as well as in the workplace. This incivility, along with generational differences, adds to the…

Attitudes toward Older People and Coworkers' Intention to Work with Older Employees: A Taiwanese Study

ERIC Educational Resources Information Center

Lu, Luo

2010-01-01

The aim of this research was to examine attitudinal barriers to the employment of Taiwanese older workers (aged 60 and above). Face-to-face interviews were conducted to collect data using structured questionnaires from a sample of full-time employees (N = 258). We found that: (1) positive attitudes toward older people in general, perceived…

What Works for Latino/Hispanic Children and Adolescents: Lessons from Experimental Evaluations of Programs and Interventions. Fact Sheet. Publication #2011-05

ERIC Educational Resources Information Center

Bandy, Tawana; Moore, Kristin A.

2011-01-01

Children and adolescents of Latino/Hispanic background often face challenges that differ from other subpopulations in the United States. Language barriers, issues related to parental citizenship status, and the economic disadvantages often faced by these children and adolescents can result in various negative outcomes, such as depression,…

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

Keysa, T.P.

Characteristics of design, construction, performance, and educational opportunity are described for a small, simple passive solar community center in Christian Bend, Tennessee. This 2500-square-foot structure was designed in cooperation with this community of 75 families by TVA architects and was built entirely by volunteer labor. An educational process paralleled all phases of this building, begining with programming sessions, continuing through design, construction, occupation, and operation of the space. The direct gain building utilizes energy planning in both the interior and exterior. Earth berming and utilization of natural topography aid in the building's compatibility with both summer and winter climatic events.more » In addition to microclimatic design, interior space planning aids in naturally tempering spaces from extremes in climate. Extensive use of buffer spaces, an airlock entry, and placement of glazing areas (for direct gain and natural and induced ventilation) aid in the natural energy utilization and distribution in the interior spaces. Unique aspects include a double roof, which aids both in prevention of heat loss and in induced ventilation, and other operable garage door type roll down insulated shutters over the south facing aperture areas utilized both as night insulation and as a radiation barrier. This is the other major unique factor in this building. It has been designed both as an energy efficient community center for business as usual, and as an evacuation point and temporary shelter in th event of natural (flood) or man-induced (nuclear) disaster.« less

Barriers and Strategies on Adoption of E-Learning in Tanzanian Higher Learning Institutions: Lessons for Adopters

ERIC Educational Resources Information Center

Kisanga, Dalton; Ireson, Gren

2015-01-01

Tanzanian Higher learning institutions (HLIs) are faced with challenges of adopting e-learning in education. This study involved experts in e-learning to examine barriers of adopting e-learning and the best strategies to address them. Data were gathered from a series of semi-structured interviews with e-learning experts from two HLIs in Tanzania.…

Towards Preparing Young People for Employment and Further Study: First Evaluation of the City & Guilds TechBac

ERIC Educational Resources Information Center

Emira, Mahmoud; Rahman, Zeeshan

2017-01-01

Despite the United Kingdom government increasing efforts to tackle unemployment, young people face a number of barriers to be employed. As a leading awarding body, City & Guilds launched the TechBac in 2014 to address some of these barriers and provide learners with a balanced programme of vocational study. This article is based on the initial…

"Just because You Can Get a Wheelchair in the Building Doesn't Necessarily Mean that You Can Still Participate": Barriers to the Career Advancement of Disabled Professionals

ERIC Educational Resources Information Center

Wilson-Kovacs, Dana; Ryan, Michelle K.; Haslam, S. Alexander; Rabinovich, Anna

2008-01-01

Despite governmental efforts and organizational initiatives, the number of disabled professionals in full-time employment is small, and the number of those occupying leadership positions remains even smaller. Past research into disability and employment has outlined a range of barriers that disabled people face in seeking and maintaining…

Development and Evaluation of a Staff Training Program on Palliative Care for Persons with Intellectual and Developmental Disabilities

ERIC Educational Resources Information Center

Hahn, Joan E.; Cadogan, Mary P.

2011-01-01

Persons with intellectual and developmental disabilities (I/DD) face barriers and disparities at end of life. Among these barriers are limited educational opportunities and a paucity of targeted training materials on palliative care for staff who provide their day-to-day care. This paper reports on a three-phase project undertaken to develop,…

To Climb or Not to Climb: The Probing of Self-Imposed Barriers that Delay or Deny Career Aspirations to be an Administrator in a Public School System

ERIC Educational Resources Information Center

McGee, Janet M.

2010-01-01

Throughout history, women have faced numerous career barriers. Although significant progress has made it possible to break through the "glass ceiling," there remains a disproportionate percentage of women at the higher educational administrative positions, specifically the superintendent and high school principal roles. This study will…

Health literacy: health professionals' understandings and their perceptions of barriers that Indigenous patients encounter.

PubMed

Lambert, Michelle; Luke, Joanne; Downey, Bernice; Crengle, Sue; Kelaher, Margaret; Reid, Susan; Smylie, Janet

2014-11-29

Despite the growing interest in health literacy, little research has been done around health professionals' knowledge of health literacy or understandings of the barriers to health literacy that patients face when navigating the health care system. Indigenous peoples in New Zealand (NZ), Canada and Australia experience numerous inequalities in health status and outcomes and international evidence reveals that Indigenous, minority, and socio-economically disadvantaged populations have greater literacy needs. To address concerns in Indigenous health literacy, a two-pronged approach inclusive of both education of health professionals, and structural reform reducing demands the system places on Indigenous patients, are important steps towards reducing these inequalities. Four Indigenous health care services were involved in the study. Interviews and one focus group were employed to explore the experiences of health professionals working with patients who had experienced cardiovascular disease (CVD) and were taking medications to prevent future events. A thematic analysis was completed and these insights were used in the development of an intervention that was tested as phase two of the study. Analysis of the data identified ten common themes. This paper concentrates on health professionals' understanding of health literacy and perceptions of barriers that their patients face when accessing healthcare. Health professionals' concepts of health literacy varied and were associated with their perceptions of the barriers that their patients face when attempting to build health literacy skills. These concepts ranged from definitions of health literacy that were focussed on patient deficit to broader definitions that focussed on both patients and the health system. All participants identified a combination of cultural, social and systemic barriers as impediments to their Indigenous patients improving their health literacy knowledge and practices. This study suggests that health professionals have a limited understanding of health literacy and of the consequences of low health literacy for their Indigenous patients. This lack of understanding combined with the perceived barriers to improving health literacy limit health professionals' ability to improve their Indigenous patients' health literacy skills and may limit patients' capacity to improve understanding of their illness and instructions on how to manage their health condition/s.

ART access-related barriers faced by HIV-positive persons linked to care in southern Ghana: a mixed method study.

PubMed

Ankomah, Augustine; Ganle, John Kuumuori; Lartey, Margaret Yaa; Kwara, Awewura; Nortey, Priscilla Awo; Okyerefo, Michael Perry Kweku; Laar, Amos Kankponang

2016-12-07

Timely and enduring access to antiretroviral therapy (ART) by HIV-infected individuals has been shown to substantially reduce HIV transmission risk, HIV-related morbidity and mortality. However, there is evidence that in addition to limited supply of antiretrovirals (ARVs) and linkage to ART in many low-income countries, HIV+ persons often encounter barriers in accessing ART-related services even in contexts where these services are freely available. In Ghana, limited research evidence exists regarding the barriers HIV+ persons already linked to ART face. This paper explores ART access-related barriers that HIV+ persons linked to care in southern Ghana face. A mixed method study design, involving a cross-sectional survey and qualitative in-depth interviews, was conducted to collect data from four healthcare providers and a total of 540 adult HIV+ persons receiving ART at four treatment centres in Ghana. We used univariate analysis to generate descriptive tabulations for key variables from the survey. Data from qualitative in-depth interviews were thematically analysed. Results from the survey and in-depth interviews were brought together to illuminate the challenges of the HIV+ persons. All (100%) the HIV+ persons interviewed were ARV-exposed and linked to ART. Reasons for taking ARVs ranged from beliefs that they will suppress the HIV virus, desire to maintain good health and prolong life, and desire to prevent infection in unborn children, desire both to avoid death and to become good therapeutic citizens (abide by doctors' advice). Despite this, more than half of the study participants (63.3%) reported seven major factors as barriers hindering access to ART. These were high financial costs associated with accessing and receiving ART (26%), delays associated with receiving care from treatment centres (24%), shortage of drugs and other commodities (23%), stigma (8.8%), fear of side effects of taking ARVs (7.9%), job insecurity arising from regular leave of absence to receive ART (5.3%), and long distance to treatment centres (4.9%). The results in this study suggest that efforts to provide and scale-up ART to all HIV+ persons must be accompanied by interventions that address structural and individual level access barriers.

Barriers and facilitators of medication reconciliation processes for recently discharged patients from community pharmacists’ perspectives

PubMed Central

Kennelty, Korey A.; Chewning, Betty; Wise, Meg; Kind, Amy; Roberts, Tonya; Kreling, David

2015-01-01

Background Community pharmacists play a vital part in reconciling medications for patients transitioning from hospital to community care, yet their roles have not been fully examined in the extant literature. Objectives The objectives of this study were to: 1) examine the barriers and facilitators community pharmacists face when reconciling medications for recently discharged patients; and 2) identify pharmacists’ preferred content and modes of information transfer regarding updated medication information for recently discharged patients. Methods Community pharmacists were purposively and conveniently sampled from the Wisconsin (U.S. state) pharmacist-based research network, Pharmacy Practice Enhancement and Action Research Link (PEARL Rx). Community pharmacists were interviewed face-to-face, and transcriptions from audio recordings were analyzed using directed content analysis. The Theory of Planned Behavior (TPB) guided the development of questions for the semi-structured interviews. Results Interviewed community pharmacists (N = 10) described the medication reconciliation process to be difficult and time-consuming for recently discharged patients. In the context of the TPB, more barriers than facilitators of reconciling medications were revealed. Themes were categorized as organizational and individual-level themes. Major organizational-level factors affecting the medication reconciliation process included: pharmacy resources, discharge communication, and hospital resources. Major individual-level factors affecting the medication reconciliation process included: pharmacists’ perceived responsibility, relationships, patient perception of pharmacist, and patient characteristics. Interviewed pharmacists consistently responded that several pieces of information items would be helpful when reconciling medications for recently discharged patients, including the hospital medication discharge list and stop-orders for discontinued medications. Conclusions The TPB was useful for identifying barriers and facilitators of medication reconciliation for recently discharged patients from community pharmacists’ perspectives. The elucidation of these specific facilitators and barriers suggest promising avenues for future research interventions to improve exchange of medication information between the community pharmacy, hospitals, and patients. PMID:25586885

Barriers and facilitators of medication reconciliation processes for recently discharged patients from community pharmacists' perspectives.

PubMed

Kennelty, Korey A; Chewning, Betty; Wise, Meg; Kind, Amy; Roberts, Tonya; Kreling, David

2015-01-01

Community pharmacists play a vital part in reconciling medications for patients transitioning from hospital to community care, yet their roles have not been fully examined in the extant literature. The objectives of this study were to: 1) examine the barriers and facilitators community pharmacists face when reconciling medications for recently discharged patients; and 2) identify pharmacists' preferred content and modes of information transfer regarding updated medication information for recently discharged patients. Community pharmacists were purposively and conveniently sampled from the Wisconsin (U.S. state) pharmacist-based research network, Pharmacy Practice Enhancement and Action Research Link (PEARL Rx). Community pharmacists were interviewed face-to-face, and transcriptions from audio recordings were analyzed using directed content analysis. The Theory of Planned Behavior (TPB) guided the development of questions for the semi-structured interviews. Interviewed community pharmacists (N = 10) described the medication reconciliation process to be difficult and time-consuming for recently discharged patients. In the context of the TPB, more barriers than facilitators of reconciling medications were revealed. Themes were categorized as organizational and individual-level themes. Major organizational-level factors affecting the medication reconciliation process included: pharmacy resources, discharge communication, and hospital resources. Major individual-level factors affecting the medication reconciliation process included: pharmacists' perceived responsibility, relationships, patient perception of pharmacist, and patient characteristics. Interviewed pharmacists consistently responded that several pieces of information items would be helpful when reconciling medications for recently discharged patients, including the hospital medication discharge list and stop-orders for discontinued medications. The TPB was useful for identifying barriers and facilitators of medication reconciliation for recently discharged patients from community pharmacists' perspectives. The elucidation of these specific facilitators and barriers suggest promising avenues for future research interventions to improve exchange of medication information between the community pharmacy, hospitals, and patients. Published by Elsevier Inc.

Introduction to Climate Change from an Indigenous Perspective: an undergraduate course developed by and for Tribal Colleges and Universities

NASA Astrophysics Data System (ADS)

Mitchell, K. A.; Pandya, R. E.; Kahn-Thornbrugh, C.; Newberry, T.; Carroll, M.; Guinn, M.; Vanlopik, W.; Haines, C.; Wildcat, D.

2010-12-01

Thirty-six Tribal Colleges and Universities (TCUs) serve over 20,000 Native American undergraduate students across the US. TCUs were created in response to the higher education needs of American Indians and generally serve geographically isolated populations that have no other means accessing education beyond the high school level. TCUs have become increasingly important to educational opportunity for Native American students and are unique institutions that combine personal attention with cultural relevance to encourage Native Americans to overcome the barriers they face to higher education. The American Indian Higher Education Consortium (AIHEC) coordinated development of a semester-long geosciences program of study with a unique curriculum that introduces tribal college students to multiple disciplines in the geosciences within the topic of global climate change. Importantly, the curriculum structure does not parallel typical college climate change survey courses, but rather is taught from the perspective of the traditional ecological knowledge held by native peoples of North America. The richly varied history, geography, ecology, culture and scientific knowledge of Native American tribes across the US serves as the starting point from which students are taught about atmospheric and earth sciences and the connection of climate change to all our lives. In addition, examples and case studies focusing specifically on tribal lands foster the development of future Native American leaders with the scientific, technological and cultural skills required to assist tribal communities in managing their lands and maintaining their cultures as they face a climate-altered future. The "Introduction to Climate Change from an Indigenous Perspective" curriculum was developed by tribal college faculty from multiple institutions through a collaborative workshop process. The course was piloted and taught at 5 tribal colleges during spring semester 2010. This presentation provides an overview of the course goals, content and delivery.

Electrical properties of MOS devices fabricated on the 4H-SiC C-face.

NASA Astrophysics Data System (ADS)

Chen, Zengjun; Ahyi, A. C.; Williams, J. R.

2007-11-01

The electrical characteristics of MOS devices fabricated on the carbon face of 4H-SiC will be described. The C-face has a higher oxidation rate and a higher interface trap density compared to the Si-face. The thermal oxidation rate and the distribution of interface traps under different oxidation conditions will be discussed in this presentation. Sequential post-oxidation anneals in nitric oxide and hydrogen effectively reduces the interface density (Dit) near the conduction band edge. However, deeper in the band gap, the trap density remains higher compared to the Si-face. Time-dependent dielectric breakdown (TDDB) studies have also been performed to investigate oxide reliability on the C-face, and current-voltage measurements show that a low barrier height against carrier injection likely contributes to oxide degradation. Nevertheless, the effective channel mobility and threshold voltage for n-channel C-face lateral MOSFETs compare favorably with similar Si-face devices.

A Flexible and Integrated System for the Remote Acquisition of Neuropsychological Data in Stroke Research

PubMed Central

Durisko, Corrine; McCue, Michael; Doyle, Patrick J.; Dickey, Michael Walsh

2016-01-01

Abstract Background: Neuropsychological testing is a central aspect of stroke research because it provides critical information about the cognitive-behavioral status of stroke survivors, as well as the diagnosis and treatment of stroke-related disorders. Standard neuropsychological methods rely upon face-to-face interactions between a patient and researcher, which creates geographic and logistical barriers that impede research progress and treatment advances. Introduction: To overcome these barriers, we created a flexible and integrated system for the remote acquisition of neuropsychological data (RAND). The system we developed has a secure architecture that permits collaborative videoconferencing. The system supports shared audiovisual feeds that can provide continuous virtual interaction between a participant and researcher throughout a testing session. Shared presentation and computing controls can be used to deliver auditory and visual test items adapted from standard face-to-face materials or execute computer-based assessments. Spoken and manual responses can be acquired, and the components of the session can be recorded for offline data analysis. Materials and Methods: To evaluate its feasibility, our RAND system was used to administer a speech-language test battery to 16 stroke survivors with a variety of communication, sensory, and motor impairments. The sessions were initiated virtually without prior face-to-face instruction in the RAND technology or test battery. Results: Neuropsychological data were successfully acquired from all participants, including those with limited technology experience, and those with a communication, sensory, or motor impairment. Furthermore, participants indicated a high level of satisfaction with the RAND system and the remote assessment that it permits. Conclusions: The results indicate the feasibility of using the RAND system for virtual home-based neuropsychological assessment without prior face-to-face contact between a participant and researcher. Because our RAND system architecture uses off-the-shelf technology and software, it can be duplicated without specialized expertise or equipment. In sum, our RAND system offers a readily available and promising alternative to face-to-face neuropsychological assessment in stroke research. PMID:27214198

Implementing Comprehensive Reform: Implications for Practice

ERIC Educational Resources Information Center

Stout, Karen A.

2016-01-01

This chapter describes the challenges and practical barriers community colleges face when implementing comprehensive reform, exploring how reforms are leading to some improvements but not often scaled improvements.

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

PubMed

Scheier, Donna B

2009-01-01

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

Mode of action of claudin peptidomimetics in the transient opening of cellular tight junction barriers.

PubMed

Staat, Christian; Coisne, Caroline; Dabrowski, Sebastian; Stamatovic, Svetlana M; Andjelkovic, Anuska V; Wolburg, Hartwig; Engelhardt, Britta; Blasig, Ingolf E

2015-06-01

In epithelial/endothelial barriers, claudins form tight junctions, seal the paracellular cleft, and limit the uptake of solutes and drugs. The peptidomimetic C1C2 from the C-terminal half of claudin-1's first extracellular loop increases drug delivery through epithelial claudin-1 barriers. However, its molecular and structural mode of action remains unknown. In the present study, >100 μM C1C2 caused paracellular opening of various barriers with different claudin compositions, ranging from epithelial to endothelial cells, preferentially modulating claudin-1 and claudin-5. After 6 h incubation, C1C2 reversibly increased the permeability to molecules of different sizes; this was accompanied by redistribution of claudins and occludin from junctions to cytosol. Internalization of C1C2 in epithelial cells depended on claudin-1 expression and clathrin pathway, whereby most C1C2 was retained in recyclosomes >2 h. In freeze-fracture electron microscopy, C1C2 changed claudin-1 tight junction strands to a more parallel arrangement and claudin-5 strands from E-face to P-face association - drastic and novel effects. In conclusion, C1C2 is largely recycled in the presence of a claudin, which explains the delayed onset of barrier and junction loss, the high peptide concentration required and the long-lasting effect. Epithelial/endothelial barriers are specifically modulated via claudin-1/claudin-5, which can be targeted to improve drug delivery. Copyright © 2015 Elsevier Ltd. All rights reserved.

Bringing nanomedicines to market: regulatory challenges, opportunities, and uncertainties.

PubMed

Nijhara, Ruchika; Balakrishnan, Krishna

2006-06-01

Scientists and entrepreneurs who contemplate developing nanomedicine products face several unique challenges in addition to many of the traditional hurdles of product development. In this review we analyze the major physicochemical, biologic and functional characteristics of several nanomedicine products on the market and explore the question of what made them unique. What made them successful? We also focus on the regulatory challenges faced by nanomedicine product developers. Based on these analyses, we propose the factors that are most likely to contribute to the success of nanomedicine products.

Confronting Physical Activity Programming Barriers for People with Disabilities: The Empowerment Model

ERIC Educational Resources Information Center

Moran, Thomas Eugene; Taliaferro, Andrea R.; Pate, Joshua R.

2014-01-01

Community-based physical activity programs for people with disabilities have barriers that are unique to their program leader qualifications and the population they serve. Moran and Block (2010) argued that there is a need for practical strategies that are easy for communities to implement, maximize resources, and minimize the impact of barriers…

Health care providers' perceived barriers to and need for the implementation of a national integrated health care standard on childhood obesity in the Netherlands - a mixed methods approach.

PubMed

Schalkwijk, Annemarie A H; Nijpels, Giel; Bot, Sandra D M; Elders, Petra J M

2016-03-08

In 2010, a national integrated health care standard for (childhood) obesity was published and disseminated in the Netherlands. The aim of this study is to gain insight into the needs of health care providers and the barriers they face in terms of implementing this integrated health care standard. A mixed-methods approach was applied using focus groups, semi-structured, face-to-face interviews and an e-mail-based internet survey. The study's participants included: general practitioners (GPs) (focus groups); health care providers in different professions (face-to-face interviews) and health care providers, including GPs; youth health care workers; pediatricians; dieticians; psychologists and physiotherapists (survey). First, the transcripts from the focus groups were analyzed thematically. The themes identified in this process were then used to analyze the interviews. The results of the analysis of the qualitative data were used to construct the statements used in the e-mail-based internet survey. Responses to items were measured on a 5-point Likert scale and were categorized into three outcomes: 'agree' or 'important' (response categories 1 and 2), 'disagree' or 'not important'. Twenty-seven of the GPs that were invited (51 %) participated in four focus groups. Seven of the nine health care professionals that were invited (78 %) participated in the interviews and 222 questionnaires (17 %) were returned and included in the analysis. The following key barriers were identified with regard to the implementation of the integrated health care standard: reluctance to raise the subject; perceived lack of motivation and knowledge on the part of the parents; previous negative experiences with lifestyle programs; financial constraints and the lack of a structured multidisciplinary approach. The main needs identified were: increased knowledge and awareness on the part of both health care providers and parents/children; a social map of effective intervention; structural funding; task rearrangements; a central care coordinator and structural information feedback from the health care providers involved. The integrated health care standard stipulate that the care of overweight or obese children be provided using an integrated approach. The barriers and needs identified in this study can be used to define strategies to improve the implementation of the integrated health care standard pertaining to overweight and obese children in the Netherlands.

Immigrant Health in Rural Maryland: A Qualitative Study of Major Barriers to Health Care Access.

PubMed

Sangaramoorthy, Thurka; Guevara, Emilia M

2017-08-01

Immigration to rural areas in new receiving communities like Maryland's Eastern Shore is growing. Despite a rapid rise in immigration and diminishing health system resources, little attention has been focused on barriers to health care access in this region for immigrants. A total of 33 in-depth key informant interviews with providers and immigrants were conducted. Qualitative analysis employing a constant comparison approach was used to explore emergent themes related to barriers to health care access for a growing immigrant population. Participants perceived limited health care resources, lack of health insurance coverage, high health expenditures, language barriers, and non-citizenship status as barriers to immigrants' access of health care. Findings imply that immigrants living and working on the rural Eastern Shore face serious barriers to health care access. Additional work on immigrant health in rural areas and the impacts of immigration to rural health systems are needed.

Finding Hope in the Face-to-Face.

PubMed

Edgoose, Jennifer Y C; Edgoose, Julian M

2017-05-01

What does it mean to look into the face of a patient who looks back? Face-to-face encounters are at the heart of the patient-clinician relationship but their singular significance is often lost amid the demands of today's high-tech, metric-driven health care systems. Using the framework provided by the philosopher and Holocaust survivor Emmanuel Levinas, the authors explore the unique responsibility and potential for hope found only in face-to-face encounters. Revisiting this most fundamental attribute of medicine is likely our greatest chance to reclaim who we are as clinicians and why we do what we do. © 2017 Annals of Family Medicine, Inc.

Evacuating damaged and destroyed buildings on 9/11: behavioral and structural barriers.

PubMed

Groeger, Justina L; Stellman, Steven D; Kravitt, Alexandra; Brackbill, Robert M

2013-12-01

Evacuation of the World Trade Center (WTC) twin towers and surrounding buildings damaged in the September 11, 2001 attacks provides a unique opportunity to study factors that affect emergency evacuation of high rise buildings. Problem The goal of this study is to understand the extent to which structural and behavioral barriers and limitations of personal mobility affected evacuation by occupants of affected buildings on September 11, 2001. This analysis included 5,023 civilian, adult enrollees within the World Trade Center Health Registry who evacuated the two World Trade Center towers and over 30 other Lower Manhattan buildings that were damaged or destroyed on September 11, 2001. Multinomial logistic regression was used to predict total evacuation time (<30 to ≤60 minutes, >1 hour to <2 hours relative to ≤30 minutes) in relation to number of infrastructure barriers and number of behavioral barriers, adjusted for demographic and other factors. A higher percentage of evacuees reported encountering at least one behavioral barrier (84.9%) than reported at least one infrastructure barrier (51.9%). This pattern was consistent in all buildings except WTC 1, the first building attacked, where >90% of evacuees reported encountering both types of barriers. Smoke and poor lighting were the most frequently-reported structural barriers. Extreme crowding, lack of communication with officials, and being surrounded by panicked crowds were the most frequently-reported behavioral barriers. Multivariate analyses showed evacuation time to be independently associated with the number of each type of barrier as well as gender (longer times for women), but not with the floor from which evacuation began. After adjustment, personal mobility impairment was not associated with increased evacuation time. Because most high-rise buildings have unique designs, infrastructure factors tend to be less predictable than behavioral factors, but both need to be considered in developing emergency evacuation plans in order to decrease evacuation time and, consequently, risk of injury and death during an emergency evacuation.

Facial detection using deep learning

NASA Astrophysics Data System (ADS)

Sharma, Manik; Anuradha, J.; Manne, H. K.; Kashyap, G. S. C.

2017-11-01

In the recent past, we have observed that Facebook has developed an uncanny ability to recognize people in photographs. Previously, we had to tag people in photos by clicking on them and typing their name. Now as soon as we upload a photo, Facebook tags everyone on its own. Facebook can recognize faces with 98% accuracy which is pretty much as good as humans can do. This technology is called Face Detection. Face detection is a popular topic in biometrics. We have surveillance cameras in public places for video capture as well as security purposes. The main advantages of this algorithm over other are uniqueness and approval. We need speed and accuracy to identify. But face detection is really a series of several related problems: First, look at a picture and find all the faces in it. Second, focus on each face and understand that even if a face is turned in a weird direction or in bad lighting, it is still the same person. Third select features which can be used to identify each face uniquely like size of the eyes, face etc. Finally, compare these features to data we have to find the person name. As a human, your brain is wired to do all of this automatically and instantly. In fact, humans are too good at recognizing faces. Computers are not capable of this kind of high-level generalization, so we must teach them how to do each step in this process separately. The growth of face detection is largely driven by growing applications such as credit card verification, surveillance video images, authentication for banking and security system access.

Corrosion resistant coatings suitable for elevated temperature application

DOEpatents

Chan, Kwai S [San Antonio, TX; Cheruvu, Narayana Sastry [San Antonio, TX; Liang, Wuwei [Austin, TX

2012-07-31

The present invention relates to corrosion resistance coatings suitable for elevated temperature applications, which employ compositions of iron (Fe), chromium (Cr), nickel (Ni) and/or aluminum (Al). The compositions may be configured to regulate the diffusion of metals between a coating and a substrate, which may then influence coating performance, via the formation of an inter-diffusion barrier layer. The inter-diffusion barrier layer may comprise a face-centered cubic phase.

College Choice Interrupted or Facilitated: A Qualitative Case Study Examining How Social Class and Schools Structure Opportunity for Students in Urban High Schools

ERIC Educational Resources Information Center

Reavis, Tangela Blakely

2017-01-01

Although college enrollment rates have expanded over the last several decades, low-income students and students of color continue to face formidable barriers as they seek entry into higher education. While the existence of these barriers are often viewed as macro-level roadblocks that are largely systemic, much of the literature around access to…

Return to Work: Work-Based Learning and the Reintegration of Unemployed Adults into the Labour Market. Working Paper No 21

ERIC Educational Resources Information Center

Dehmel, Alexandra

2013-01-01

Low-qualified adults have experienced a greater rise in unemployment than any other group in Europe. What particular barriers are they facing in (re-)entering the labour market? How can VET be used in active labour market policies to help overcome these barriers? How can training programmes be designed to address the particular needs of this…

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

NASA Technical Reports Server (NTRS)

LaRocco, Mark T.; Pierson, Duane L.

1999-01-01

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

Perspectives of oncology nurses and oncologists regarding barriers to working with patients from a minority background: Systemic issues and working with interpreters.

PubMed

Watts, K J; Meiser, B; Zilliacus, E; Kaur, R; Taouk, M; Girgis, A; Butow, P; Kissane, D W; Hale, S; Perry, A; Aranda, S K; Goldstein, D

2018-03-01

This study aimed to ascertain the systemic barriers encountered by oncology health professionals (HPs) working with patients from ethnic minorities to guide the development of a communication skills training programme. Twelve medical and five radiation oncologists and 21 oncology nurses were invited to participate in this qualitative study. Participants were interviewed individually or in a focus group about their experiences working with people from minority backgrounds. All interviews were transcribed verbatim and analysed thematically. HPs encountered language and communication barriers in their interactions with patients and their families, which were perceived to impact negatively on the quality and amount of information and support provided. There was a shortage of, and poor processes for engaging, interpreters and some HPs were concerned about the accuracy of interpretation. HPs expressed a need for training in cultural awareness and communication skills with a preference for face-to-face delivery. A lack of funding, a culture of "learning on the job", and time constraints were systemic barriers to training. Oncologists and oncology nurses encounter complex challenges in clinical interactions with minority patients and their families, including difficulties working with interpreters. Formal training programmes targeted to the development of culturally competent communication skills are required. © 2017 John Wiley & Sons Ltd.

Intraspecific Variation in Learning: Worker Wasps Are Less Able to Learn and Remember Individual Conspecific Faces than Queen Wasps.

PubMed

Tibbetts, Elizabeth A; Injaian, Allison; Sheehan, Michael J; Desjardins, Nicole

2018-05-01

Research on individual recognition often focuses on species-typical recognition abilities rather than assessing intraspecific variation in recognition. As individual recognition is cognitively costly, the capacity for recognition may vary within species. We test how individual face recognition differs between nest-founding queens (foundresses) and workers in Polistes fuscatus paper wasps. Individual recognition mediates dominance interactions among foundresses. Three previously published experiments have shown that foundresses (1) benefit by advertising their identity with distinctive facial patterns that facilitate recognition, (2) have robust memories of individuals, and (3) rapidly learn to distinguish between face images. Like foundresses, workers have variable facial patterns and are capable of individual recognition. However, worker dominance interactions are muted. Therefore, individual recognition may be less important for workers than for foundresses. We find that (1) workers with unique faces receive amounts of aggression similar to those of workers with common faces, indicating that wasps do not benefit from advertising their individual identity with a unique appearance; (2) workers lack robust memories for individuals, as they cannot remember unique conspecifics after a 6-day separation; and (3) workers learn to distinguish between facial images more slowly than foundresses during training. The recognition differences between foundresses and workers are notable because Polistes lack discrete castes; foundresses and workers are morphologically similar, and workers can take over as queens. Overall, social benefits and receiver capacity for individual recognition are surprisingly plastic.

Lifestyle counseling in overweight truck and bus drivers - Effects on dietary patterns and physical activity.

PubMed

Puhkala, Jatta; Kukkonen-Harjula, Katriina; Aittasalo, Minna; Mansikkamäki, Kirsi; Partinen, Markku; Hublin, Christer; Kärmeniemi, Paula; Sallinen, Mikael; Olkkonen, Seppo; Tokola, Kari; Ojala, Anna; Nygård, Clas-Håkan; Fogelholm, Mikael

2016-12-01

We studied dietary patterns, physical activity (PA), and monthly goal setting in a weight reduction intervention in long-distance professional drivers. The study was conducted in Finland in 2009-2012. Male drivers with waist circumference > 100 cm were randomized to a lifestyle counseling (LIFE, N = 55) and a reference (REF, N = 58) group. During 12 months, LIFE participated in 6 face-to-face and 7 telephone counseling sessions on diet and PA. Dietary patterns were assessed using an index combining food diary and counselor interview, and PA with the number of daily steps using a pedometer. Monthly lifestyle goals, perceived facilitators and barriers, and adverse effects of PA in the LIFE participants were monitored using counselors' log books. Forty-seven (85%) LIFE participants completed the 12-month program. After 12 months, the mean dietary index score improved by 12% (p = 0.002, N = 24), and the number of daily steps increased by 1811 steps (median; p = 0.01, N = 22). The most frequent dietary goals dealt with meal frequency, plate model, and intake of vegetables, fruits, and berries. The most common PA mode was walking. Typical facilitators to reach monthly lifestyle goals were support from family and friends and ailment prevention; typical barriers were working schedules and ailments. Adverse effects, most commonly musculoskeletal pain, occurred among 83% of the LIFE participants. Positive changes in lifestyle habits were observed during counseling. Monthly lifestyle counseling combining face-to-face and phone contacts seemed appropriate to long-distance drivers. Barriers for reaching lifestyle changes, and adverse effects of PA were common and need to be addressed when planning counseling. Clinical Trials NCT00893646.

Faculty Development for Medical School Community-Based Faculty: A Council of Academic Family Medicine Educational Research Alliance Study Exploring Institutional Requirements and Challenges.

PubMed

Drowos, Joanna; Baker, Suzanne; Harrison, Suzanne Leonard; Minor, Suzanne; Chessman, Alexander W; Baker, Dennis

2017-08-01

Community-based faculty play a large role in training medical students nationwide and require faculty development. The authors hypothesized that positive relationships exist between clerkships paying preceptors and requiring faculty development, and between protected clerkship directors' time and delivering face-to-face preceptor training, as well as with the number or length of community-based preceptor visits. Through under standing the quantity, delivery methods, barriers, and institutional support for faculty development provided to community-based preceptors teaching in family medicine clerkships, best practices can be developed. Data from the 2015 Council of Academic Family Medicine's Educational Research Alliance survey of Family Medicine Clerkship Directors were analyzed. The cross-sectional survey of clerkship directors is distributed annually to institutional representatives of U.S. and Canadian accredited medical schools. Survey questions focused on the requirements, delivery methods, barriers, and institutional support available for providing faculty development to community-based preceptors. Paying community-based preceptors was positively correlated with requiring faculty development in family medicine clerkships. The greatest barrier to providing faculty development was community-based preceptor time availability; however, face-to-face methods remain the most common delivery strategy. Many family medicine clerkship directors perform informal or no needs assessment in developing faculty development topics for community-based faculty. Providing payment to community preceptors may allow schools to enhance faculty development program activities and effectiveness. Medical schools could benefit from constructing a formal curriculum for faculty development, including formal preceptor needs assessment and program evaluation. Clerkship directors may consider recruiting and retaining community-based faculty by employing innovative faculty development delivery methods.

Assessing the possibilities and challenges of patient involvement in sexual, reproductive and HIV/AIDS services.

PubMed

Meyrick, Jane; Gray, Debra; Jones, Abigail

2016-06-01

Patient and public involvement (PPI) is a key feature of healthcare services in the UK. Sexual and reproductive health and HIV (SRHH) services face unique PPI challenges, as the anonymity and confidentiality required by service users can be a barrier to attracting patient input. PPI could improve sexual health services, through increased trust in services and the ability to tackle sexual health inequalities. However, specific practical guidance on how to address PPI in sexual health and the evidence to support it is sparse. This research aims to begin building an evidence base for PPI in sexual health services through: 1) an audit of PPI in SRHH in the Bristol region; and 2) a parallel survey of potential users of sexual health services about their experiences of PPI. For the audit, 18 SRHH organisations from all those in the region invited complete a short online survey, representing a range of different service providers. For the survey, participants, through a convenience sample via the University of the West of England and social media, were invited to complete an anonymous online survey of their experiences of PPI in SSRHs; 96 people responded. Reliance on customer satisfaction approaches and patients not being asked for feedback or what PP is for are reported. Services cite under-resourcing and a lack of time as barriers. Improving the use of patient's voice in SRHH could be supported through clarity of purpose (measured against outcomes), better communication with patients, and the need for flexible methods.

Seniors' perspectives on care: a case study of the Alex Seniors health clinic, Calgary.

PubMed

Shaw, Marta; Rypien, Candace; Drummond, Neil; Harasym, Patricia; Nixon, Lara

2015-02-25

Primary care initiatives face an imperative to not only reduce barriers to care for their patients but also to uniquely accommodate the complex needs of at-risk patient populations. Patient-centered multidisciplinary care team models for primary care, like the Alex Seniors Clinic, are one approach for providing comprehensive care for marginalized seniors. The purpose of this qualitative study was to explore patient perspectives on the responsiveness of the Alex Seniors Clinic to their stated health needs. Themes reflected participants' perspectives on factors impacting their health needs as vulnerable seniors as well as on the measures that the Alex Seniors Clinic has taken to meet those needs. Factors impacting health included: the nature of their relationships to the physical environment in which they lived, the nature of the relationships they had to others in that environment, and independence and autonomy. Participants identified accessibility, respect and support, and advocacy as the ways in which the clinic was working to address those health needs. While respect and support, as well as advocacy, effectively addressed some patient needs, participants felt that accessibility problems continue to be health-related barriers for clinic patients. This may be due to the fact that issues of accessibility reflect larger community and social problems. Nevertheless, it is only through engaging the patient community for input on clinic approaches that an understanding can be gained of how closely a clinic's care goals are currently aligning with patient perspectives of the care and services they receive.

Limitations of and Barriers to Using Performance Measurement: Purchasers' Perspectives

PubMed Central

Ginsberg, Caren; Sheridan, Samantha

2001-01-01

Although health plan performance data are becoming increasingly more available, many purchasers are still not using these data to make their purchasing decisions. In this article, we review barriers that private purchasers face to using performance data. In addition, we consider the effects of the larger health care purchasing environment and employers' quality improvement activities on their use of the data. We conclude that a variety of factors, including trends, the health care purchasing environment, characteristics of firms, and problems with performance data and their presentation to users create barriers to incorporating this information into health care decisionmaking. PMID:25372184

Disability and HIV in Africa: Breaking the barriers to sexual health care.

PubMed

Rohleder, Poul

2017-09-01

Three decades into the HIV pandemic, the issues affecting people with disabilities remain less known. Increasing attention has been given to this overlooked population when it comes to HIV prevention, treatment and care. This is related to the significant unmet sexual and reproductive healthcare needs facing people with disabilities worldwide. This article discusses the barriers to sexual health for people with disabilities in Africa and presents an argument about how mainstream HIV prevention work and research do not adequately attend to the sorts of systemic barriers that exclude people with disabilities, which a more targeted and critical approach could.

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.

Barriers and benefits to using mobile health technology after operation: A qualitative study.

PubMed

Abelson, Jonathan S; Kaufman, Elinore; Symer, Matthew; Peters, Alexander; Charlson, Mary; Yeo, Heather

2017-09-01

Recently, mobile health technology has emerged as a promising avenue for improving physician-patient communication and patient outcomes. The objective of our study was to determine the public's perception of barriers and benefits to using mobile health technology technologies to enhance recovery after operation. We used the Empire State Poll to ask 2 open-ended questions to 800 participants assessing their perceptions of benefits and barriers to use mobile health technology after operation. All responses were coded independently, and any discrepancies were resolved by consensus. We used grounded theory to allow themes to arise from the codes. Interrater reliability was calculated using Cohen's Kappa. Participants identified a range of possible barriers to using mobile health technology apps after operation including: protecting personal health information, technology effectiveness and failure, preference for face-to-face interaction with their surgeon, level of effort required, and ability of the older adults to navigate mobile health technology. Participants identified multiple possible benefits including: better monitoring, improved communication with their surgeon, minimizing follow-up visits, improved convenience, and increased patient knowledge. In the study, 15% of all respondents stated there were no barriers whereas 6% stated there were no benefits. Participants were receptive to the many potential benefits of this technology to enhance not only their relationships with providers and the convenience of access, but also their health outcomes. We must address participants concerns about data security and their fears of losing a personal relationship with their doctor. Copyright © 2017 Elsevier Inc. All rights reserved.

Perceived Barriers and Facilitators for Return to Work Among Colorectal Cancer Survivors: Malaysian Healthcare Professionals Experience-　A Qualitative Inquiry.

PubMed

Chow, Sze Loon; Loh, Siew Yim; Su, Tin Tin

2015-06-01

Return to work (RTW) can be a challenging occupational health (OH) issue among previously-employed colorectal cancer survivors. This study aimed to explore the various perceived barriers and facilitators encountered during the RTW process in cancer survivorship, from the perception of healthcare professionals (HCP). Face to face, semistructured interviews were carried out on twelve HCP (government and private sectors) from various disciplines. Data collected were transcribed verbatim and data management was aided by NVivo software 8.0. A new theory from contextual data was generated using open coding, axial coding and selective coding. The HCP shared numerous barriers and facilitators associated with RTW, under four categories. The key barriers were disturbing side effects, psychological barriers (personal factor), compensation (financial factor), poor ability to multitask (work-related factor), long paid medical leaves policy, employer's lackadaisical attitude, lack of knowledge and awareness of RTW (environmental factor). Key facilitators identified were desire to resume working life and to contribute to society (personal factor), financial pressure, maintain organizational health insurance (financial factor), less physically demanding job (work-related factor), supportive workplace and strict organizational policy on medical leaves (environmental factor). While not all HCP were trained in RTW, they all agreed that RTW is important for survivors and workplace. Occupational health doctors have a direct role in helping survivors RTW. Early Intervention on RTW during survivorship should involve occupational health doctors and employers, targeting the modifiable factors (environmental and work-related) to improve RTW after cancer.

Disease management programs: barriers and benefits.

PubMed

Magnezi, Racheli; Kaufman, Galit; Ziv, Arnona; Kalter-Leibovici, Ofra; Reuveni, Haim

2013-04-01

The healthcare system in Israel faces difficulties similar to those of most industrialized countries, including limited resources, a growing chronically ill population, and demand for high quality care. Disease management programs (DMPs) for patients with a chronic illness aim to alleviate some of these problems, primarily by improving patient self-management skills and quality of care. This study surveyed the opinions of senior healthcare administrators regarding barriers, benefits, and support for implementing DMPs. Cross-sectional survey. A 21-item questionnaire was self-completed by 87 of 105 (83%) healthcare administrators included in the study. Participants were 65.5% male and 47% physicians, 25.3% nurses, 17.3% administrators, and 10.3% other healthcare professionals. The main perceived benefit of DMPs among all respondents was improving quality of care. Other benefits noted were better contact with patients (81.6%) and better compliance with treatment (75.9%). Efficient long-term utilization of system resources was perceived as a benefit by only 58.6%. The main perceived barriers to implementing DMPs were lack of budgetary resources (69%) and increased time required versus financial compensation received (63.2%). The benefits of DMPs were patient oriented; barriers were perceived as financial and limiting professional autonomy. Information regarding long-term benefits (better patient outcomes) that ultimately provide better value for the system versus short-term barriers (increased costs and expenditures of time without compensation) might encourage the implementation of DMPs in countries faced with a growing population of patients with at least 1 chronic illness.

Attempting to be active: Self-efficacy and barrier limitation differentiate activity levels of working mothers.

PubMed

Gierc, Madelaine; Locke, Sean; Jung, Mary; Brawley, Lawrence

2016-07-01

Working mothers are less physically active than working women without children and mothers who do not work. The purpose of this study was to examine concurrent self-regulatory efficacy and barriers to physical activity in a sample of working mothers. Women completed a mixed-methods survey which included measures of physical activity, concurrent self-regulatory efficacy, and barriers. Sufficiently active women experienced significantly greater concurrent self-regulatory efficacy and significantly less barrier limitation and frequency. No significant group differences were found for age, domestic duties performed, and children's extracurricular activities. Thematic analysis of barriers revealed six themes of common and unique factors, including limited time and family activities. © The Author(s) 2014.

Mental Health Needs and Service Utilization by Hispanic Immigrants Residing in Mid-Southern United States

PubMed Central

Bridges, Ana J.; Andrews, Arthur R.; Deen, Tisha L.

2014-01-01

Purpose This study assessed mental health needs and service utilization patterns in a convenience sample of Hispanic immigrants. Design and Method A total of 84 adult Hispanic participants completed a structured diagnostic interview and a semistructured service utilization interview with trained bilingual research assistants. Results In the sample, 36% met diagnostic criteria for at least one mental disorder. Although 42% of the sample saw a physician in the prior year, mental health services were being rendered primarily by religious leaders. The most common barriers to service utilization were cost (59%), lack of health insurance (35%), and language (31%). Although more women than men met criteria for a disorder, service utilization rates were comparable. Participants with a mental disorder were significantly more likely to have sought medical, but not psychiatric, services in the prior year and faced significantly more cost barriers than participants without a mental disorder. Conclusions Findings suggest that Hispanic immigrants, particularly those with a mental illness, need to access services but face numerous systemic barriers. The authors recommend specific ways to make services more affordable and linguistically accessible. PMID:22802297

Barriers faced by Vietnamese immigrant women in Taiwan who do not regularly undergo cervical screenings: a qualitative study.

PubMed

Lee, Fang Hsin; Wang, Hsiu Hung; Yang, Yung Mei; Tsai, Hsiu Min

2014-01-01

To assess and understand the barriers faced by Vietnamese marital immigrant women who do not regularly undergo cervical screenings in Southeast Taiwan. Studies have shown a low uptake rate of preventive medical services among immigrants. As immigrant women may not be aware of the healthcare delivery system in their host country, their uptake of and access to healthcare services might be limited. A qualitative, descriptive inquiry design was adopted. This qualitative study employed semi-structured, individual, in-depth interviews of 17 Vietnamese immigrant women. Data were collected from February-July 2011 and analysed using content analysis. The barriers to receiving cervical screening were lack of health literacy, lack of female healthcare providers, negative perceptions of cervical screening and personal reasons. The results might serve as a reference for government entities and healthcare providers in Taiwan to improve cervical screening rates; this should help enhance the effectiveness of healthcare services for Vietnamese immigrant women. The findings can also provide a reference for making appropriate healthcare policies for immigrant women in other countries. © 2013 Blackwell Publishing Ltd.

Bridging barriers to clinic-based HIV testing with new technology: translating self-implemented testing for African American youth.

PubMed

Catania, J A; Dolcini, M M; Harper, G W; Dowhower, D P; Dolcini-Catania, L G; Towner, S L; Timmons, A; Motley, D N; Tyler, D H

2015-12-01

Numerous barriers to clinic-based HIV testing exist (e.g., stigmatization) for African American youth. These barriers may be addressed by new technology, specifically HIV self-implemented testing (SIT). We conducted a series of formative phase 3 translation studies (49 face-to-face interviews, 9 focus groups, 1 advisory panel review) among low-income African American youth (15-19 years) and providers of adolescent services in two US cities to identify potential translation difficulties of the OraQuick SIT. Based on content analysis, we found that providers and African American youth viewed SITs positively compared to clinic-based testing. Data suggest that SITs may reduce social stigma and privacy concerns and increase convenience and normalization of HIV testing. Challenges with SIT implementation include difficulties accessing confirmatory testing, coping with adverse outcomes, and instructional materials that may be inappropriate for low socioeconomic status (SES) persons. Study results underscore the need for translation studies to identify specific comprehension and implementation problems African American youth may have with oral SITs.

Perceived Barriers to Healthy Eating and Physical Activity Among Participants in a Workplace Obesity Intervention.

PubMed

Stankevitz, Kayla; Dement, John; Schoenfisch, Ashley; Joyner, Julie; Clancy, Shayna M; Stroo, Marissa; Østbye, Truls

2017-08-01

To characterize barriers to healthy eating (BHE) and physical activity (BPA) among participants in a workplace weight management intervention. Steps to health participants completed a questionnaire to ascertain barriers to physical activity and healthy eating faced. Exploratory factor analysis was used to determine the factor structure for BPA and BHE. The relationships of these factors with accelerometer data and dietary behaviors were assessed using linear regression. Barriers to physical activity included time constraints and lack of interest and motivation, and to healthy eating, lack of self-control and convenience, and lack of access to healthy foods. Higher BHE correlated with higher sugary beverage intake but not fruit and vegetable and fat intake. To improve their effectiveness, workplace weight management programs should consider addressing and reducing barriers to healthy eating and physical activity.

Lena Burkett | NREL

Science.gov Websites

technological and implementation barriers faced by the residential construction industry. Prior to working at provides technical research management for DOE's Building America Program. In this role, she works to

The Online Instructional Dynamic: A Study of Community College Faculty Teaching Online Courses and Their Perceptions of Barriers to Student Success

ERIC Educational Resources Information Center

Hadsell, Jory Andrew

2012-01-01

Online students at some California community colleges are experiencing lower success rates than their peers in face-to-face versions of the same courses. Insight into the forces shaping student success in online courses is needed to address such disparities. The purpose of this study was to explore, in-depth, the lived experiences of faculty…

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

ERIC Educational Resources Information Center

Jang, Bong Gee

2017-01-01

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

Adult Learners in Higher Education: Barriers to Success and Strategies to Improve Results. Employment and Training Administration. Occasional Paper 2007-03

ERIC Educational Resources Information Center

Kazis, Richard; Callahan, Abigail; Davidson, Chris; McLeod, Annie; Bosworth, Brian; Choitz, Vickie; Hoops, John

2007-01-01

This reports synthesizes the research literature on the challenges facing adult learners in higher education today and emerging strategies for increasing the number of adults over 24 who earn college credentials and degrees. This synthesis is meant to provide perspectives on key issues facing adults as more and more of them see the need for higher…

Examining the structural challenges to communication as experienced by nurse managers in two US hospital settings.

PubMed

Marx, Marcia

2014-11-01

This study examined the structural barriers to communication for first-line nurse managers with their staff nurses. The delivery of quality care depends on effective communication in hospital units. First-line nurse managers are central figures in networks whose responsibility is to communicate information from the senior management to staff nurses. The data were collected using face-to-face interviews with first-line managers at two US hospitals The interviews were transcribed and coded with limited use of the qualitative software atlas Interview questions focused on work experiences of managers with special emphases on communication. Structural barriers that influenced managers' communication included the amount of face-to-face interaction with nurses, the amount of information to communicate, levels of formalization, outreach to all nurses, time constraints and nurses' subcultural networks These factors compromised managers' ability to communicate effectively with nurses. Managers should carefully examine how structure affects communication recognizing that some dynamics of structure cannot be changed but that they can influence others, such as formalization and communication networks. Managers should examine their own positioning within nurses' networks and demonstrate to nurses that their expertise contributes to the collaborative capital upon which nursing practice depends. © 2013 John Wiley & Sons Ltd.

Impact of depression on the intensity of patient navigation for women with abnormal cancer screenings.

PubMed

De La Cruz, Ignacio I; Freund, Karen M; Battaglia, Tracy A; Chen, Clara A; Bak, Sharon; Kalish, Richard; Lottero, Barbara; Egan, Patrick; Heeren, Tim; Kronman, Andrea C

2014-02-01

Patient navigation is increasingly being used to support vulnerable patients to receive timely and quality medical care. We sought to understand whether patients with depression utilize additional patient navigation services after abnormal cancer screening. We compared depressed and non-depressed women using three different measures of intensity of patient navigation: number of patient-navigator encounters, encounter time, and number of unique barriers to care. The study population consisted of 1,455 women who received navigation after abnormal screening for breast or cervical cancer at one of six community health centers in Boston. Navigators spent a median of 60-75 minutes over one or two encounters per participant, with 49% of participants having one or more documented barrier to care. Depressed women did not differ in total numbers of encounters, encounter time, or unique barriers compared with non-depressed women. Our findings suggest that pre-existing depression does not predict which women will utilize additional navigation services.

Laminated Object Manufacturing-Based Design Ceramic Matrix Composites

DTIC Science & Technology

2001-04-01

components for DoD applications. Program goals included the development of (1) a new LOM based design methodology for CMC, (2) optimized preceramic polymer ...3.1.1-20 3.1.1-12 Detail of LOM Composites Forming System w/ glass fiber/ polymer laminate................ 3.1.1-21 3.1.1-13...such as polymer matrix composites have faced similar barriers to implementation. These barriers have been overcome through the development of suitable

Impact of chemical peeling combined with negative pressure on human skin.

PubMed

Kim, S J; Kang, I J; Shin, M K; Jeong, K H; Baek, J H; Koh, J S; Lee, S J

2016-10-01

In vivo changes in skin barrier function after chemical peeling with alpha hydroxyacids (AHAs) have been previously reported. However, the additional effects of physical treatment with chemical agents on skin barrier function have not been adequately studied. This study measured the degree of acute skin damage and the time required for skin barrier repair using non-invasive bioengineering methods in vivo with human skin to investigate the additional effect of a 4% AHA chemical jet accelerated at supersonic velocities. Thirteen female subjects (average age: 29.54 ± 4.86 years) participated in this study. The faces of the subjects were divided into half according to the block randomization design and were then assigned to receive AHA peeling alone or AHA peeling combined with pneumatic pressure on each side of the face. Transepidermal water loss (TEWL), skin colour and skin blood flow were evaluated at baseline and at 30 min, 2, 5 and 7 days after treatment. The TEWL and skin blood flow were significantly increased after 30 min in chemodermabrasion compared with chemical peeling alone (P < 0.05). The TEWL and skin blood flow recovered to baseline after 2 days, and TEWL was significantly decreased at 7 days compared with chemical peeling alone (P < 0.05). Chemodermabrasion can temporarily impair skin barriers, but it is estimated that it can enhance the skin barrier function after 7 days compared to the use of a chemical agent alone. In addition, chemodermabrasion has a more effective impact in the dermis and relatively preserves the skin barrier. © 2016 Society of Cosmetic Scientists and the Société Française de Cosmétologie.

Barriers to the use of Information and Communication Technology by occupational therapists working in a rural area of New South Wales, Australia.

PubMed

Chedid, Rebecca Jean; Dew, Angela; Veitch, Craig

2013-06-01

This qualitative study formed part of a large-scale, multi-phase study into the delivery of therapy services to people with a disability, living in one rural area of New South Wales, Australia. The study's purpose was to identify the impact of Information and Communication Technology on the workforce practices of occupational therapists' working in a rural area of New South Wales. Individual semi-structured telephone interviews were conducted with 13 occupational therapists working in disability, health and private practice in a rural area of New South Wales. Participants were asked about access to, skills and limitations of using Information and Communication Technology. A modified grounded theory approach, based on thematic analysis and constant comparison, was used to analyse the interview transcripts. This study found widespread use of technology by rurally based occupational therapists working in the disability sector in New South Wales. However, Information and Communication Technology was primarily used for client contact, professional development and professional networking rather than therapy provision. The study identified individual, workplace and community barriers to greater uptake of Information and Communication Technology by this group. The individual barriers included: age cohort, knowledge and personal preferences. The workplace barriers included: support and training and availability of resources. The community barriers included: infrastructure and perceptions of clients' acceptance. The potential exists for Information and Communication Technology to supplement face-to-face therapy provision, enhance access to professional development and reduce professional isolation thereby addressing the rural challenges of large distances, travel times and geographic isolation. To overcome these challenges, individual, workplace and community Information and Communication Technology barriers should be addressed concurrently. © 2012 The Authors Australian Occupational Therapy Journal © 2012 Occupational Therapy Australia.

Elder Abuse and Neglect Intervention in the Clinical Setting: Perceptions and Barriers Faced by Primary Care Physicians in Malaysia.

PubMed

Mohd Mydin, Fadzilah Hanum; Othman, Sajaratulnisah

2017-08-01

This qualitative study attempts to explore the definition, perceptions, practice experience, and barriers of primary care physicians (PCPs) in identifying and intervening in cases of elder abuse and neglect at the primary care level. Semistructured in-depth interview was conducted among 10 PCPs. Participants were selected by purposive sampling. The interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. In general, PCPs showed consistency in defining elder abuse and neglect. PCPs considered that they were optimally positioned to intervene in cases of elder abuse and neglect, but indicated the potential of overlooking such problems. The hurdles faced by PCPs in the identification and intervention of elder abuse were determined to be occurring at three levels: clinical, organizational, and policy. At the clinical level, PCPs recognize that they are lacking both the confidence and knowledge of elder abuse and neglect intervention. PCPs' conflicting personal and professional beliefs create barriers during the clinical practice. Time constraints, patients' other clinical problems, and, in addition, the preservation of a good doctor-patient relationship overshadow the importance of addressing and intervening in elder abuse and neglect issues during the consultation. This is further exacerbated by the barriers perceived by the patients: their nondisclosure and reluctance to accept outside intervention. At the organizational level, the lack of efficient interagency networks or support for the health system poses barriers. At the policy level, the absence of legislation specifically addressing elder abuse also creates considerable difficulties. However, PCPs gave differing responses when asked about a law concerning the elderly and mandatory reporting. Addressing these multilevel barriers is critical for ensuring that opportunities arising at the primary care level for elder maltreatment intervention are correctly utilized.

Service provider perceptions of telerehabilitation as an additional service delivery option within an Australian neurosurgical and orthopaedic physiotherapy screening clinic: A qualitative study.

PubMed

Cottrell, Michelle A; Hill, Anne J; O'Leary, Shaun P; Raymer, Maree E; Russell, Trevor G

2017-12-01

The Neurosurgical & Orthopaedic Physiotherapy Screening Clinic and Multidisciplinary Service (N/OPSC&MDS) originated as a complementary, non-surgical pathway for patients referred to public neurosurgical and orthopaedic specialist services. Patient access to the N/OPSC&MDS could potentially be improved with the implementation of telerehabilitation as an additional method of service delivery. To evaluate service provider's views on (1) current barriers to patients' accessing N/OPSC & MD services, and (2) the implementation of telerehabilitation within the N/OPSC&MDS. Qualitative descriptive study design. Healthcare providers (n = 26) were recruited from six N/OPSC&MD services located throughout Queensland, Australia. Semi-structured interviews were conducted to explore service providers' views with respect to existing barriers to patients accessing the N/OPSC&MDS, and if telerehabilitation could be feasibly adopted to address current barriers. Template analysis resulted in six themes: (1) barriers to some patients' accessing current N/OPSC&MD services are complex & multifaceted; (2) telerehabilitation could improve patient access to appropriate management for their musculoskeletal condition; (3) telerehabilitation may have limitations when compared to face-to-face healthcare; (4) the delivery of telerehabilitation needs to be flexible; (5) perceived barriers, and (6) facilitators to the successful implementation of telerehabilitation within the N/OPSC&MDS. This study represents a critical step in determining the readiness of service providers for the implementation of telerehabilitation within the N/OPSC&MDS. Although cautious, service providers are overall accepting of the implementation of telerehabilitation, acknowledging that it could eliminate several current barriers, subsequently achieving more equitable access to the service. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

From Mammy to Superwoman: Images that Hinder Black Women's Career Development

ERIC Educational Resources Information Center

Reynolds-Dobbs, Wendy; Thomas, Kecia M.; Harrison, Matthew S.

2008-01-01

Black women, like other women of color, find themselves at the intersection of both racism and sexism in the workplace. Due to their unique dual status as racial and gender minorities, they encounter unique and unexplored barriers that inhibit their career as well as leadership development. The goal of this article is to highlight the emerging…

STAKEHOLDER INVOLVEMENT THROUGHOUT HEALTH TECHNOLOGY ASSESSMENT: AN EXAMPLE FROM PALLIATIVE CARE.

PubMed

Brereton, Louise; Wahlster, Philip; Mozygemba, Kati; Lysdahl, Kristin Bakke; Burns, Jake; Polus, Stephanie; Tummers, Marcia; Refolo, Pietro; Sacchini, Dario; Leppert, Wojciech; Chilcott, James; Ingleton, Christine; Gardiner, Clare; Goyder, Elizabeth

2017-01-01

Internationally, funders require stakeholder involvement throughout health technology assessment (HTA). We report successes, challenges, and lessons learned from extensive stakeholder involvement throughout a palliative care case study that demonstrates new concepts and methods for HTA. A 5-step "INTEGRATE-HTA Model" developed within the INTEGRATE-HTA project guided the case study. Using convenience or purposive sampling or directly / indirectly identifying and approaching individuals / groups, stakeholders participated in qualitative research or consultation meetings. During scoping, 132 stakeholders, aged ≥ 18 years in seven countries (England, Italy, Germany, The Netherlands, Norway, Lithuania, and Poland), highlighted key issues in palliative care that assisted identification of the intervention and comparator. Subsequently stakeholders in four countries participated in face-face, telephone and / or video Skype meetings to inform evidence collection and / or review assessment results. An applicability assessment to identify contextual and implementation barriers and enablers for the case study findings involved twelve professionals in the three countries. Finally, thirteen stakeholders participated in a mock decision-making meeting in England. Views about the best methods of stakeholder involvement vary internationally. Stakeholders make valuable contributions in all stages of HTA; assisting decision making about interventions, comparators, research questions; providing evidence and insights into findings, gap analyses and applicability assessments. Key challenges exist regarding inclusivity, time, and resource use. Stakeholder involvement is feasible and worthwhile throughout HTA, sometimes providing unique insights. Various methods can be used to include stakeholders, although challenges exist. Recognition of stakeholder expertise and further guidance about stakeholder consultation methods is needed.

A web platform for landuse, climate, demography, hydrology and beach erosion in the Black Sea catchment

PubMed Central

Lehmann, Anthony; Guigoz, Yaniss; Ray, Nicolas; Mancosu, Emanuele; Abbaspour, Karim C.; Rouholahnejad Freund, Elham; Allenbach, Karin; De Bono, Andrea; Fasel, Marc; Gago-Silva, Ana; Bär, Roger; Lacroix, Pierre; Giuliani, Gregory

2017-01-01

The Black Sea catchment (BSC) is facing important demographic, climatic and landuse changes that may increase pollution, vulnerability and scarcity of water resources, as well as beach erosion through sea level rise. Limited access to reliable time-series monitoring data from environmental, statistical, and socio-economical sources is a major barrier to policy development and decision-making. To address these issues, a web-based platform was developed to enable discovery and access to key environmental information for the region. This platform covers: landuse, climate, and demographic scenarios; hydrology and related water vulnerability and scarcity; as well as beach erosion. Each data set has been obtained with state-of-the-art modelling tools from available monitoring data using appropriate validation methods. These analyses were conducted using global and regional data sets. The data sets are intended for national to regional assessments, for instance for prioritizing environmental protection projects and investments. Together they form a unique set of information, which lay out future plausible change scenarios for the BSC, both for scientific and policy purposes. PMID:28675383

A web platform for landuse, climate, demography, hydrology and beach erosion in the Black Sea catchment.

PubMed

Lehmann, Anthony; Guigoz, Yaniss; Ray, Nicolas; Mancosu, Emanuele; Abbaspour, Karim C; Rouholahnejad Freund, Elham; Allenbach, Karin; De Bono, Andrea; Fasel, Marc; Gago-Silva, Ana; Bär, Roger; Lacroix, Pierre; Giuliani, Gregory

2017-07-04

The Black Sea catchment (BSC) is facing important demographic, climatic and landuse changes that may increase pollution, vulnerability and scarcity of water resources, as well as beach erosion through sea level rise. Limited access to reliable time-series monitoring data from environmental, statistical, and socio-economical sources is a major barrier to policy development and decision-making. To address these issues, a web-based platform was developed to enable discovery and access to key environmental information for the region. This platform covers: landuse, climate, and demographic scenarios; hydrology and related water vulnerability and scarcity; as well as beach erosion. Each data set has been obtained with state-of-the-art modelling tools from available monitoring data using appropriate validation methods. These analyses were conducted using global and regional data sets. The data sets are intended for national to regional assessments, for instance for prioritizing environmental protection projects and investments. Together they form a unique set of information, which lay out future plausible change scenarios for the BSC, both for scientific and policy purposes.

Unlocking Solar for Low- and Moderate-Income Residents: A Matrix of Financing Options by Resident, Provider, and Housing Type

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

Cook, Jeffrey J.; Bird, Lori A.

Historically the low and moderate income (LMI) market has been underserved by solar photovoltaics (PV), in part due to the unique barriers LMI residents face to participation in the PV market. The intent of this report is to identify the most promising strategies state policymakers might consider to finance PV for LMI customers across three housing types: single family, multi-family, and manufactured housing. The result is a financing matrix that documents the first and second tier financing options states may consider for each housing type. The first tier options were selected based upon their potential impact on LMI PV deployment.more » Second tier financing approaches could also be used to achieve state policy goals, but may not have as much effect on the relevant LMI market segment. Nevertheless, each financing option comes with tradeoffs that state policymakers may wish to consider when they make decisions about which financing approaches are best suited to achieve their LMI PV deployment goals.« less

Barriers and Opportunities in Consent and Access Procedures in Low- and Middle-Income Country Biobanks: Meeting Notes from the BCNet Training and General Assembly.

PubMed

Zawati, Ma'n H; Tassé, Anne Marie; Mendy, Maimuna; Caboux, Elodie; Lang, Michael

2018-04-18

As biobanking research in low- and middle-income countries (LMICs) continues to grow, novel legal and policy considerations have arisen. Also, while an expansive literature has developed around these issues, the views and concerns of individual researchers in these contexts have been less actively studied. These meeting notes aim to contribute to the growing literature on biobanking in LMICs by communicating a number of challenges and opportunities identified by biobank researchers themselves. Specifically, we describe concerns that emerge in consent and access policy domains. First, we present a review of the literature on distinct policy and legal concerns faced in LMICs, giving special attention to the general absence of practitioner perspectives. From there, we outline and discuss considerations that were raised by meeting participants at a Biobank and Cohort Building Network (BCNet) Ethical, Legal, and Social Issues training program. We conclude by proposing that the unique perspectives of biobank researchers in LMICs should be given serious attention and further research on these perspectives should be conducted.

Unraveling the complexities of invasive multimodality neuromonitoring.

PubMed

Sinha, Saurabh; Hudgins, Eric; Schuster, James; Balu, Ramani

2017-11-01

Acute brain injuries are a major cause of death and disability worldwide. Survivors of life-threatening brain injury often face a lifetime of dependent care, and novel approaches that improve outcome are sorely needed. A delayed cascade of brain damage, termed secondary injury, occurs hours to days and even weeks after the initial insult. This delayed phase of injury provides a crucial window for therapeutic interventions that could limit brain damage and improve outcome. A major barrier in the ability to prevent and treat secondary injury is that physicians are often unable to target therapies to patients' unique cerebral physiological disruptions. Invasive neuromonitoring with multiple complementary physiological monitors can provide useful information to enable this tailored, precision approach to care. However, integrating the multiple streams of time-varying data is challenging and often not possible during routine bedside assessment. The authors review and discuss the principles and evidence underlying several widely used invasive neuromonitors. They also provide a framework for integrating data for clinical decision making and discuss future developments in informatics that may allow new treatment paradigms to be developed.

A discrete mechanics framework for real time virtual surgical simulations with application to virtual laparoscopic nephrectomy.

PubMed

Zhou, Xiangmin; Zhang, Nan; Sha, Desong; Shen, Yunhe; Tamma, Kumar K; Sweet, Robert

2009-01-01

The inability to render realistic soft-tissue behavior in real time has remained a barrier to face and content aspects of validity for many virtual reality surgical training systems. Biophysically based models are not only suitable for training purposes but also for patient-specific clinical applications, physiological modeling and surgical planning. When considering the existing approaches for modeling soft tissue for virtual reality surgical simulation, the computer graphics-based approach lacks predictive capability; the mass-spring model (MSM) based approach lacks biophysically realistic soft-tissue dynamic behavior; and the finite element method (FEM) approaches fail to meet the real-time requirement. The present development stems from physics fundamental thermodynamic first law; for a space discrete dynamic system directly formulates the space discrete but time continuous governing equation with embedded material constitutive relation and results in a discrete mechanics framework which possesses a unique balance between the computational efforts and the physically realistic soft-tissue dynamic behavior. We describe the development of the discrete mechanics framework with focused attention towards a virtual laparoscopic nephrectomy application.

Ensuring it works: a community-based approach to HIV prevention intervention development for men who have sex with men in Chennai, India.

PubMed

Thomas, Beena; Mimiaga, Matthew J; Mayer, Kenneth H; Closson, Elizabeth F; Johnson, Carey V; Menon, Sunil; Mani, Jamuna; Vijaylakshmi, R; Dilip, Meenalochini; Betancourt, Theresa; Safren, Steven A

2012-12-01

Men who have sex with men (MSM) in India have an HIV seroprevalence 22 times greater than the country's general population and face unique challenges that may hinder the effectiveness of current HIV prevention efforts. To obtain an understanding of the logistical and sociocultural barriers MSM experience while accessing HIV prevention services, focus groups and key informant interviews were conducted with 55 MSM in Chennai, India. Qualitative data were analyzed using descriptive qualitative content analysis. Sixty-five percent of participants identified as kothi (receptive partners), 9% as panthi (insertive partners), 22% as double decker (receptive and insertive), and 4% did not disclose. Themes included: (a) fatigue with current HIV risk reduction messages; (b) increased need for non-judgmental and confidential services; and (c) inclusion of content that acknowledges individual and structural-level determinants of risk such as low self-esteem, depression, and social discrimination. MSM interventions may benefit from approaches that address multilevel psychosocial factors, including skills building and strategies to foster self-acceptance and increased social support.

Sirtuins and the metabolic hurdles in cancer

PubMed Central

German, Natalie J.; Haigis, Marcia C.

2017-01-01

The metabolic demands of cancer cannot be met by normal cell metabolism. Cancer cells undergo dramatic alteration of metabolic pathways in a process called reprogramming, characterized by increased nutrient uptake and re-purposing of these fuels for biosynthetic, bioenergetic or signaling pathways. Partitioning carbon sources toward growth and away from ATP production necessitates other means of generating energy for biosynthetic reactions. Additionally, cancer cell adaptations frequently leads to increased production of reactive oxygen species and lactic acid- metabolites which can be beneficial to cancer growth but also are potentially toxic and must be appropriately cleared. Sirtuins are a family of deacylases and ADP-ribosyltransferases with clear links to the regulation of cancer metabolism. Through their unique ability to integrate cellular stress and nutrient status with coordination of metabolic outputs, sirtuins are well poised to play pivotal roles in tumor metabolism. Here, we review the multi-faceted duties of sirtuins in tackling the metabolic hurdles in cancer. We focus on both beneficial and adverse effects of sirtuins in the regulation of energetic, biosynthetic and toxicity barriers faced by cancer cells. PMID:26126285

Developing the next generation of dissemination and implementation researchers: insights from initial trainees.

PubMed

Stamatakis, Katherine A; Norton, Wynne E; Stirman, Shannon W; Melvin, Cathy; Brownson, Ross C

2013-03-12

Dissemination and implementation (D&I) research is a relatively young discipline, underscoring the importance of training and career development in building and sustaining the field. As such, D&I research faces several challenges in designing formal training programs and guidance for career development. A cohort of early-stage investigators (ESI) recently involved in an implementation research training program provided a resource for formative data in identifying needs and solutions around career development. Responses outlined fellows' perspectives on the perceived usefulness and importance of, as well as barriers to, developing practice linkages, acquiring additional methods training, academic advancement, and identifying institutional supports. Mentorship was a cross-cutting issue and was further discussed in terms of ways it could foster career advancement in the context of D&I research. Advancing an emerging field while simultaneously developing an academic career offers a unique challenge to ESIs in D&I research. This article summarizes findings from the formative data that outlines some directions for ESIs and provides linkages to the literature and other resources on key points.

ENSURING IT WORKS: A COMMUNITY-BASED APPROACH TO HIV PREVENTION INTERVENTION DEVELOPMENT FOR MEN WHO HAVE SEX WITH MEN IN CHENNAI, INDIA

PubMed Central

Thomas, Beena; Mimiaga, Matthew J.; Mayer, Kenneth H.; Closson, Elizabeth F.; Johnson, Carey V.; Menon, Sunil; Mani, Jamuna; Vijaylakshmi, R.; Dilip, Meenalochini; Betancourt, Theresa; Safren, Steven A.

2013-01-01

Men who have sex with men (MSM) in India have an HIV seroprevalence 22 times greater than the country’s general population and face unique challenges that may hinder the effectiveness of current HIV prevention efforts. To obtain an understanding of the logistical and sociocultural barriers MSM experience while accessing HIV prevention services, focus groups and key informant interviews were conducted with 55 MSM in Chennai, India. Qualitative data were analyzed using descriptive qualitative content analysis. Sixty-five percent of participants identified as kothi (receptive partners), 9% as panthi (insertive partners), 22% as double decker (receptive and insertive), and 4% did not disclose. Themes included: (a) fatigue with current HIV risk reduction messages; (b) increased need for non-judgmental and confidential services; and (c) inclusion of content that acknowledges individual and structural-level determinants of risk such as low self-esteem, depression, and social discrimination. MSM interventions may benefit from approaches that address multilevel psychosocial factors, including skills building and strategies to foster self-acceptance and increased social support. PMID:23206199