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

PubMed

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

2015-12-01

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

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

PubMed

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

2007-12-01

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

Monitoring the Vadose Zone Moisture Regime Below a Surface Barrier

NASA Astrophysics Data System (ADS)

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

2009-12-01

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

Security barriers with automated reconnaissance

DOEpatents

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

2015-04-07

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

Adeno-associated virus serotype 8 efficiently delivers genes to muscle and heart.

PubMed

Wang, Zhong; Zhu, Tong; Qiao, Chunping; Zhou, Liqiao; Wang, Bing; Zhang, Jian; Chen, Chunlian; Li, Juan; Xiao, Xiao

2005-03-01

Systemic gene delivery into muscle has been a major challenge for muscular dystrophy gene therapy, with capillary blood vessels posing the principle barrier and limiting vector dissemination. Previous efforts to deliver genes into multiple muscles have relied on isolated vessel perfusion or pharmacological interventions to enforce broad vector distribution. We compared the efficiency of multiple adeno-associated virus (AAV) vectors after a single injection via intraperitoneal or intravenous routes without additional intervention. We show that AAV8 is the most efficient vector for crossing the blood vessel barrier to attain systemic gene transfer in both skeletal and cardiac muscles of mice and hamsters. Serotypes such as AAV1 and AAV6, which demonstrate robust infection in skeletal muscle cells, were less effective in crossing the blood vessel barrier. Gene expression persisted in muscle and heart, but diminished in tissues undergoing rapid cell division, such as neonatal liver. This technology should prove useful for muscle-directed systemic gene therapy.

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

PubMed

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

2016-12-01

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

Ocular Drug Delivery Barriers—Role of Nanocarriers in the Treatment of Anterior Segment Ocular Diseases

PubMed Central

Bachu, Rinda Devi; Chowdhury, Pallabitha; Al-Saedi, Zahraa H. F.; Karla, Pradeep K.; Boddu, Sai H. S.

2018-01-01

Ocular drug delivery is challenging due to the presence of anatomical and physiological barriers. These barriers can affect drug entry into the eye following multiple routes of administration (e.g., topical, systemic, and injectable). Topical administration in the form of eye drops is preferred for treating anterior segment diseases, as it is convenient and provides local delivery of drugs. Major concerns with topical delivery include poor drug absorption and low bioavailability. To improve the bioavailability of topically administered drugs, novel drug delivery systems are being investigated. Nanocarrier delivery systems demonstrate enhanced drug permeation and prolonged drug release. This review provides an overview of ocular barriers to anterior segment delivery, along with ways to overcome these barriers using nanocarrier systems. The disposition of nanocarriers following topical administration, their safety, toxicity and clinical trials involving nanocarrier systems are also discussed. PMID:29495528

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

ERIC Educational Resources Information Center

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

2011-01-01

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

Loading, Release, Biodegradation, and Biocompatibility of a Nanovector Delivery System

NASA Technical Reports Server (NTRS)

Ferrai, Mauro; Tasciotti, Ennio

2012-01-01

A nanovector multistage system has been created to overcome or bypass sequential barriers within the human body, in order to deliver a therapeutic or imaging agent to a specific location. This innovation consists of a composition that includes two or more stages of particles, such that smaller, later-stage particles are contained in the larger, early-stage particles. An active agent, such as a therapeutic agent or imaging agent, is preferentially delivered and/or localized to a particular target site in the body of a subject. The multistage composition overcomes multiple biological barriers in the body. The multistage composition also allows for simultaneous delivery and localization at the same or different target sites of multiple active agents.

Semiconductor systems utilizing materials that form rectifying junctions in both N and P-type doping regions, whether metallurgically or field induced, and methods of use

DOEpatents

Welch, James D.

2000-01-01

Disclosed are semiconductor systems, such as integrated circuits utilizing Schotky barrier and/or diffused junction technology, which semiconductor systems incorporate material(s) that form rectifying junctions in both metallurgically and/or field induced N and P-type doping regions, and methods of their use. Disclosed are Schottky barrier based inverting and non-inverting gate voltage channel induced semiconductor single devices with operating characteristics similar to multiple device CMOS systems and which can be operated as modulators, N and P-channel MOSFETS and CMOS formed therefrom, and (MOS) gate voltage controlled rectification direction and gate voltage controlled switching devices, and use of such material(s) to block parasitic current flow pathways. Simple demonstrative five mask fabrication procedures for inverting and non-inverting gate voltage channel induced semiconductor single devices with operating characteristics similar to multiple device CMOS systems are also presented.

Global interrupt and barrier networks

DOEpatents

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

2008-10-28

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

Progressive multiple sclerosis: from pathogenic mechanisms to treatment.

PubMed

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

2017-03-01

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

Signature-based store checking buffer

DOEpatents

Sridharan, Vilas; Gurumurthi, Sudhanva

2015-06-02

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

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

PubMed

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

2012-01-01

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

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

DTIC Science & Technology

2000-06-23

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

Multifactorial skin barrier deficiency and atopic dermatitis: Essential topics to prevent the atopic march.

PubMed

Egawa, Gyohei; Kabashima, Kenji

2016-08-01

Atopic dermatitis (AD) is the most common inflammatory skin disease in the industrialized world and has multiple causes. Over the past decade, data from both experimental models and patients have highlighted the primary pathogenic role of skin barrier deficiency in patients with AD. Increased access of environmental agents into the skin results in chronic inflammation and contributes to the systemic "atopic (allergic) march." In addition, persistent skin inflammation further attenuates skin barrier function, resulting in a positive feedback loop between the skin epithelium and the immune system that drives pathology. Understanding the mechanisms of skin barrier maintenance is essential for improving management of AD and limiting downstream atopic manifestations. In this article we review the latest developments in our understanding of the pathomechanisms of skin barrier deficiency, with a particular focus on the formation of the stratum corneum, the outermost layer of the skin, which contributes significantly to skin barrier function. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2010-06-15

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

Emittance and absorptance of NASA ceramic thermal barrier coating system. [for turbine cooling

NASA Technical Reports Server (NTRS)

Liebert, C. H.

1978-01-01

Spectral emittance measurements were made on a two-layer ceramic thermal barrier coating system consisting of a metal substrate, a NiCrAly bond coating and a yttria-stabilized zirconia ceramic coating. Spectral emittance data were obtained for the coating system at temperatures of 300 to 1590 K, ceramic thickness of zero to 0.076 centimeter, and wavelengths of 0.4 to 14.6 micrometers. The data were transformed into total hemispherical emittance values and correlated with respect to ceramic coating thickness and temperature using multiple regression curve fitting techniques. The results show that the ceramic thermal barrier coating system is highly reflective and significantly reduces radiation heat loads on cooled gas turbine engine components. Calculation of the radiant heat transfer within the nonisothermal, translucent ceramic coating material shows that the gas-side ceramic coating surface temperature can be used in heat transfer analysis of radiation heat loads on the coating system.

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

PubMed

Alkraiji, Abdullah; Jackson, Thomas; Murray, Ian

2013-04-01

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

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

PubMed

Fallah, Parisa Nicole; Bernstein, Mark

2018-04-06

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

Healthcare waste management: an interpretive structural modeling approach.

PubMed

Thakur, Vikas; Anbanandam, Ramesh

2016-06-13

Purpose - The World Health Organization identified infectious healthcare waste as a threat to the environment and human health. India's current medical waste management system has limitations, which lead to ineffective and inefficient waste handling practices. Hence, the purpose of this paper is to: first, identify the important barriers that hinder India's healthcare waste management (HCWM) systems; second, classify operational, tactical and strategical issues to discuss the managerial implications at different management levels; and third, define all barriers into four quadrants depending upon their driving and dependence power. Design/methodology/approach - India's HCWM system barriers were identified through the literature, field surveys and brainstorming sessions. Interrelationships among all the barriers were analyzed using interpretive structural modeling (ISM). Fuzzy-Matrice d'Impacts Croisés Multiplication Appliquée á un Classement (MICMAC) analysis was used to classify HCWM barriers into four groups. Findings - In total, 25 HCWM system barriers were identified and placed in 12 different ISM model hierarchy levels. Fuzzy-MICMAC analysis placed eight barriers in the second quadrant, five in third and 12 in fourth quadrant to define their relative ISM model importance. Research limitations/implications - The study's main limitation is that all the barriers were identified through a field survey and barnstorming sessions conducted only in Uttarakhand, Northern State, India. The problems in implementing HCWM practices may differ with the region, hence, the current study needs to be replicated in different Indian states to define the waste disposal strategies for hospitals. Practical implications - The model will help hospital managers and Pollution Control Boards, to plan their resources accordingly and make policies, targeting key performance areas. Originality/value - The study is the first attempt to identify India's HCWM system barriers and prioritize them.

A Multi-Level Examination of Stakeholder Perspectives of Implementation of Evidence-Based Practices in a Large Urban Publicly-Funded Mental Health System

PubMed Central

Beidas, Rinad S.; Stewart, Rebecca E.; Adams, Danielle R.; Fernandez, Tara; Lustbader, Susanna; Powell, Byron J.; Aarons, Gregory; Hoagwood, Kimberly E.; Evans, Arthur C.; Hurford, Matthew O.; Rubin, Ronnie; Hadley, Trevor; Mandell, David; Barg, Frances

2015-01-01

Our goal was to identify barriers and facilitators to the implementation of evidence-based practices from the perspectives of multiple stakeholders in a large publicly funded mental health system. We completed 56 interviews with three stakeholder groups: treatment developers (n = 7), agency administrators (n = 33), and system leadership (n = 16). The three stakeholder groups converged on the importance of inner (e.g., agency competing resources and demands, therapist educational background) and outer context (e.g., funding) factors as barriers to implementation. Potential threats to implementation and sustainability included the fiscal landscape of community mental health clinics and an evolving workforce. Intervention characteristics were rarely endorsed as barriers. Inner context, outer context, and intervention characteristics were all seen as important facilitators. All stakeholders endorsed the importance of coordinated collaboration across stakeholder groups within the system to successfully implement evidence-based practices. PMID:26658692

A case study evaluation of an intervention aiming to strengthen the midwifery professional role in Morocco: anticipated barriers to reaching outcomes

PubMed Central

Abou Malham, Sabina; Hatem, Marie; Leduc, Nicole

2015-01-01

Background In order to reduce the high maternal mortality ratio, Morocco is strongly committed to strengthen its midwifery professional role. This study aimed to identify barriers that could potentially hinder an action plan to strengthen the midwifery professional role from achieving desired outcomes. We used a conceptual framework, which is derived from Hatem-Asmar’s (1997) framework on the interaction of educational, professional, and sociocultural systems in which a professional role evolves and from Damschroder et al’s (2009) framework for the implementation analysis. Methods This paper builds on a qualitative case study on the factors affecting the action plan’s implementation process that also revealed rich data about anticipated barriers to reaching outcomes. Data were collected through training sessions, field observations, documents, focus groups (n=20), and semistructured interviews (n=11) with stakeholders pertaining to the three systems under study. Content analysis was used to identify themes related to barriers. Results Seven barriers that may compromise the achievement of desired results were found. They relate to the legal framework, social representations, and media support in the sociocultural system and the practice environment, networks and communication mechanisms, and characteristics related to the role and the readiness in the professional system. Conclusion Disregarding sociocultural and professional system level, barriers may impede efforts to strengthen the midwife’s role and to provide qualified midwives who can improve the quality of maternal care. Making changes in the educational system cannot be thought of as an isolated process. Its success is closely tied with multiple contextual factors pertaining to the two other systems. Activities recommended to address these barriers may have great potential to build a competent midwifery workforce that contributes to positive maternal and neonatal health outcomes. PMID:26445547

Provider perspectives on barriers and facilitators to adjuvant endocrine therapy-related symptom management.

PubMed

Samuel, Cleo A; Turner, Kea; Donovan, Heidi A S; Beckjord, Ellen; Cardy, Alexandra; Dew, Mary Amanda; van Londen, G J

2017-12-01

Adjuvant endocrine therapy (AET) utilization is linked to improved clinical outcomes among breast cancer survivors (BCS); yet, AET adherence rates remain suboptimal. Little is known about provider perspectives regarding barriers and facilitators to AET-related symptom management (SM). In this study, we examined provider perspectives on the barriers and facilitators to AET-related SM among BCS and opportunities for improvement. We conducted three focus groups (FGs) with a multidisciplinary group of healthcare providers (n = 13) experienced in caring for BCS undergoing AET. We utilized semi-structured discussion guides to elicit provider perspectives on AET-related SM. FGs were audiotaped, transcribed, and analyzed using qualitative software to identify key themes. Providers described patient-, provider-, and system-level barriers and facilitators to AET-related SM. At the patient-level, barriers included competing demands, limited time/resources, and possible misattribution of some symptoms to AET, while family/social relationships and insurance emerged as important facilitators. Discomfort with SM, limited time, and challenges distinguishing AET-related symptoms from other conditions were key provider-level barriers. Provider-level facilitators included routine symptom documentation and strong provider relationships. Care fragmentation and complexity of the cancer care delivery system were described as system-level barriers; however, survivor clinics were endorsed by providers. Provider perspectives on AET-related SM can shed light on SM barriers and facilitators spanning multiple levels of the cancer care delivery system. Strategies for improving AET-related SM in BCS include increasing patients' knowledge and engagement in SM, equipping providers with efficient SM strategies, and improving coordination of symptom-related services through survivorship programs.

Distributed rendering for multiview parallax displays

NASA Astrophysics Data System (ADS)

Annen, T.; Matusik, W.; Pfister, H.; Seidel, H.-P.; Zwicker, M.

2006-02-01

3D display technology holds great promise for the future of television, virtual reality, entertainment, and visualization. Multiview parallax displays deliver stereoscopic views without glasses to arbitrary positions within the viewing zone. These systems must include a high-performance and scalable 3D rendering subsystem in order to generate multiple views at real-time frame rates. This paper describes a distributed rendering system for large-scale multiview parallax displays built with a network of PCs, commodity graphics accelerators, multiple projectors, and multiview screens. The main challenge is to render various perspective views of the scene and assign rendering tasks effectively. In this paper we investigate two different approaches: Optical multiplexing for lenticular screens and software multiplexing for parallax-barrier displays. We describe the construction of large-scale multi-projector 3D display systems using lenticular and parallax-barrier technology. We have developed different distributed rendering algorithms using the Chromium stream-processing framework and evaluate the trade-offs and performance bottlenecks. Our results show that Chromium is well suited for interactive rendering on multiview parallax displays.

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

PubMed

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

2014-05-28

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

On the performance of capillary barriers as landfill cover

NASA Astrophysics Data System (ADS)

Kämpf, M.; Montenegro, H.

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

Abortion training at multiple sites: an unexpected curriculum for teaching systems-based practice.

PubMed

Herbitter, Cara; Kumar, Vanita; Karasz, Alison; Gold, Marji

2010-04-01

In 1999, the Accreditation Council for Graduate Medical Education endorsed systems-based practice as one of six general competencies. The objective is to explore the paradigm of teaching residents systems-based practice during a women's health rotation that included abortion training in multiple settings. During a routine women's health rotation, residents from two urban family medicine residency programs received early abortion training at a high-volume abortion clinic and their continuity clinic. Thirty-min semistructured interviews were conducted with all 26 residents who rotated between July 2005 and August 2006. Transcripts were analyzed using thematic codes. Through exposure to different healthcare delivery systems, residents learned about systems-based practice, including understanding the failure of the larger system to meet patients' reproductive healthcare needs, differences between two systems, and potential systems barriers they might face as providers. Abortion training in multiple settings may serve as a paradigm for teaching systems-based practice during other rotations that include training in multiple sites.

Disclosure of Adverse Events in the United States and Canada: An Update, and a Proposed Framework for Improvement

PubMed Central

Wu, Albert W.; Boyle, Dennis J.; Wallace, Gordon; Mazor, Kathleen M.

2013-01-01

There is consensus that physicians, health professionals and health care organizations should discuss harm that results from health care delivery (adverse events), including the reasons for harm, with patients and their families. Thought leaders and policy makers in the USA and Canada support this goal. However, there are gaps in both countries between patients and physicians in their attitudes about how errors should be handled, and between disclosure policies and their implementation in practice. This paper reviews the state of disclosure policy and practice in the two countries, and the barriers to full disclosure. Important barriers include fear of consequences, attitudes about disclosure, lack of skill and role models, and lack of peer and institutional support. The paper also describes the problem of the second victim, a corollary of disclosure whereby health care workers are also traumatized by the same events that harm patients. The presence of multiple practical and personal barriers to disclosure suggests the need for a comprehensive solution directed at multiple levels of the health care system, including health departments, institutions, local managers, professional staff, patients and families, and including legal, health system and local institutional support. At the local level, implementation could be based on a translating-evidence-into-practice framework. Applying this framework would involve the formation of teams, training, measurement and identification of local barriers to achieving universal disclosure of adverse events. Significance for public health It is inevitable that some patients will be harmed rather than helped by health care. There is consensus that patients and their families must be told about these harmful events. However, there are gaps between patient and physician attitudes about how errors should be handled, and between disclosure policies and their implementation. There are important barriers that impede disclosure, including fear of consequences, attitudes about disclosure, lack of skill, and lack of institutional support. A related problem is that of the second victim, whereby health care workers are traumatized by the same harmful events. This can impair their performance and further compromise safety. The problem is unlikely to be solved by focusing solely on increasing disclosure. A comprehensive solution is needed, directed at multiple levels of the health care system, including health departments, institutions, local managers, professional staff, patients and families, and including legal, health system and local institutional support. PMID:25170503

An Analytic Hierarchy Process-based Method to Rank the Critical Success Factors of Implementing a Pharmacy Barcode System.

PubMed

Alharthi, Hana; Sultana, Nahid; Al-Amoudi, Amjaad; Basudan, Afrah

2015-01-01

Pharmacy barcode scanning is used to reduce errors during the medication dispensing process. However, this technology has rarely been used in hospital pharmacies in Saudi Arabia. This article describes the barriers to successful implementation of a barcode scanning system in Saudi Arabia. A literature review was conducted to identify the relevant critical success factors (CSFs) for a successful dispensing barcode system implementation. Twenty-eight pharmacists from a local hospital in Saudi Arabia were interviewed to obtain their perception of these CSFs. In this study, planning (process flow issues and training requirements), resistance (fear of change, communication issues, and negative perceptions about technology), and technology (software, hardware, and vendor support) were identified as the main barriers. The analytic hierarchy process (AHP), one of the most widely used tools for decision making in the presence of multiple criteria, was used to compare and rank these identified CSFs. The results of this study suggest that resistance barriers have a greater impact than planning and technology barriers. In particular, fear of change is the most critical factor, and training is the least critical factor.

A dynamic in vivo-like organotypic blood-brain barrier model to probe metastatic brain tumors

NASA Astrophysics Data System (ADS)

Xu, Hui; Li, Zhongyu; Yu, Yue; Sizdahkhani, Saman; Ho, Winson S.; Yin, Fangchao; Wang, Li; Zhu, Guoli; Zhang, Min; Jiang, Lei; Zhuang, Zhengping; Qin, Jianhua

2016-11-01

The blood-brain barrier (BBB) restricts the uptake of many neuro-therapeutic molecules, presenting a formidable hurdle to drug development in brain diseases. We proposed a new and dynamic in vivo-like three-dimensional microfluidic system that replicates the key structural, functional and mechanical properties of the blood-brain barrier in vivo. Multiple factors in this system work synergistically to accentuate BBB-specific attributes-permitting the analysis of complex organ-level responses in both normal and pathological microenvironments in brain tumors. The complex BBB microenvironment is reproduced in this system via physical cell-cell interaction, vascular mechanical cues and cell migration. This model possesses the unique capability to examine brain metastasis of human lung, breast and melanoma cells and their therapeutic responses to chemotherapy. The results suggest that the interactions between cancer cells and astrocytes in BBB microenvironment might affect the ability of malignant brain tumors to traverse between brain and vascular compartments. Furthermore, quantification of spatially resolved barrier functions exists within a single assay, providing a versatile and valuable platform for pharmaceutical development, drug testing and neuroscientific research.

A Multi-Level Examination of Stakeholder Perspectives of Implementation of Evidence-Based Practices in a Large Urban Publicly-Funded Mental Health System.

PubMed

Beidas, Rinad S; Stewart, Rebecca E; Adams, Danielle R; Fernandez, Tara; Lustbader, Susanna; Powell, Byron J; Aarons, Gregory A; Hoagwood, Kimberly E; Evans, Arthur C; Hurford, Matthew O; Rubin, Ronnie; Hadley, Trevor; Mandell, David S; Barg, Frances K

2016-11-01

Our goal was to identify barriers and facilitators to the implementation of evidence-based practices from the perspectives of multiple stakeholders in a large publicly funded mental health system. We completed 56 interviews with three stakeholder groups: treatment developers (n = 7), agency administrators (n = 33), and system leadership (n = 16). The three stakeholder groups converged on the importance of inner (e.g., agency competing resources and demands, therapist educational background) and outer context (e.g., funding) factors as barriers to implementation. Potential threats to implementation and sustainability included the fiscal landscape of community mental health clinics and an evolving workforce. Intervention characteristics were rarely endorsed as barriers. Inner context, outer context, and intervention characteristics were all seen as important facilitators. All stakeholders endorsed the importance of coordinated collaboration across stakeholder groups within the system to successfully implement evidence-based practices.

Restriction-modification mediated barriers to exogenous DNA uptake and incorporation employed by Prevotella intermedia.

PubMed

Johnston, Christopher D; Skeete, Chelsey A; Fomenkov, Alexey; Roberts, Richard J; Rittling, Susan R

2017-01-01

Prevotella intermedia, a major periodontal pathogen, is increasingly implicated in human respiratory tract and cystic fibrosis lung infections. Nevertheless, the specific mechanisms employed by this pathogen remain only partially characterized and poorly understood, largely due to its total lack of genetic accessibility. Here, using Single Molecule, Real-Time (SMRT) genome and methylome sequencing, bisulfite sequencing, in addition to cloning and restriction analysis, we define the specific genetic barriers to exogenous DNA present in two of the most widespread laboratory strains, P. intermedia ATCC 25611 and P. intermedia Strain 17. We identified and characterized multiple restriction-modification (R-M) systems, some of which are considerably divergent between the two strains. We propose that these R-M systems are the root cause of the P. intermedia transformation barrier. Additionally, we note the presence of conserved Clustered Regularly Interspaced Short Palindromic Repeat (CRISPR) systems in both strains, which could provide a further barrier to exogenous DNA uptake and incorporation. This work will provide a valuable resource during the development of a genetic system for P. intermedia, which will be required for fundamental investigation of this organism's physiology, metabolism, and pathogenesis in human disease.

Restriction-modification mediated barriers to exogenous DNA uptake and incorporation employed by Prevotella intermedia

PubMed Central

Skeete, Chelsey A.; Fomenkov, Alexey; Roberts, Richard J.; Rittling, Susan R.

2017-01-01

Prevotella intermedia, a major periodontal pathogen, is increasingly implicated in human respiratory tract and cystic fibrosis lung infections. Nevertheless, the specific mechanisms employed by this pathogen remain only partially characterized and poorly understood, largely due to its total lack of genetic accessibility. Here, using Single Molecule, Real-Time (SMRT) genome and methylome sequencing, bisulfite sequencing, in addition to cloning and restriction analysis, we define the specific genetic barriers to exogenous DNA present in two of the most widespread laboratory strains, P. intermedia ATCC 25611 and P. intermedia Strain 17. We identified and characterized multiple restriction-modification (R-M) systems, some of which are considerably divergent between the two strains. We propose that these R-M systems are the root cause of the P. intermedia transformation barrier. Additionally, we note the presence of conserved Clustered Regularly Interspaced Short Palindromic Repeat (CRISPR) systems in both strains, which could provide a further barrier to exogenous DNA uptake and incorporation. This work will provide a valuable resource during the development of a genetic system for P. intermedia, which will be required for fundamental investigation of this organism’s physiology, metabolism, and pathogenesis in human disease. PMID:28934361

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

NASA Astrophysics Data System (ADS)

Wang, Bin; Xu, Bingqian

2014-02-01

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

Oligoclonal banding of IgG in CSF, blood-brain barrier function, and MRI findings in patients with sarcoidosis, systemic lupus erythematosus, and Behçet's disease involving the nervous system.

PubMed Central

McLean, B N; Miller, D; Thompson, E J

1995-01-01

A retrospective study of CSF and serum analysis from a total of 43 patients with sarcoidosis, 20 with systemic lupus erythematosus, and 12 with Behçet's disease with neurological involvement found local synthesis of oligoclonal IgG using isoelectric focusing and immunoblotting in 51%, 25%, and 8% respectively at some stage in their disease. Blood-brain barrier breakdown, when assessed with an albumin ratio found 47% of patients with sarcoidosis, 30% of those with systemic lupus erythematosus, and 42% of patients with Behçet's disease exhibiting abnormal barrier function at some time. Serial CSF analysis showed that clinical relapses were associated with worsening barrier function and in some patients the development of local oligoclonal IgG synthesis; conversely steroid treatment led to a statistically significant improvement in barrier function, and in two patients a loss of oligoclonal IgG bands. A higher proportion of patients had MRI abnormalities than oligoclonal IgG or blood-brain barrier breakdown, MRI being abnormal in 16 of 19 patients with sarcoidosis, three of four patients with systemic lupus erythematosus, and seven of nine patients with Behçet's disease, although this may have been due to temporal factors. In the differential diagnosis of chronic neurological disorders, locally synthesised oligoclonal IgG cannot distinguish between diseases, but the loss of bands seen in two patients contrasts with what is seen in multiple sclerosis, and thus may be a useful diagnostic clue. PMID:7745401

Understanding the free energy barrier and multiple timescale dynamics of charge separation in organic photovoltaic cells.

PubMed

Yan, Yaming; Song, Linze; Shi, Qiang

2018-02-28

By employing several lattice model systems, we investigate the free energy barrier and real-time dynamics of charge separation in organic photovoltaic (OPV) cells. It is found that the combined effects of the external electric field, entropy, and charge delocalization reduce the free energy barrier significantly. The dynamic disorder reduces charge carrier delocalization and results in the increased charge separation barrier, while the effect of static disorder is more complicated. Simulation of the real-time dynamics indicates that the free charge generation process involves multiple time scales, including an ultrafast component within hundreds of femtoseconds, an intermediate component related to the relaxation of the hot charge transfer (CT) state, and a slow component on the time scale of tens of picoseconds from the thermally equilibrated CT state. Effects of hot exciton dissociation as well as its dependence on the energy offset between the Frenkel exciton and the CT state are also analyzed. The current results indicate that only a small energy offset between the band gap and the lowest energy CT state is needed to achieve efficient free charge generation in OPV devices, which agrees with recent experimental findings.

Understanding the free energy barrier and multiple timescale dynamics of charge separation in organic photovoltaic cells

NASA Astrophysics Data System (ADS)

Yan, Yaming; Song, Linze; Shi, Qiang

2018-02-01

By employing several lattice model systems, we investigate the free energy barrier and real-time dynamics of charge separation in organic photovoltaic (OPV) cells. It is found that the combined effects of the external electric field, entropy, and charge delocalization reduce the free energy barrier significantly. The dynamic disorder reduces charge carrier delocalization and results in the increased charge separation barrier, while the effect of static disorder is more complicated. Simulation of the real-time dynamics indicates that the free charge generation process involves multiple time scales, including an ultrafast component within hundreds of femtoseconds, an intermediate component related to the relaxation of the hot charge transfer (CT) state, and a slow component on the time scale of tens of picoseconds from the thermally equilibrated CT state. Effects of hot exciton dissociation as well as its dependence on the energy offset between the Frenkel exciton and the CT state are also analyzed. The current results indicate that only a small energy offset between the band gap and the lowest energy CT state is needed to achieve efficient free charge generation in OPV devices, which agrees with recent experimental findings.

Access to the US Department of Veterans Affairs health system: self-reported barriers to care among returnees of Operations Enduring Freedom and Iraqi Freedom

PubMed Central

2013-01-01

Background The U.S. Department of Veterans Affairs (VA) implemented the Polytrauma System of Care to meet the health care needs of military and veterans with multiple injuries returning from combat operations in Afghanistan and Iraq. Studies are needed to systematically assess barriers to use of comprehensive and exclusive VA healthcare services from the perspective of veterans with polytrauma and with other complex health outcomes following their service in Afghanistan and Iraq. These perspectives can inform policy with regard to the optimal delivery of care to returning veterans. Methods We studied combat veterans (n = 359) from two polytrauma rehabilitation centers using structured clinical interviews and qualitative open-ended questions, augmented with data collected from electronic health records. Our outcomes included several measures of exclusive utilization of VA care with our primary exposure as reported access barriers to care. Results Nearly two thirds of the veterans reported one or more barriers to their exclusive use of VA healthcare services. These barriers predicted differences in exclusive use of VA healthcare services. Experiencing any barriers doubled the returnees’ odds of not using VA exclusively, the geographic distance to VA barrier resulted in a 7 fold increase in the returnees odds of not using VA, and reporting a wait time barrier doubled the returnee’s odds of not using VA. There were no striking differences in access barriers for veterans with polytrauma compared to other returning veterans, suggesting the barriers may be uniform barriers that predict differences in using the VA exclusively for health care. Conclusions This study provides an initial description of utilization of VA polytrauma rehabilitation and other medical care for veteran returnees from all military services who were involved in combat operations in Afghanistan or Iraq. Our findings indicate that these veterans reported important stigmatization and barriers to receiving services exclusively from the VA, including mutable health delivery system factors. PMID:24289747

Health information system linkage and coordination are critical for increasing access to secondary prevention in Aboriginal health: a qualitative study.

PubMed

Digiacomo, Michelle; Davidson, Patricia M; Taylor, Kate P; Smith, Julie S; Dimer, Lyn; Ali, Mohammed; Wood, Marianne M; Leahy, Timothy G; Thompson, Sandra C

2010-01-01

Aboriginal Australians have low rates of participation in cardiac rehabilitation (CR), despite having high rates of cardiovascular disease. Barriers to CR participation reflect multiple patient-related issues. However, an examination of the broader context of health service delivery design and implementation is needed. To identify health professionals' perspectives of systems related barriers to implementation of the National Health and Medical Research Council (NHMRC) guidelines Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander Peoples. Semi-structured interviews were conducted with health professionals involved in CR within mainstream and Aboriginal Community Controlled Health Services in Western Australia (WA). Thirty-eight health professionals from 17 services (ten rural, seven metropolitan) listed in the WA Directory of CR services and seven Aboriginal Medical Services in WA were interviewed. Respondents reported barriers encountered in health information management and the impact of access to CR services for Aboriginal people. Crucial issues identified by participants were: poor communication across the health care sector and between providers, inconsistent and insufficient data collection processes (particularly relating to Aboriginal ethnicity identification), and challenges resulting from multiple clinical information systems and incompatible technologies. This study has demonstrated that inadequate information systems and communication strategies, particularly those representing the interface between primary and secondary care, contribute to the low participation rates of Aboriginal Australians in CR. Although these challenges are shared by non-Aboriginal Australians, the needs are greater for Aboriginal Australians and innovative solutions are required.

InGaP Heterojunction Barrier Solar Cells

NASA Technical Reports Server (NTRS)

Welser, Roger E.

2010-01-01

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

A qualitative, interprofessional analysis of barriers to and facilitators of implementation of the Department of Veterans Affairs' Clostridium difficile prevention bundle using a human factors engineering approach.

PubMed

Yanke, Eric; Moriarty, Helene; Carayon, Pascale; Safdar, Nasia

2018-03-01

Clostridium difficile infection (CDI) is increasingly prevalent, severe, and costly. Adherence to infection prevention practices remains suboptimal. More effective strategies to implement guidelines and evidence are needed. Interprofessional focus groups consisting of physicians, resident physicians, nurses, and health technicians were conducted for a quality improvement project evaluating adherence to the Department of Veterans Affairs' (VA) nationally mandated C difficile prevention bundle. Qualitative analysis with a visual matrix display identified barrier and facilitator themes guided by the Systems Engineering Initiative for Patient Safety model, a human factors engineering approach. Several themes, encompassing both barriers and facilitators to bundle adherence, emerged. Rapid turnaround time of C difficile polymerase chain reaction testing was a facilitator of timely diagnosis. Too few, poorly located, and cluttered sinks were barriers to appropriate hand hygiene. Patient care workload and the time-consuming process of contact isolation precautions were also barriers to adherence. Multiple work system components serve as barriers to and facilitators of adherence to the VA CDI prevention bundle among an interprofessional group of health care workers. Organizational factors appear to significantly influence bundle adherence. Interprofessional perspectives are needed to identify barriers to and facilitators of bundle implementation, which is a necessary first step to address adherence to bundled infection prevention practices. Published by Elsevier Inc.

Early Detection of Junctional Adhesion Molecule-1 (JAM-1) in the Circulation after Experimental and Clinical Polytrauma

PubMed Central

Denk, Stephanie; Wiegner, Rebecca; Hönes, Felix M.; Messerer, David A. C.; Radermacher, Peter; Kalbitz, Miriam; Braumüller, Sonja; McCook, Oscar; Gebhard, Florian; Weckbach, Sebastian; Huber-Lang, Markus

2015-01-01

Severe tissue trauma-induced systemic inflammation is often accompanied by evident or occult blood-organ barrier dysfunctions, frequently leading to multiple organ dysfunction. However, it is unknown whether specific barrier molecules are shed into the circulation early after trauma as potential indicators of an initial barrier dysfunction. The release of the barrier molecule junctional adhesion molecule-1 (JAM-1) was investigated in plasma of C57BL/6 mice 2 h after experimental mono- and polytrauma as well as in polytrauma patients (ISS ≥ 18) during a 10-day period. Correlation analyses were performed to indicate a linkage between JAM-1 plasma concentrations and organ failure. JAM-1 was systemically detected after experimental trauma in mice with blunt chest trauma as a driving force. Accordingly, JAM-1 was reduced in lung tissue after pulmonary contusion and JAM-1 plasma levels significantly correlated with increased protein levels in the bronchoalveolar lavage as a sign for alveolocapillary barrier dysfunction. Furthermore, JAM-1 was markedly released into the plasma of polytrauma patients as early as 4 h after the trauma insult and significantly correlated with severity of disease and organ dysfunction (APACHE II and SOFA score). The data support an early injury- and time-dependent appearance of the barrier molecule JAM-1 in the circulation indicative of a commencing trauma-induced barrier dysfunction. PMID:26556956

Barriers to and facilitators of the acceptance process for individuals with serious mental illness.

PubMed

Mizock, Lauren; Russinova, Zlatka; Millner, Uma Chandrika

2014-09-01

The process of acceptance of mental illness is a central component of recovery and has been linked to functioning, illness management, and quality of life. A number of barriers and facilitators have been theorized as impacting this process. This study was conducted with 30 participants with serious mental illness (a major psychiatric disorder with impairment in multiple areas of functioning) to elicit the barriers to and facilitators of the acceptance of mental illness. Grounded theory methodology was utilized to analyze the 30 semistructured interviews. Results revealed barriers to and facilitators of acceptance of mental illness at the micro level (cognitive, emotional, behavioral, identity-related), meso level (relational), and macro level (cultural, systemic). Clinical and research implications are discussed with regard to facilitating acceptance of mental illness. © The Author(s) 2014.

Barriers to rehabilitative care for young breast cancer survivors: a qualitative understanding.

PubMed

Miedema, Baukje; Easley, Julie

2012-06-01

The goal of this study was to assess the rehabilitation needs of young women breast cancer survivors under the age of 50 and to identify factors that may impact or prevent cancer rehabilitation utilization. Utilizing a grounded theory methodology, 35 young breast cancer survivors were interviewed twice in four Atlantic Canadian provinces. A considerable number of barriers exist to receiving rehabilitative care post-treatment for young breast cancer survivors. The systemic barriers include the lack of availability of services, travel issues, cost of services, and the lack of support to address the unique needs for this age group. However, the most complicated barriers to accessing rehabilitative care were personal barriers which related more to choice and circumstances, such as the lack of time due to family responsibilities and appointment fatigue. Many of these personal barriers were rooted in the complex set of gender roles of young women as patients, mothers, workers, and caregivers. The contexts of young women's lives can have a substantial impact on their decisions to seek and receive rehabilitative care after breast cancer treatment. The systemic barriers can be reduced by introducing more services or financial assistance; however, the personal barriers to rehabilitation services are difficult to ameliorate due to the complex set of roles within and outside the family for this group of young breast cancer survivors. Health care providers need to take into consideration the multiple contexts of women's lives when developing and promoting breast cancer rehabilitation services and programs.

Neuro-immune interactions at barrier surfaces

PubMed Central

Veiga-Fernandes, Henrique; Mucida, Daniel

2016-01-01

Multidirectional interactions between the nervous and immune systems have been documented in homeostasis and pathologies ranging from multiple sclerosis to autism, and from leukemia to acute and chronic inflammation. Recent studies have addressed this crosstalk using cell-specific targeting, novel sequencing, imaging and analytical tools, shedding light on unappreciated mechanisms of neuro-immune regulation. This review focuses on neuro-immune interactions at barrier surfaces, mostly the gut, but also including the skin and the airways, areas densely populated by neurons and immune cells that constantly sense and adapt to tissue-specific environmental challenges. PMID:27153494

Fission Meter Information Barrier Attribute Measurement System: Task 1 Report: Document existing Fission Meter neutron IB system

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

Kerr, P. L.

An SNM attribute Information Barrier (IB) system was developed for a 2011 US/UK Exercise. The system was modified and extensively tested in a 2013-2014 US-UK Measurement Campaign. This work demonstrated rapid deployment of an IB system for potential treaty use. The system utilizes an Ortec Fission Meter neutron multiplicity counter and custom computer code. The system demonstrates a proof-of-principle automated Pu-240 mass determination with an information barrier. After a software start command is issued, the system automatically acquires and downloads data, performs an analysis, and displays the results. This system conveys the results of a Pu mass threshold measurements inmore » a way the does not reveal sensitive information. In full IB mode, only red/green ‘lights’ are displayed in the software. In test mode, more detailed information is displayed. The code can also read in, analyze, and display results from previously acquired or simulated data. Because the equipment is commercial-off-the-shelf (COTS), the system demonstrates a low-cost short-lead-time technology for treaty SNM attribute measurements. A deployed system will likely require integration of additional authentication and tamper-indicating technologies. This will be discussed for the project in this and future progress reports.« less

Epstein Barr Virus and Blood Brain Barrier in Multiple Sclerosis

DTIC Science & Technology

2013-07-01

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

Emerging potential of stimulus-responsive nanosized anticancer drug delivery systems for systemic applications.

PubMed

Ruttala, Hima Bindu; Ramasamy, Thiruganesh; Madeshwaran, Thiagarajan; Hiep, Tran Tuan; Kandasamy, Umadevi; Oh, Kyung Taek; Choi, Han-Gon; Yong, Chul Soon; Kim, Jong Oh

2018-02-01

The development of novel drug delivery systems based on well-defined polymer therapeutics has led to significant improvements in the treatment of multiple disorders. Advances in material chemistry, nanotechnology, and nanomedicine have revolutionized the practices of drug delivery. Stimulus-responsive material-based nanosized drug delivery systems have remarkable properties that allow them to circumvent biological barriers and achieve targeted intracellular drug delivery. Specifically, the development of novel nanocarrier-based therapeutics is the need of the hour in managing complex diseases. In this review, we have briefly described the fundamentals of drug targeting to diseased tissues, physiological barriers in the human body, and the mechanisms/modes of drug-loaded carrier systems. To that end, this review serves as a comprehensive overview of the recent developments in stimulus-responsive drug delivery systems, with focus on their potential applications and impact on the future of drug delivery.

Shock wave attenuation by grids and orifice plates

NASA Astrophysics Data System (ADS)

Britan, A.; Igra, O.; Ben-Dor, G.; Shapiro, H.

2006-11-01

The interaction of weak shock waves with porous barriers of different geometries and porosities is examined. Installing a barrier inside the shock tube test section will cause the development of the following wave pattern upon a head-on collision between the incident shock wave and the barrier: a reflected shock from the barrier and a transmitted shock propagating towards the shock tube end wall. Once the transmitted shock wave reaches the end wall it is reflected back towards the barrier. This is the beginning of multiple reflections between the barrier and the end wall. This full cycle of shock reflections/interactions resulting from the incident shock wave collision with the barrier can be studied in a single shock tube test. A one-dimensional (1D), inviscid flow model was proposed for simulating the flow resulting from the initial collision of the incident shock wave with the barrier. Fairly good agreement is found between experimental findings and simulations based on a 1D flow model. Based on obtained numerical and experimental findings an optimal design procedure for shock wave attenuator is suggested. The suggested attenuator may ensure the safety of the shelter’s ventilation systems.

Teacher Evaluation in Colorado: How Policy Frustrates Practice

ERIC Educational Resources Information Center

Ramirez, Al; Clouse, Wendi; Davis, Kristyn White

2014-01-01

This article is a report of a study that used data from multiple sources to explore the hypothesis that systemic barriers inherent in Colorado's teacher evaluation policies often contribute to ineffective teacher evaluations across the state. Data were collected from extant studies, focus groups, and surveys of teachers, site administrators/head…

Using concept mapping in the knowledge-to-action process to compare stakeholder opinions on barriers to use of cancer screening among South Asians.

PubMed

Lobb, Rebecca; Pinto, Andrew D; Lofters, Aisha

2013-03-23

Using the knowledge-to-action (KTA) process, this study examined barriers to use of evidence-based interventions to improve early detection of cancer among South Asians from the perspective of multiple stakeholders. In 2011, we used concept mapping with South Asian residents, and representatives from health service and community service organizations in the region of Peel Ontario. As part of concept mapping procedures, brainstorming sessions were conducted with stakeholders (n = 53) to identify barriers to cancer screening among South Asians. Participants (n = 46) sorted barriers into groups, and rated barriers from lowest (1) to highest (6) in terms of importance for use of mammograms, Pap tests and fecal occult blood tests, and how feasible it would be to address them. Multi-dimensional scaling, cluster analysis, and descriptive statistics were used to analyze the data. A total of 45 unique barriers to use of mammograms, Pap tests, and fecal occult blood tests among South Asians were classified into seven clusters using concept mapping procedures: patient's beliefs, fears, lack of social support; health system; limited knowledge among residents; limited knowledge among physicians; health education programs; ethno-cultural discordance with the health system; and cost. Overall, the top three ranked clusters of barriers were 'limited knowledge among residents,' 'ethno-cultural discordance,' and 'health education programs' across surveys. Only residents ranked 'cost' second in importance for fecal occult blood testing, and stakeholders from health service organizations ranked 'limited knowledge among physicians' third for the feasibility survey. Stakeholders from health services organizations ranked 'limited knowledge among physicians' fourth for all other surveys, but this cluster consistently ranked lowest among residents. The limited reach of cancer control programs to racial and ethnic minority groups is a critical implementation issue that requires attention. Opinions of community service and health service organizations on why this deficit in implementation occurs are fundamental to understanding the solutions because these are the settings in which evidence-based interventions are implemented. Using concept mapping within a KTA process can facilitate the engagement of multiple stakeholders in the utilization of study results and in identifying next steps for action.

Identification of potential barriers to nurse-sensitive outcome demonstration.

PubMed

Beckel, Jean; Wolf, Gail; Wilson, Roxanne; Hoolahan, Susan

2013-12-01

The objective of this study was to determine differences in chief nursing officer, Magnet(®) program director, nurse leader, and direct care RN perspectives of potential barriers to demonstration of nurse-sensitive outcomes. The Magnet Recognition Program(®) and other designations are focusing on patient outcomes. No evidence is available addressing barriers to demonstration of nursing outcomes at multiple levels of practice. A Likert scale tool was developed and administered to 526 attendees at the 2012 national Magnet conference. Questions related to available resources, benchmarks, outcome demonstration process understanding, perception of value, and competing priorities. Significant perception differences by role were demonstrated related to available resources, competing priorities, and process understanding supporting demonstration of nurse-sensitive outcomes. No significant differences were identified related to benchmarks or perception of process value to the organization. This study provides new information demonstrating potential barriers to demonstration of nurse-sensitive outcomes differing by role. Opportunity exists to develop systems and processes to reduce perceived barriers among the nursing workforce.

Listening to rural Hispanic immigrants in the Midwest: a community-based participatory assessment of major barriers to health care access and use.

PubMed

Cristancho, Sergio; Garces, D Marcela; Peters, Karen E; Mueller, Benjamin C

2008-05-01

Hispanic immigrants are increasingly residing in rural communities, including in the midwestern United States. Limitations in the ability of rural Hispanics to access and utilize health care contribute to patterns of poor health and health disparity. A conceptual model of "vulnerability" guides this community-based participatory assessment project designed to explore rural Hispanics' perceived barriers to accessing and utilizing health care. Findings from a series of 19 focus groups with 181 participants from three communities in the upper Midwest identified perceived barriers at the individual and health care system levels. The most commonly perceived barriers were the lack of and limitations in health insurance coverage, high costs of health care services, communication issues involving patients and providers, legal status/discrimination, and transportation concerns. Findings imply that these barriers could be addressed using multiple educational and health service delivery policy-related strategies that consider the vulnerable nature of this growing population.

Integrating surgical robots into the next medical toolkit.

PubMed

Lai, Fuji; Entin, Eileen

2006-01-01

Surgical robots hold much promise for revolutionizing the field of surgery and improving surgical care. However, despite the potential advantages they offer, there are multiple barriers to adoption and integration into practice that may prevent these systems from realizing their full potential benefit. This study elucidated some of the most salient considerations that need to be addressed for integration of new technologies such as robotic systems into the operating room of the future as it evolves into a complex system of systems. We conducted in-depth interviews with operating room team members and other stakeholders to identify potential barriers in areas of workflow, teamwork, training, clinical acceptance, and human-system interaction. The findings of this study will inform an approach for the design and integration of robotics and related computer-assisted technologies into the next medical toolkit for "computer-enhanced surgery" to improve patient safety and healthcare quality.

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.

Barriers and facilitators to family planning access in Canada.

PubMed

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

2015-02-01

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

Laser-Based Optical System for Reactive Radical Concentration Measurements in Plasmas and Flames

DTIC Science & Technology

2006-08-01

role of different plasma components in chain propagation support: (1) and (2) - corona plasma generators with high-voltage multiple needle electrodes ; (3...H20 2) and HCN. Measurements in Gliding Arc, Dielectric Barrier Discharge and Pulsed Corona Plasma systems and in flame and flow reactor systems are...discharges operating in air with iron electrodes - 260V.35 Using visual quantification from high speed camera arc images, the approximate thickness of

Barriers to Clinical Trial Enrollment in Racial and Ethnic Minority Patients With Cancer

PubMed Central

Hamel, Lauren M.; Penner, Louis A.; Albrecht, Terrance L.; Heath, Elisabeth; Gwede, Clement K.; Eggly, Susan

2016-01-01

Background Clinical trials that study cancer are essential for testing the safety and effectiveness of promising treatments, but most people with cancer never enroll in a clinical trial — a challenge exemplified in racial and ethnic minorities. Underenrollment of racial and ethnic minorities reduces the generalizability of research findings and represents a disparity in access to high-quality health care. Methods Using a multilevel model as a framework, potential barriers to trial enrollment of racial and ethnic minorities were identified at system, individual, and interpersonal levels. Exactly how each level directly or indirectly contributes to doctor–patient communication was also reviewed. Selected examples of implemented interventions are included to help address these barriers. We then propose our own evidence-based intervention addressing barriers at the individual and interpersonal levels. Results Barriers to enrolling a diverse population of patients in clinical trials are complex and multilevel. Interventions focused at each level have been relatively successful, but multilevel interventions have the greatest potential for success. Conclusion To increase the enrollment of racial and ethnic minorities in clinical trials, future interventions should address barriers at multiple levels. PMID:27842322

Thick thermal barrier coatings for diesel components

NASA Technical Reports Server (NTRS)

Yonushonis, T. M.

1991-01-01

An engineered thick thermal barrier coating consisting of multiple layers of zirconia and CoCrAlY with a zirconia top layer and having a system thermal conductance less than 410 w/m(exp 2)K exceeded the 100 hour engine durability goals set forth in this program. The thermal barrier coatings were intact at the test conclusion. Back to back single cylinder research engine tests were conducted with watercooled, metal hardware and oil-cooled, thermal barrier coating insulated hardware to determine apparent heat release and fuel economy. Apparent heat release data revealed that the insulated engine had a shorter ignition delay and a longer combustion duration than the metal engine. The insulated engine fuel economy was approximately two percent worse on average for this series of tests. There was no attempt to optimize engine efficiency of the insulated engine by modifying the engine timing, coating, or other techniques.

Facilitators & Barriers to the Adoption of Ergonomic Solutions in Construction

PubMed Central

Dale, Ann Marie; Jaegers, Lisa; Welch, Laura; Barnidge, Ellen; Weaver, Nancy; Evanoff, Bradley A.

2017-01-01

Background Rates of musculoskeletal disorders in construction remain high. Few studies have described barriers and facilitators to the use of available ergonomic solutions. This paper describes these barriers and facilitators and their relationship to the level of adoption. Methods Three analysts rated 16 proposed ergonomic solutions from a participatory ergonomics study and assessed the level of adoption, six adoption characteristics, and identified the category of adoption from a theoretical model. Results Twelve solutions were always or intermittently used and were rated positively for characteristics of relative advantage, compatibility with existing work processes, and trialability. Locus of control (worker vs. contractor) was not related to adoption. Simple solutions faced fewer barriers to adoption than those rated as complex. Conclusions Specific adoption characteristics can help predict the use of new ergonomic solutions in construction. Adoption of complex solutions must involve multiple stakeholders, more time, and shifts in culture or work systems. PMID:28195660

The role of information system in multiple sclerosis management

PubMed Central

Ajami, Sima; Ahmadi, Golchehreh; Etemadifar, Masoud

2014-01-01

Multiple sclerosis (MS) is a chronic disease of central nervous system. The multiple sclerosis information system (MSIS), such as other information system (IS), depends on identification, collection and processing of data for producing useful information. Lack of the integrated IS for collecting standard data causes undesirable effects on exchanging, comparing, and managing. The aim of this study was to recognize the role of the IS in the MS management and determine the advantages and barriers in implementing of the MSIS. The present study was a nonsystematized review that was done in order to recognize the role of the IS in the MS management. In this study, electronic scientific resources such as scientific magazines and books and published topics at conferences were used. We used key words (IS, chronic disease management, and multiple sclerosis), their combination or their synonyms in title, key words, abstracts, and text of English articles and published reports from 1980 until 2013, and by using search engines such as Google, Google Scholar and scientific databases and electronic issues such as iPubMed, sufficiently important difference, Scopus, Medlib, and Magiran for gathering information. More than 200 articles and reports were collected and assessed and 139 of them. Findings showed that the MSIS can reduce of disease expenses through continuously collecting correct, accurate, sufficient, and timely patients and disease nature information; recoding; editing; processing; exchanging, and distributing among different health care centers. Although the MSIS has many advantages; but, we cannot ignore cultural, economic, technical, organizational, and managerial barriers. Therefore, it is necessary to do studies for preventing, reducing, and controlling them. One of the ways is to recognize the advantages of the MSIS and usage information technology in optimizing disease management. PMID:25709660

The role of information system in multiple sclerosis management.

PubMed

Ajami, Sima; Ahmadi, Golchehreh; Etemadifar, Masoud

2014-12-01

Multiple sclerosis (MS) is a chronic disease of central nervous system. The multiple sclerosis information system (MSIS), such as other information system (IS), depends on identification, collection and processing of data for producing useful information. Lack of the integrated IS for collecting standard data causes undesirable effects on exchanging, comparing, and managing. The aim of this study was to recognize the role of the IS in the MS management and determine the advantages and barriers in implementing of the MSIS. The present study was a nonsystematized review that was done in order to recognize the role of the IS in the MS management. In this study, electronic scientific resources such as scientific magazines and books and published topics at conferences were used. We used key words (IS, chronic disease management, and multiple sclerosis), their combination or their synonyms in title, key words, abstracts, and text of English articles and published reports from 1980 until 2013, and by using search engines such as Google, Google Scholar and scientific databases and electronic issues such as iPubMed, sufficiently important difference, Scopus, Medlib, and Magiran for gathering information. More than 200 articles and reports were collected and assessed and 139 of them. Findings showed that the MSIS can reduce of disease expenses through continuously collecting correct, accurate, sufficient, and timely patients and disease nature information; recoding; editing; processing; exchanging, and distributing among different health care centers. Although the MSIS has many advantages; but, we cannot ignore cultural, economic, technical, organizational, and managerial barriers. Therefore, it is necessary to do studies for preventing, reducing, and controlling them. One of the ways is to recognize the advantages of the MSIS and usage information technology in optimizing disease management.

A Multiple Indicators Multiple Causes (MIMIC) model of internal barriers to drug treatment in China.

PubMed

Qi, Chang; Kelly, Brian C; Liao, Yanhui; He, Haoyu; Luo, Tao; Deng, Huiqiong; Liu, Tieqiao; Hao, Wei; Wang, Jichuan

2015-03-01

Although evidence exists for distinct barriers to drug abuse treatment (BDATs), investigations of their inter-relationships and the effect of individual characteristics on the barrier factors have been sparse, especially in China. A Multiple Indicators Multiple Causes (MIMIC) model is applied for this target. A sample of 262 drug users were recruited from three drug rehabilitation centers in Hunan Province, China. We applied a MIMIC approach to investigate the effect of gender, age, marital status, education, primary substance use, duration of primary drug use, and drug treatment experience on the internal barrier factors: absence of problem (AP), negative social support (NSS), fear of treatment (FT), and privacy concerns (PC). Drug users of various characteristics were found to report different internal barrier factors. Younger participants were more likely to report NSS (-0.19, p=0.038) and PC (-0.31, p<0.001). Compared to other drug users, ice users were more likely to report AP (0.44, p<0.001) and NSS (0.25, p=0.010). Drug treatment experiences related to AP (0.20, p=0.012). In addition, differential item functioning (DIF) occurred in three items when participant from groups with different duration of drug use, ice use, or marital status. Individual characteristics had significant effects on internal barriers to drug treatment. On this basis, BDAT perceived by different individuals could be assessed before tactics were utilized to successfully remove perceived barriers to drug treatment. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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

PubMed

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

2018-01-01

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

Patient Perspectives on Language Discordance During Healthcare Visits: Findings From the Extremely High-Density Multicultural State of Qatar.

PubMed

Abdelrahim, Huda; Elnashar, Maha; Khidir, Amal; Killawi, Amal; Hammoud, Maya; Al-Khal, Abdul Latif; Fetters, Michael D

2017-04-01

Reducing language and cultural barriers in healthcare are significant factors in resolving health disparities. Qatar's rapidly growing multicultural population presents new challenges to the healthcare system. The purpose of this research was to explore patients' perspectives about language discordance, and the strategies used to overcome language barriers during patients' visits. Participants were recruited and interviewed from four language groups (Arabic = 24, English = 20, Hindi = 20, and Urdu = 20), all of whom were living in Qatar and utilizing Hamad General Hospital-Outpatient Clinics as a source of their healthcare services. Using qualitative analysis procedures, relevant themes and codes were generated and data analyzed using Atlas-ti. As for results, most participants had experienced or witnessed language barriers during their outpatient clinics visits. Participants essentially were unfamiliar with professional medical interpreters and described their adaptive solutions, for example utilizing incidental interpreters, stringing together fragments of multiple languages, and using body language. Those not speaking mainstream languages of Hamad General Hospital (English and Arabic) were more vulnerable to health disparities due to language barriers. Despite the patient impetus to do something, patient-reported adaptive strategies could compromise patients' safety and access to quality healthcare. Polices tackling the language barrier need to be reviewed in Qatar's multicultural healthcare system and similar settings.

Access to medicines from a health system perspective

PubMed Central

Bigdeli, Maryam; Jacobs, Bart; Tomson, Goran; Laing, Richard; Ghaffar, Abdul; Dujardin, Bruno; Van Damme, Wim

2013-01-01

Most health system strengthening interventions ignore interconnections between systems components. In particular, complex relationships between medicines and health financing, human resources, health information and service delivery are not given sufficient consideration. As a consequence, populations' access to medicines (ATM) is addressed mainly through fragmented, often vertical approaches usually focusing on supply, unrelated to the wider issue of access to health services and interventions. The objective of this article is to embed ATM in a health system perspective. For this purpose, we perform a structured literature review: we examine existing ATM frameworks, review determinants of ATM and define at which level of the health system they are likely to occur; we analyse to which extent existing ATM frameworks take into account access constraints at different levels of the health system. Our findings suggest that ATM barriers are complex and interconnected as they occur at multiple levels of the health system. Existing ATM frameworks only partially address the full range of ATM barriers. We propose three essential paradigm shifts that take into account complex and dynamic relationships between medicines and other components of the health system. A holistic view of demand-side constraints in tandem with consideration of multiple and dynamic relationships between medicines and other health system resources should be applied; it should be recognized that determinants of ATM are rooted in national, regional and international contexts. These are schematized in a new framework proposing a health system perspective on ATM. PMID:23174879

Using a Classroom Response System to Improve Multiple-Choice Performance in AP® Physics

NASA Astrophysics Data System (ADS)

Bertrand, Peggy

2009-04-01

Participation in rigorous high school courses such as Advanced Placement (AP®) Physics increases the likelihood of college success, especially for students who are traditionally underserved. Tackling difficult multiple-choice exams should be part of any AP program because well-constructed multiple-choice questions, such as those on AP exams and on the Force Concept Inventory,2 are particularly good at rooting out common and persisting student misconceptions. Additionally, there are barriers to multiple-choice performance that have little to do with content mastery. For example, a student might fail to read the question thoroughly, forget to apply a reasonableness test to the answer, or simply work too slowly.

Nature, nurture, and microbes: The development of multiple sclerosis.

PubMed

Wekerle, H

2017-11-01

This paper argues that multiple sclerosis (MS) is the result of an autoimmune attack against components of the central nervous system (CNS). The effector cells involved in the pathogenic process are CNS-autoreactive T cells present in the healthy immune system in a resting state. Upon activation, these cells cross the blood-brain barrier and attack the CNS target tissue. Recent evidence indicates that autoimmune activation may happen in the intestine, following an interaction of bacterial components of the gut flora with local CNS autoreactive T cells. The consequences of this concept are discussed. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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

PubMed Central

Räsänen, Katja; Hendry, Andrew P

2014-01-01

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

Planning and Implementing Total Quality Management in the Royal Australian Air Force: A Multiple Case Study Analysis

DTIC Science & Technology

1990-09-01

change barriers, and necessary checks and balances built into processes. Furthermore, this assessment should address management system variables which...organisation’s 69 immediate product and their worklife . Focus must be maintained on improving RAAF processes. In addition to a quality committee structure as

Replication of human noroviruses in stem cell-derived human enteroids

USDA-ARS?s Scientific Manuscript database

The major barrier to research and development of effective interventions for human noroviruses (HuNoVs) has been the lack of a robust and reproducible in vitro cultivation system. HuNoVs are the leading cause of gastroenteritis worldwide. We report successful cultivation of multiple HuNoV strains in...

Limiting the public cost of stationary battery deployment by combining applications

NASA Astrophysics Data System (ADS)

Stephan, A.; Battke, B.; Beuse, M. D.; Clausdeinken, J. H.; Schmidt, T. S.

2016-07-01

Batteries could be central to low-carbon energy systems with high shares of intermittent renewable energy sources. However, the investment attractiveness of batteries is still perceived as low, eliciting calls for policy to support deployment. Here we show how the cost of battery deployment can potentially be minimized by introducing an aspect that has been largely overlooked in policy debates and underlying analyses: the fact that a single battery can serve multiple applications. Batteries thereby can not only tap into different value streams, but also combine different risk exposures. To address this gap, we develop a techno-economic model and apply it to the case of lithium-ion batteries serving multiple stationary applications in Germany. Our results show that batteries could be attractive for investors even now if non-market barriers impeding the combination of applications were removed. The current policy debate should therefore be refocused so as to encompass the removal of such barriers.

Harnessing the capacity of cell-penetrating peptides for drug delivery to the central nervous system.

PubMed

Kang, Ting; Gao, Xiaoling; Chen, Jun

2014-01-01

The existence of blood-brain barrier (BBB) represents the most formidable challenge for drug delivery to the central nervous system (CNS). Modern breakthrough in biology offers multiple choices for overcoming this barrier but yields modest outcomes for clinical application due to various problems such as safety concerns, insufficient delivery efficiency and poor penetration. Cell penetrating peptides (CPPs) possessing powerful transmembrane capacity have been shown to be effective transport vectors for bioactive molecules and an attractive alternative to traditional active targeting approaches. However, the non-specificity of CPPs has hindered them from targeting a desired site of action. Promisingly, design of novel CPP-mediated nanoparticulate delivery systems with specific targeting property may extricate CPPs from the dilemma. In this review, both the traditional and novel applications of CPPs-based strategies for CNS drug delivery will be discussed.

Lynch syndrome: barriers to and facilitators of screening and disease management.

PubMed

Watkins, Kathy E; Way, Christine Y; Fiander, Jacqueline J; Meadus, Robert J; Esplen, Mary Jane; Green, Jane S; Ludlow, Valerie C; Etchegary, Holly A; Parfrey, Patrick S

2011-09-07

Lynch syndrome is a hereditary cancer with confirmed carriers at high risk for colorectal (CRC) and extracolonic cancers. The purpose of the current study was to develop a greater understanding of the factors influencing decisions about disease management post-genetic testing. The study used a grounded theory approach to data collection and analysis as part of a multiphase project examining the psychosocial and behavioral impact of predictive DNA testing for Lynch syndrome. Individual and small group interviews were conducted with individuals from 10 families with the MSH2 intron 5 splice site mutation or exon 8 deletion. The data from confirmed carriers (n = 23) were subjected to re-analysis to identify key barriers to and/or facilitators of screening and disease management. Thematic analysis identified personal, health care provider and health care system factors as dominant barriers to and/or facilitators of managing Lynch syndrome. Person-centered factors reflect risk perceptions and decision-making, and enduring screening/disease management. The perceived knowledge and clinical management skills of health care providers also influenced participation in recommended protocols. The health care system barriers/facilitators are defined in terms of continuity of care and coordination of services among providers. Individuals with Lynch syndrome often encounter multiple barriers to and facilitators of disease management that go beyond the individual to the provider and health care system levels. The current organization and implementation of health care services are inadequate. A coordinated system of local services capable of providing integrated, efficient health care and follow-up, populated by providers with knowledge of hereditary cancer, is necessary to maintain optimal health.

Barriers to free antiretroviral treatment access among kothi-identified men who have sex with men and aravanis (transgender women) in Chennai, India

PubMed Central

Chakrapani, Venkatesan; Shunmugam, Murali; Dubrow, Robert

2011-01-01

The Indian government provides free antiretroviral treatment (ART) for people living with HIV. To assist in developing policies and programs to advance equity in ART access, we explored barriers to ART access among kothis (men who have sex with men whose gender expression is feminine) and aravanis (transgender women, also known as hijras) living with HIV in Chennai. In the last quarter of 2007, we conducted six focus groups and four key-informant interviews. Data were explored using framework analysis to identify categories and derive themes. We identified barriers to ART access at the family/social-level, healthcare system-level, and individual-level; however we found these barriers to be highly interrelated. The primary individual-level barrier was integrally linked to the family/social and healthcare levels: many kothis and aravanis feared serious adverse consequences if their HIV-positive status were revealed to others. Strong motivations to keep one’s HIV-positive status and same-sex attraction secret were interconnected with sexual prejudice against MSM and transgenders, and HIV stigma prevalent in families, the healthcare system, and the larger society. HIV stigma was present within kothi and aravani communities as well. Consequences of disclosure, including rejection by family, eviction from home, social isolation, loss of subsistence income, and maltreatment (although improving) within the healthcare system, presented powerful disincentives to accessing ART. Given the multi-level barriers to ART access related to stigma and discrimination, interventions to facilitate ART uptake should address multiple constituencies: the general public, healthcare providers, and the kothi and aravani communities. India needs a national policy and action plan to address barriers to ART access at family/social, healthcare system, and individual levels for aravanis, kothis, other subgroups of men who have sex with men and other marginalized groups. PMID:22117127

Barriers to free antiretroviral treatment access among kothi-identified men who have sex with men and aravanis (transgender women) in Chennai, India.

PubMed

Chakrapani, Venkatesan; Newman, Peter A; Shunmugam, Murali; Dubrow, Robert

2011-12-01

The Indian government provides free antiretroviral treatment (ART) for people living with HIV. To assist in developing policies and programs to advance equity in ART access, we explored barriers to ART access among kothis (men who have sex with men [MSM] whose gender expression is feminine) and aravanis (transgender women, also known as hijras) living with HIV in Chennai. In the last quarter of 2007, we conducted six focus groups and four key-informant interviews. Data were explored using framework analysis to identify categories and derive themes. We identified barriers to ART access at the family/social-level, health care system-level, and individual-level; however, we found these barriers to be highly interrelated. The primary individual-level barrier was integrally linked to the family/social and health care levels: many kothis and aravanis feared serious adverse consequences if their HIV-positive status were revealed to others. Strong motivations to keep one's HIV-positive status and same-sex attraction secret were interconnected with sexual prejudice against MSM and transgenders, and HIV stigma prevalent in families, the health care system, and the larger society. HIV stigma was present within kothi and aravani communities as well. Consequences of disclosure, including rejection by family, eviction from home, social isolation, loss of subsistence income, and maltreatment (although improving) within the health care system, presented powerful disincentives to accessing ART. Given the multi-level barriers to ART access related to stigma and discrimination, interventions to facilitate ART uptake should address multiple constituencies: the general public, health care providers, and the kothi and aravani communities. India needs a national policy and action plan to address barriers to ART access at family/social, health care system, and individual levels for aravanis, kothis, other subgroups of MSM and other marginalized groups.

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

NASA Astrophysics Data System (ADS)

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

2018-03-01

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

Group 3 Innate Lymphoid Cells: Communications Hubs of the Intestinal Immune System.

PubMed

Withers, David R; Hepworth, Matthew R

2017-01-01

The maintenance of mammalian health requires the generation of appropriate immune responses against a broad range of environmental and microbial challenges, which are continually encountered at barrier tissue sites including the skin, lung, and gastrointestinal tract. Dysregulated barrier immune responses result in inflammation, both locally and systemically in peripheral organs. Group 3 innate lymphoid cells (ILC3) are constitutively present at barrier sites and appear to be highly specialized in their ability to sense a range of environmental and host-derived signals. Under homeostatic conditions, ILC3 respond to local cues to maintain tissue homeostasis and restrict inflammatory responses. In contrast, perturbations in the tissue microenvironment resulting from disease, infection, or tissue damage can drive dysregulated pro-inflammatory ILC3 responses and contribute to immunopathology. The tone of the ILC3 response is dictated by a balance of "exogenous" signals, such as dietary metabolites and commensal microbes, and "endogenous" host-derived signals from stromal cells, immune cells, and the nervous system. ILC3 must therefore have the capacity to simultaneously integrate a wide array of complex and dynamic inputs in order to regulate barrier function and tissue health. In this review, we discuss the concept of ILC3 as a "communications hub" in the intestinal tract and associated lymphoid tissues and address the variety of signals, derived from multiple biological systems, which are interpreted by ILC3 to modulate the release of downstream effector molecules and regulate cell-cell crosstalk. Successful integration of environmental cues by ILC3 and downstream propagation to the broader immune system is required to maintain a tolerogenic and anti-inflammatory tone and reinforce barrier function, whereas dysregulation of ILC3 responses can contribute to the onset or progression of clinically relevant chronic inflammatory diseases.

Group 3 Innate Lymphoid Cells: Communications Hubs of the Intestinal Immune System

PubMed Central

Withers, David R.; Hepworth, Matthew R.

2017-01-01

The maintenance of mammalian health requires the generation of appropriate immune responses against a broad range of environmental and microbial challenges, which are continually encountered at barrier tissue sites including the skin, lung, and gastrointestinal tract. Dysregulated barrier immune responses result in inflammation, both locally and systemically in peripheral organs. Group 3 innate lymphoid cells (ILC3) are constitutively present at barrier sites and appear to be highly specialized in their ability to sense a range of environmental and host-derived signals. Under homeostatic conditions, ILC3 respond to local cues to maintain tissue homeostasis and restrict inflammatory responses. In contrast, perturbations in the tissue microenvironment resulting from disease, infection, or tissue damage can drive dysregulated pro-inflammatory ILC3 responses and contribute to immunopathology. The tone of the ILC3 response is dictated by a balance of “exogenous” signals, such as dietary metabolites and commensal microbes, and “endogenous” host-derived signals from stromal cells, immune cells, and the nervous system. ILC3 must therefore have the capacity to simultaneously integrate a wide array of complex and dynamic inputs in order to regulate barrier function and tissue health. In this review, we discuss the concept of ILC3 as a “communications hub” in the intestinal tract and associated lymphoid tissues and address the variety of signals, derived from multiple biological systems, which are interpreted by ILC3 to modulate the release of downstream effector molecules and regulate cell–cell crosstalk. Successful integration of environmental cues by ILC3 and downstream propagation to the broader immune system is required to maintain a tolerogenic and anti-inflammatory tone and reinforce barrier function, whereas dysregulation of ILC3 responses can contribute to the onset or progression of clinically relevant chronic inflammatory diseases. PMID:29085366

Tight junction protein expression and barrier properties of immortalized mouse brain microvessel endothelial cells.

PubMed

Brown, Rachel C; Morris, Andrew P; O'Neil, Roger G

2007-01-26

Understanding the molecular and biochemical mechanisms regulating the blood-brain barrier is aided by in vitro model systems. Many studies have used primary cultures of brain microvessel endothelial cells for this purpose. However, primary cultures limit the generation of material for molecular and biochemical assays since cells grow slowly, are prone to contamination by other neurovascular unit cells, and lose blood-brain barrier characteristics when passaged. To address these issues, immortalized cell lines have been generated. In these studies, we assessed the suitability of the immortalized mouse brain endothelial cell line, bEnd3, as a blood-brain barrier model. RT-PCR and immunofluorescence indicated expression of multiple tight junction proteins. bEnd3 cells formed barriers to radiolabeled sucrose, and responded like primary cultures to disrupting stimuli. Exposing cells to serum-free media on their basolateral side significantly decreased paracellular permeability; astrocyte-conditioned media did not enhance barrier properties. The serum-free media-induced decrease in permeability was correlated with an increase in claudin-5 and zonula occludens-1 immunofluorescence at cell-cell contracts. We conclude that bEnd3 cells are an attractive candidate as a model of the blood-brain barrier due to their rapid growth, maintenance of blood-brain barrier characteristics over repeated passages, formation of functional barriers and amenability to numerous molecular interventions.

TIGHT JUNCTION PROTEIN EXPRESSION AND BARRIER PROPERTIES OF IMMORTALIZED MOUSE BRAIN MICROVESSEL ENDOTHELIAL CELLS

PubMed Central

Brown, Rachel C.; Morris, Andrew P.; O’Neil, Roger G.

2007-01-01

Understanding the molecular and biochemical mechanisms regulating the blood-brain barrier is aided by in vitro model systems. Many studies have used primary cultures of brain microvessel endothelial cells for this purpose. However, primary cultures limit the generation of material for molecular and biochemical assays since cells grow slowly, are prone to contamination by other neurovascular unit cells, and lose blood-brain barrier characteristics when passaged. To address these issues, immortalized cell lines have been generated. In these studies, we assessed the suitability of the immortalized mouse brain endothelial cell line, bEnd3, as a blood-brain barrier model. RT-PCR and immunofluorescence indicated expression of multiple tight junction proteins. bEnd3 cells formed barriers to radiolabeled sucrose, and responded like primary cultures to disrupting stimuli. Exposing cells to serum-free media on their basolateral side significantly decreased paracellular permeability; astrocyte-conditioned media did not enhance barrier properties. The serum-free media-induced decrease in permeability was correlated with an increase in claudin-5 and zonula occludens-1 immunofluorescence at cell-cell contracts. We conclude that bEnd3 cells are an attractive candidate as a model of the blood-brain barrier due to their rapid growth, maintenance of blood-brain barrier characteristics over repeated passages, formation of functional barriers and amenability to numerous molecular interventions. PMID:17169347

Perceptions of family-centred services in a paediatric rehabilitation programme: strengths and complexities from multiple stakeholders.

PubMed

Arcuri, G G; McMullan, A E; Murray, A E; Silver, L K; Bergthorson, M; Dahan-Oliel, N; Coutinho, F

2016-03-01

Family-centred services (FCS) are best practice in paediatric rehabilitation and describe philosophies and approaches to medical care that emphasize the partnership and involvement of parents. While evidence supports FCS, there are complexities to its successful implementation. This mixed-methods study aimed to measure the extent to which parents and the healthcare provider (HCP) perceive service provision as being family centred, and to describe barriers and facilitators to the delivery of FCS. Parents of children participating in a rehabilitation programme and HCPs providing services participated in this study. Parents completed the measure of processes of care-20 and participated in interviews, while HCPs completed the measure of processes of care-service providers and participated in a focus group. Quantitative analysis revealed that parents were mostly satisfied with features of FCS, which included communication and support between parents and HCPs, respect of diversity and parental collaboration and participation. Parents identified communication methods and psychosocial needs as areas that facilitated but sometimes detracted from FCS. Institutional barriers led to the identification of areas for improvement identified by multiple stakeholders. HCPs identified more areas for improvement than parents. When considering these barriers, it is evident that implementation is a complex process, impacted by institutional barriers. FCS needs to be investigated further, and systemic interventions should be used to facilitate its implementation. © 2015 John Wiley & Sons Ltd.

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

PubMed

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

2015-11-01

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

Barriers to prompt and effective malaria treatment among the poorest population in Kenya.

PubMed

Chuma, Jane; Okungu, Vincent; Molyneux, Catherine

2010-05-27

Prompt access to effective malaria treatment is central to the success of malaria control worldwide, but few fevers are treated with effective anti-malarials within 24 hours of symptoms onset. The last two decades saw an upsurge of initiatives to improve access to effective malaria treatment in many parts of sub-Saharan Africa. Evidence suggests that the poorest populations remain least likely to seek prompt and effective treatment, but the factors that prevent them from accessing interventions are not well understood. With plans under way to subsidize ACT heavily in Kenya and other parts of Africa, there is urgent need to identify policy actions to promote access among the poor. This paper explores access barriers to effective malaria treatment among the poorest population in four malaria endemic districts in Kenya. The study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: a cross-sectional survey (n=708 households); 24 focus group discussions; semi-structured interviews with health workers (n=34); and patient exit interviews (n=359). Multiple factors related to affordability, acceptability and availability interact to influence access to prompt and effective treatment. Regarding affordability, about 40 percent of individuals who self-treated using shop-bought drugs and 42 percent who visited a formal health facility reported not having enough money to pay for treatment, and having to adopt coping strategies including borrowing money and getting treatment on credit in order to access care. Other factors influencing affordability were seasonality of illness and income sources, transport costs, and unofficial payments. Regarding acceptability, the major interrelated factors identified were provider patient relationship, patient expectations, beliefs on illness causation, perceived effectiveness of treatment, distrust in the quality of care and poor adherence to treatment regimes. Availability barriers identified were related to facility opening hours, organization of health care services, drug and staff shortages. Ensuring that all individuals suffering from malaria have prompt access to effective treatment remains a challenge for resource constrained health systems. Policy actions to address the multiple barriers of access should be designed around access dimensions, and should include broad interventions to revitalize the public health care system. Unless additional efforts are directed towards addressing access barriers among the poor and vulnerable, malaria will remain a major cause of morbidity and mortality in sub-Saharan Africa.

Perspectives of Patients, Clinicians, and Health System Leaders on Changes Needed to Improve the Health Care and Outcomes of Older Adults With Multiple Chronic Conditions.

PubMed

Ferris, Rosie; Blaum, Caroline; Kiwak, Eliza; Austin, Janet; Esterson, Jessica; Harkless, Gene; Oftedahl, Gary; Parchman, Michael; Van Ness, Peter H; Tinetti, Mary E

2018-06-01

To ascertain perspectives of multiple stakeholders on contributors to inappropriate care for older adults with multiple chronic conditions. Perspectives of 36 purposively sampled patients, clinicians, health systems, and payers were elicited. Data analysis followed a constant comparative method. Structural factors triggering burden and fragmentation include disease-based quality metrics and need to interact with multiple clinicians. The key cultural barrier identified is the assumption that "physicians know best." Inappropriate decision making may result from inattention to trade-offs and adherence to multiple disease guidelines. Stakeholders recommended changes in culture, structure, and decision making. Care options and quality metrics should reflect a focus on patients' priorities. Clinician-patient partnerships should reflect patients knowing their health goals and clinicians knowing how to achieve them. Access to specialty expertise should not require visits. Stakeholders' recommendations suggest health care redesigns that incorporate patients' health priorities into care decisions and realign relationships across patients and clinicians.

Do π-conjugative effects facilitate SN2 reactions?

PubMed

Wu, Chia-Hua; Galabov, Boris; Wu, Judy I-Chia; Ilieva, Sonia; Schleyer, Paul von R; Allen, Wesley D

2014-02-26

Rigorous quantum chemical investigations of the SN2 identity exchange reactions of methyl, ethyl, propyl, allyl, benzyl, propargyl, and acetonitrile halides (X = F(-), Cl(-)) refute the traditional view that the acceleration of SN2 reactions for substrates with a multiple bond at Cβ (carbon adjacent to the reacting Cα center) is primarily due to π-conjugation in the SN2 transition state (TS). Instead, substrate-nucleophile electrostatic interactions dictate SN2 reaction rate trends. Regardless of the presence or absence of a Cβ multiple bond in the SN2 reactant in a series of analogues, attractive Cβ(δ(+))···X(δ(-)) interactions in the SN2 TS lower net activation barriers (E(b)) and enhance reaction rates, whereas repulsive Cβ(δ(-))···X(δ(-)) interactions increase E(b) barriers and retard SN2 rates. Block-localized wave function (BLW) computations confirm that π-conjugation lowers the net activation barriers of SN2 allyl (1t, coplanar), benzyl, propargyl, and acetonitrile halide identity exchange reactions, but does so to nearly the same extent. Therefore, such orbital interactions cannot account for the large range of E(b) values in these systems.

Achieving development goals for HIV, tuberculosis and malaria in sub-Saharan Africa through integrated antenatal care: barriers and challenges.

PubMed

Fowkes, Freya J I; Draper, Bridget L; Hellard, Margaret; Stoové, Mark

2016-12-12

The global health community is currently transitioning from the Millennium Development Goals (MDGs) to the Sustainable Development Goals (SDGs). Unfortunately, progress towards maternal, newborn and infant health MDGs has lagged significantly behind other key health goals, demanding a renewed global effort in this key health area. The World Health Organization and other institutions heralded integrated antenatal care (ANC) as the best way to address the inter-related health issues of HIV, tuberculosis (TB) and malaria in the high risk groups of pregnant women and infants; integrated ANC services also offer a mechanism to address slow progress towards improved maternal health. There is remarkably limited evidence on best practice approaches of program implementation, acceptability and effectiveness for integrated ANC models targeting multiple diseases. Here, we discuss current integrated ANC global guidelines and the limited literature describing integrated ANC implementation and evidence for their role in addressing HIV, malaria and TB during pregnancy in sub-Saharan Africa. We highlight the paucity of data on the effectiveness of integrated ANC models and identify significant structural barriers in the health system (funding, infrastructure, distribution, human resources), the adoption system (limited buy-in from implementers, leadership, governance) and, in the broader context, patient-centred barriers (fear, stigma, personal burdens) and barriers in funding structures. We highlight recommendations for action and discuss avenues for the global health community to develop systems to integrate multiple disease programs into ANC models of care that better address these three priority infectious diseases. With the current transition to the SDGs and concerns regarding the failure to meet maternal health MDGs, the global health community, researchers, implementers and funding bodies must work together to ensure the establishment of quality operational and implementation research to inform integrated ANC models. It is imperative that the global health community engages in a timely discussion about such implementation innovations and instigates appropriate actions to ensure advances in maternal health are sufficient to meet applicable SDGs.

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

PubMed

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

2015-09-01

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

Language Development in Down Syndrome: From the Prelinguistic Period to the Acquisition of Literacy

ERIC Educational Resources Information Center

Abbeduto, Leonard; Warren, Steven F.; Conners, Frances A.

2007-01-01

Down syndrome (DS) is associated with abnormalities in multiple organ systems and a characteristic phenotype that includes numerous behavioral features. Language, however, is among the most impaired domains of functioning in DS and, perhaps, also the greatest barrier to independent meaningful inclusion in the community. In this article, we review…

Perceived Barriers and Protective Factors of Juvenile Offenders on Their Developmental Pathway to Adulthood

ERIC Educational Resources Information Center

Unruh, Deanne; Povenmire-Kirk, Tiana; Yamamoto, Scott

2009-01-01

Adolescents involved in the juvenile justice system face multiple challenges on their pathway to adulthood. These adolescents not only have an increased risk of committing future crimes and are further at risk of not becoming healthy, productive adults. The purpose of this study was to examine the risk and protective factors and associations…

Barriers to Abortion Care and Their Consequences For Patients Traveling for Services: Qualitative Findings from Two States

PubMed Central

Jerman, Jenna; Frohwirth, Lori; Kavanaugh, Megan L.; Blades, Nakeisha

2018-01-01

CONTEXT Abortion availability and accessibility vary by state. Especially in areas where services are restricted or limited, some women travel to obtain abortion services in other states. Little is known about the experience of travel to obtain abortion. METHODS In January and February 2015, in-depth interviews were conducted with 29 patients seeking abortion services at six facilities in Michigan and New Mexico. Eligible women were 18 or older, spoke English, and had traveled either across state lines or more than 100 miles within the state. Respondents were asked to describe their experience from pregnancy discovery to the day of the abortion procedure. Barriers to accessing abortion care and consequences of these barriers were identified through inductive and deductive analysis. RESULTS Respondents described 15 barriers to abortion care while traveling to obtain services, and three major consequences of experiencing those barriers. Barriers were grouped into five categories: travel-related logistical issues, system navigation issues, limited clinic options, financial issues, and state or clinic restrictions. Consequences were delays in care, negative mental health impacts and considering self-induction. The experience of barriers complicated the process of obtaining an abortion, but the effect of any individual barrier was unclear. Instead, the experience of multiple barriers appeared to have a compounding effect, resulting in negative consequences for women traveling for abortion. CONCLUSION The amalgamation of barriers to abortion care experienced simultaneously can have significant consequences for patients. PMID:28394463

Health care barriers and interventions for battered women.

PubMed Central

Loring, M T; Smith, R W

1994-01-01

Family violence is a major public health problem. Battered women present with multiple physical injuries in hospital emergency rooms, clinics, and personal physicians' offices. Yet, they are often not identified as battered and fail to receive appropriate treatment for the nonphysical effects of these events. Instead, only discrete physical injuries are identified. The authors explore the literature to identify barriers in recognizing and treating battered women. These barriers are viewed as a microcosm of the larger public health problem in which battered women fear identifying themselves and often are not recognized by public health professionals. Some barriers pertain to the victims themselves; others can be attributed to the attitudes of medical care providers in emergency rooms, clinics, and private physicians' offices. The many faceted needs of victims require a variety of interventions including medical models, criminal justice intervention systems, and social models for change. Some intervention strategies that are currently being employed in various programs in the United States are described. PMID:8190856

Noninvasive ocular drug delivery: potential transcorneal and other alternative delivery routes for therapeutic molecules in glaucoma.

PubMed

Foldvari, Marianna

2014-01-01

Drug delivery to the eye is made difficult by multiple barriers (such as the tear film, cornea, and vitreous) between the surface of the eye and the treatment site. These barriers are difficult to surmount for the purposes of drug delivery without causing toxicity. Using nanotechnology tools to control, manipulate, and study delivery systems, new approaches to delivering drugs, genes, and antigens that are effective and safe can be developed. Topical administration to the ocular surface would be the safest method for delivery, as it is noninvasive and painless compared with other delivery methods. However, there is only limited success using topical delivery methods, especially for gene therapy. Current thinking on treatments of the future enabled by nanodelivery systems and the identification of target specificity parameters that require deeper understanding to develop successful topical delivery systems for glaucoma is highlighted.

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

PubMed

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

2009-01-01

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

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

ERIC Educational Resources Information Center

Villalobos, Ricardo

2017-01-01

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

Why are there gaps in our management of those with high cardiovascular risk?

PubMed

Doolan-Noble, Fiona; Tracey, Jocelyn; Mann, Stewart

2012-03-01

Multiple New Zealand and other international studies have identified gaps in the management of those identified at high risk of a future cardiovascular (CV) event. This study sought to explore the views of health professionals about the barriers and facilitators present within the current primary health care system to the optimal management of those at high CV risk. This qualitative study utilised a focus group methodology to examine the barriers and facilitators within primary health care (PHC), and employed a general inductive approach to analyse the text data. The analysis of text data resulted in the emergence of interrelated themes, underpinned by subthemes. The patient, their circumstances and their characteristics and perceptions provided the first key theme and subthemes. The next key theme was primary health care providers, with subthemes of communication and values and beliefs. The general practice was the third theme and included multiple subthemes: implementation planning and pathway development, time and workload and roles and responsibilities. The final main theme was the health system with the subthemes linking to funding and leadership. This study determined the factors that act as barriers and facilitators to the effective management of those at high CV risk within the New Zealand PHC sector. General practice has a pivotal role in preventive health care, but to succeed there needs to be a refocusing of the PHC sector, requiring support from policy makers, District Health Boards and Primary Health Organisations, as well as those working in the sector.

Barriers, Facilitators and Priorities for Implementation of WHO Maternal and Perinatal Health Guidelines in Four Lower-Income Countries: A GREAT Network Research Activity.

PubMed

Vogel, Joshua P; Moore, Julia E; Timmings, Caitlyn; Khan, Sobia; Khan, Dina N; Defar, Atkure; Hadush, Azmach; Minwyelet Terefe, Marta; Teshome, Luwam; Ba-Thike, Katherine; Than, Kyu Kyu; Makuwani, Ahmad; Mbaruku, Godfrey; Mrisho, Mwifadhi; Mugerwa, Kidza Yvonne; Puchalski Ritchie, Lisa M; Rashid, Shusmita; Straus, Sharon E; Gülmezoglu, A Metin

2016-01-01

Health systems often fail to use evidence in clinical practice. In maternal and perinatal health, the majority of maternal, fetal and newborn mortality is preventable through implementing effective interventions. To meet this challenge, WHO's Department of Reproductive Health and Research partnered with the Knowledge Translation Program at St. Michael's Hospital (SMH), University of Toronto, Canada to establish a collaboration on knowledge translation (KT) in maternal and perinatal health, called the GREAT Network (Guideline-driven, Research priorities, Evidence synthesis, Application of evidence, and Transfer of knowledge). We applied a systematic approach incorporating evidence and theory to identifying barriers and facilitators to implementation of WHO maternal heath recommendations in four lower-income countries and to identifying implementation strategies to address these. We conducted a mixed-methods study in Myanmar, Uganda, Tanzania and Ethiopia. In each country, stakeholder surveys, focus group discussions and prioritization exercises were used, involving multiple groups of health system stakeholders (including administrators, policymakers, NGOs, professional associations, frontline healthcare providers and researchers). Despite differences in guideline priorities and contexts, barriers identified across countries were often similar. Health system level factors, including health workforce shortages, and need for strengthened drug and equipment procurement, distribution and management systems, were consistently highlighted as limiting the capacity of providers to deliver high-quality care. Evidence-based health policies to support implementation, and improve the knowledge and skills of healthcare providers were also identified. Stakeholders identified a range of tailored strategies to address local barriers and leverage facilitators. This approach to identifying barriers, facilitators and potential strategies for improving implementation proved feasible in these four lower-income country settings. Further evaluation of the impact of implementing these strategies is needed.

Barriers, Facilitators and Priorities for Implementation of WHO Maternal and Perinatal Health Guidelines in Four Lower-Income Countries: A GREAT Network Research Activity

PubMed Central

Vogel, Joshua P.; Moore, Julia E.; Timmings, Caitlyn; Khan, Sobia; Khan, Dina N.; Defar, Atkure; Hadush, Azmach; Minwyelet Terefe, Marta; Teshome, Luwam; Ba-Thike, Katherine; Than, Kyu Kyu; Makuwani, Ahmad; Mbaruku, Godfrey; Mrisho, Mwifadhi; Mugerwa, Kidza Yvonne; Puchalski Ritchie, Lisa M.; Rashid, Shusmita; Straus, Sharon E.; Gülmezoglu, A. Metin

2016-01-01

Background Health systems often fail to use evidence in clinical practice. In maternal and perinatal health, the majority of maternal, fetal and newborn mortality is preventable through implementing effective interventions. To meet this challenge, WHO’s Department of Reproductive Health and Research partnered with the Knowledge Translation Program at St. Michael’s Hospital (SMH), University of Toronto, Canada to establish a collaboration on knowledge translation (KT) in maternal and perinatal health, called the GREAT Network (Guideline-driven, Research priorities, Evidence synthesis, Application of evidence, and Transfer of knowledge). We applied a systematic approach incorporating evidence and theory to identifying barriers and facilitators to implementation of WHO maternal heath recommendations in four lower-income countries and to identifying implementation strategies to address these. Methods We conducted a mixed-methods study in Myanmar, Uganda, Tanzania and Ethiopia. In each country, stakeholder surveys, focus group discussions and prioritization exercises were used, involving multiple groups of health system stakeholders (including administrators, policymakers, NGOs, professional associations, frontline healthcare providers and researchers). Results Despite differences in guideline priorities and contexts, barriers identified across countries were often similar. Health system level factors, including health workforce shortages, and need for strengthened drug and equipment procurement, distribution and management systems, were consistently highlighted as limiting the capacity of providers to deliver high-quality care. Evidence-based health policies to support implementation, and improve the knowledge and skills of healthcare providers were also identified. Stakeholders identified a range of tailored strategies to address local barriers and leverage facilitators. Conclusion This approach to identifying barriers, facilitators and potential strategies for improving implementation proved feasible in these four lower-income country settings. Further evaluation of the impact of implementing these strategies is needed. PMID:27806041

Integrating observational and modelling systems for the management of the Great Barrier Reef

NASA Astrophysics Data System (ADS)

Baird, M. E.; Jones, E. M.; Margvelashvili, N.; Mongin, M.; Rizwi, F.; Robson, B.; Schroeder, T.; Skerratt, J.; Steven, A. D.; Wild-Allen, K.

2016-02-01

Observational and modelling systems provide two sources of knowledge that must be combined to provide a more complete view than either observations or models alone can provide. Here we describe the eReefs coupled hydrodynamic, sediment and biogeochemical model that has been developed for the Great Barrier Reef; and the multiple observations that are used to constrain the model. Two contrasting examples of model - observational integration are highlighted. First we explore the carbon chemistry of the waters above the reef, for which observations are accurate, but expensive and therefore sparse, while model behaviour is highly skilful. For carbon chemistry, observations are used to constrain model parameterisation and quantify model error, with the model output itself providing the most useable knowledge for management purposes. In contrast, ocean colour provides inaccurate, but cheap and spatially and temporally extensive observations. Thus observations are best combined with the model in a data assimilating framework, where a custom-designed optical model has been developed for the purposes of incorporating ocean colour observations. The future management of Great Barrier Reef water quality will be based on an integration of observing and modelling systems, providing the most robust information available.

Intersections of discrimination due to unemployment and mental health problems: the role of double stigma for job- and help-seeking behaviors.

PubMed

Staiger, Tobias; Waldmann, Tamara; Oexle, Nathalie; Wigand, Moritz; Rüsch, Nicolas

2018-05-21

The everyday lives of unemployed people with mental health problems can be affected by multiple discrimination, but studies about double stigma-an overlap of identities and experiences of discrimination-in this group are lacking. We therefore studied multiple discrimination among unemployed people with mental health problems and its consequences for job- and help-seeking behaviors. Everyday discrimination and attributions of discrimination to unemployment and/or to mental health problems were examined among 301 unemployed individuals with mental health problems. Job search self-efficacy, barriers to care, and perceived need for treatment were compared among four subgroups, depending on attributions of experienced discrimination to unemployment and to mental health problems (group i); neither to unemployment nor to mental health problems (group ii); mainly to unemployment (group iii); or mainly to mental health problems (group iv). In multiple regressions among all participants, higher levels of discrimination predicted reduced job search self-efficacy and higher barriers to care; and attributions of discrimination to unemployment were associated with increased barriers to care. In ANOVAs for subgroup comparisons, group i participants, who attributed discrimination to both unemployment and mental health problems, reported lower job search self-efficacy, more perceived stigma-related barriers to care and more need for treatment than group iii participants, as well as more stigma-related barriers to care than group iv. Multiple discrimination may affect job search and help-seeking among unemployed individuals with mental health problems. Interventions to reduce public stigma and to improve coping with multiple discrimination for this group should be developed.

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

PubMed Central

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

2016-01-01

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

Role of the blood-brain barrier in multiple sclerosis.

PubMed

Ortiz, Genaro Gabriel; Pacheco-Moisés, Fermín Paul; Macías-Islas, Miguel Ángel; Flores-Alvarado, Luis Javier; Mireles-Ramírez, Mario A; González-Renovato, Erika Daniela; Hernández-Navarro, Vanessa Elizabeth; Sánchez-López, Angélica Lizeth; Alatorre-Jiménez, Moisés Alejandro

2014-11-01

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system associated with demyelination and axonal loss eventually leading to neurodegeneration. MS exhibits many of the hallmarks of an inflammatory autoimmune disorder including breakdown of the blood-brain barrier (BBB). The BBB is a complex organization of cerebral endothelial cells, pericytes and their basal lamina, which are surrounded and supported by astrocytes and perivascular macrophages. In pathological conditions, lymphocytes activated in the periphery infiltrate the central nervous system to trigger a local immune response that ultimately damages myelin and axons. Cytotoxic factors including pro-inflammatory cytokines, proteases, and reactive oxygen and nitrogen species accumulate and may contribute to myelin destruction. Dysregulation of the BBB and transendothelial migration of activated leukocytes are among the earliest cerebrovascular abnormalities seen in MS brains and parallel the release of inflammatory cytokines. In this review we establish the importance of the role of the BBB in MS. Improvements in our understanding of molecular mechanism of BBB functioning in physiological and pathological conditions could lead to improvement in the quality of life of MS patients. Copyright © 2015 IMSS. Published by Elsevier Inc. All rights reserved.

Adaptive Neural Control of Uncertain MIMO Nonlinear Systems With State and Input Constraints.

PubMed

Chen, Ziting; Li, Zhijun; Chen, C L Philip

2017-06-01

An adaptive neural control strategy for multiple input multiple output nonlinear systems with various constraints is presented in this paper. To deal with the nonsymmetric input nonlinearity and the constrained states, the proposed adaptive neural control is combined with the backstepping method, radial basis function neural network, barrier Lyapunov function (BLF), and disturbance observer. By ensuring the boundedness of the BLF of the closed-loop system, it is demonstrated that the output tracking is achieved with all states remaining in the constraint sets and the general assumption on nonsingularity of unknown control coefficient matrices has been eliminated. The constructed adaptive neural control has been rigorously proved that it can guarantee the semiglobally uniformly ultimate boundedness of all signals in the closed-loop system. Finally, the simulation studies on a 2-DOF robotic manipulator system indicate that the designed adaptive control is effective.

Geographically multifarious phenotypic divergence during speciation

PubMed Central

Gompert, Zachariah; Lucas, Lauren K; Nice, Chris C; Fordyce, James A; Alex Buerkle, C; Forister, Matthew L

2013-01-01

Speciation is an important evolutionary process that occurs when barriers to gene flow evolve between previously panmictic populations. Although individual barriers to gene flow have been studied extensively, we know relatively little regarding the number of barriers that isolate species or whether these barriers are polymorphic within species. Herein, we use a series of field and lab experiments to quantify phenotypic divergence and identify possible barriers to gene flow between the butterfly species Lycaeides idas and Lycaeides melissa. We found evidence that L. idas and L. melissa have diverged along multiple phenotypic axes. Specifically, we identified major phenotypic differences in female oviposition preference and diapause initiation, and more moderate divergence in mate preference. Multiple phenotypic differences might operate as barriers to gene flow, as shown by correlations between genetic distance and phenotypic divergence and patterns of phenotypic variation in admixed Lycaeides populations. Although some of these traits differed primarily between species (e.g., diapause initiation), several traits also varied among conspecific populations (e.g., male mate preference and oviposition preference). PMID:23532669

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

PubMed

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

2016-12-24

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

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2015-07-01

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

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

PubMed

Stroud, Nicole; Minahan, Clare; Sabapathy, Surendran

2009-01-01

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

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

PubMed

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

2013-09-01

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

Role of proteoglycans in neuro-inflammation and central nervous system fibrosis.

PubMed

Heindryckx, Femke; Li, Jin-Ping

2018-01-31

Fibrosis is defined as the thickening and scarring of connective tissue, usually as a consequence of tissue damage. The central nervous system (CNS) is special in the sense that fibrogenic cells are restricted to vascular and meningeal areas. Inflammation and the disruption of the blood-brain barrier can lead to the infiltration of fibroblasts and trigger fibrotic response. While the initial function of the fibrotic tissue is to restore the blood-brain barrier and to limit the site of injury, it also demolishes the structure of extracellular matrix and impedes the healing process by producing inhibitory molecules and forming a physical and biochemical barrier that prevents axon regeneration. As a major constituent in the extracellular matrix, proteoglycans participate in the neuro-inflammation, modulating the fibrotic process. In this review, we will discuss the pathophysiology of fibrosis during acute injuries of the CNS, as well as during chronic neurodegenerative conditions such as Alzheimer's disease, Parkinson's disease, multiple sclerosis and age-related neurodegeneration with focus on the functional roles of proteoglycans. Copyright © 2017 International Society of Matrix Biology. Published by Elsevier B.V. All rights reserved.

Barriers to Abortion Care and Their Consequences For Patients Traveling for Services: Qualitative Findings from Two States.

PubMed

Jerman, Jenna; Frohwirth, Lori; Kavanaugh, Megan L; Blades, Nakeisha

2017-06-01

Abortion availability and accessibility vary by state. Especially in areas where services are restricted or limited, some women travel to obtain abortion services in other states. Little is known about the experience of travel to obtain abortion. In January and February 2015, in-depth interviews were conducted with 29 patients seeking abortion services at six facilities in Michigan and New Mexico. Eligible women were 18 or older, spoke English, and had traveled either across state lines or more than 100 miles within the state. Respondents were asked to describe their experience from pregnancy discovery to the day of the abortion procedure. Barriers to accessing abortion care and consequences of these barriers were identified through inductive and deductive analysis. Respondents described 15 barriers to abortion care while traveling to obtain services, and three major consequences of experiencing those barriers. Barriers were grouped into five categories: travel-related logistical issues, system navigation issues, limited clinic options, financial issues, and state or clinic restrictions. Consequences were delays in care, negative mental health impacts and considering self-induction. The experience of barriers complicated the process of obtaining an abortion, but the effect of any individual barrier was unclear. Instead, the experience of multiple barriers appeared to have a compounding effect, resulting in negative consequences for women traveling for abortion. The amalgamation of barriers to abortion care experienced simultaneously can have significant consequences for patients. © 2017 The Authors. Perspectives on Sexual and Reproductive Health published by Wiley Periodicals, Inc., on behalf of the Guttmacher Institute.

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

PubMed Central

Jenkins, Melissa M.; Haine-Schlagel, Rachel

2012-01-01

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

Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model.

PubMed

Wallace, Cara L

2016-08-01

This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care.

Knowledge production and learning for sustainable landscapes: seven steps using social-ecological systems as laboratories.

PubMed

Angelstam, Per; Elbakidze, Marine; Axelsson, Robert; Dixelius, Malcolm; Törnblom, Johan

2013-03-01

There are multiple challenges regarding use and governance of landscapes' goods, functions and intangible values for ecosystem health and human well-being. One group of challenges is to measure and assess principal sustainability dimensions through performance targets, so stakeholders have transparent information about states and trends. Another group is to develop adaptive governance at multiple levels, and management of larger geographical areas across scales. Addressing these challenges, we present a framework for transdisciplinary research using multiple landscapes as place-based case studies that integrates multiple research disciplines and non-academic actors: (1) identify a suite of landscapes, and for each (2) review landscape history, (3) map stakeholders, use and non-use values, products and land use, (4) analyze institutions, policies and the system of governance, (5) measure ecological, economic, social and cultural sustainability, (6) assess sustainability dimensions and governance, and finally (7) make comparisons and synthesize. Collaboration, communication and dissemination are additional core features. We discuss barriers bridges and bridges for applying this approach.

The neuroprotective agent SR 57746A abrogates experimental autoimmune encephalomyelitis and impairs associated blood–brain barrier disruption: Implications for multiple sclerosis treatment

PubMed Central

Bourrié, Bernard; Bribes, Estelle; Esclangon, Martine; Garcia, Laurent; Marchand, Jean; Thomas, Corinne; Maffrand, Jean-Pierre; Casellas, Pierre

1999-01-01

Experimental autoimmune encephalomyelitis (EAE) is a T cell autoimmune disorder that is a widely used animal model for multiple sclerosis (MS) and, as in MS, clinical signs of EAE are associated with blood–brain barrier (BBB) disruption. SR 57746A, a nonpeptide drug without classical immunosuppressive properties, efficiently protected the BBB and impaired intrathecal IgG synthesis (two conventional markers of MS exacerbation) and consequently suppressed EAE clinical signs. This compound inhibited EAE-induced spinal cord mononuclear cell invasion and normalized tumor necrosis factor α and IFN-γ mRNA expression within the spinal cord. These data suggested that pharmacological intervention aimed at inhibiting proinflammatory cytokine expression within the central nervous system provided protection against BBB disruption, the first clinical sign of EAE and probably the key point of acute MS attacks. This finding could lead to the development of a new class of compounds for oral therapy of MS, as a supplement to immunosuppressive agents. PMID:10536012

NEURONAL ACTION ON THE DEVELOPING BLOOD VESSEL PATTERN

PubMed Central

James, Jennifer M.; Mukouyama, Yoh-suke

2011-01-01

The nervous system relies on a highly specialized network of blood vessels for development and neuronal survival. Recent evidence suggests that both the central and peripheral nervous systems (CNS and PNS) employ multiple mechanisms to shape the vascular tree to meet its specific metabolic demands, such as promoting nerve-artery alignment in the PNS or the development the blood brain barrier in the CNS. In this article we discuss how the nervous system directly influences blood vessel patterning resulting in neuro-vascular congruence that is maintained throughout development and in the adult. PMID:21978864

Advancing drug delivery systems for the treatment of multiple sclerosis.

PubMed

Tabansky, Inna; Messina, Mark D; Bangeranye, Catherine; Goldstein, Jeffrey; Blitz-Shabbir, Karen M; Machado, Suly; Jeganathan, Venkatesh; Wright, Paul; Najjar, Souhel; Cao, Yonghao; Sands, Warren; Keskin, Derin B; Stern, Joel N H

2015-12-01

Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system. It is characterized by demyelination of neurons and loss of neuronal axons and oligodendrocytes. In MS, auto-reactive T cells and B cells cross the blood-brain barrier (BBB), causing perivenous demyelinating lesions that form multiple discrete inflammatory demyelinated plaques located primarily in the white matter. In chronic MS, cortical demyelination and progressive axonal transections develop. Treatment for MS can be stratified into disease-modifying therapies (DMTs) and symptomatic therapy. DMTs aim to decrease circulating immune cells or to prevent these cells from crossing the BBB and reduce the inflammatory response. There are currently 10 DMTs approved for the relapsing forms of MS; these vary with regard to their efficacy, route and frequency of administration, adverse effects, and toxicity profile. Better drug delivery systems are being developed in order to decrease adverse effects, increase drug efficacy, and increase patient compliance through the direct targeting of pathologic cells. Here, we address the uses and benefits of advanced drug delivery systems, including nanoparticles, microparticles, fusion antibodies, and liposomal formulations. By altering the properties of therapeutic particles and enhancing targeting, breakthrough drug delivery technologies potentially applicable to multiple disease treatments may rapidly emerge.

Emotional and behavioural barriers to learning and development in the inclusive education classrooms in South Africa: Developing a training programme for teachers.

PubMed

Potgieter-Groot, Lucia; Visser, Maretha; Lubbe-de Beer, Carien

2012-07-01

The interaction between teachers, classroom strategies and learners experiencing emotional and behavioural barriers to learning and development in a system of inclusive education results in multiple dynamics on different levels. Many teachers in mainstream education lack training to deal with learners experiencing emotional and behavioural barriers. Resistance towards inclusive education is therefore evident. This paper describes the process of developing an in-service training programme for teachers who deal with learners with emotional and behavioural barriers in their classrooms. A process of action research was used to allow the researcher, in collaboration with 47 teachers from 2 primary schools, to develop a training programme to address the specific needs of teachers in dealing with learners experiencing emotional and behavioural barriers in their classes. Qualitative feedback from teachers and observations by the researcher and external observers were used to evaluate the appropriateness of the training. Teachers experienced that appropriate classroom management strategies made a significant difference in the behaviour of learners experiencing emotional and behavioural barriers. The training affected teachers' attitudes, teacher-learner interaction, learner behaviour and school organisation. In-service training for teachers can affect the effective implementation of inclusive education. This programme can be adapted to address the needs of teachers in other areas.

Implementation of Enhanced Recovery After Surgery: a strategy to transform surgical care across a health system.

PubMed

Gramlich, Leah M; Sheppard, Caroline E; Wasylak, Tracy; Gilmour, Loreen E; Ljungqvist, Olle; Basualdo-Hammond, Carlota; Nelson, Gregg

2017-05-19

Enhanced Recovery After Surgery (ERAS) programs have been shown to have a positive impact on outcome. The ERAS care system includes an evidence-based guideline, an implementation program, and an interactive audit system to support practice change. The purpose of this study is to describe the use of the Theoretic Domains Framework (TDF) in changing surgical care and application of the Quality Enhancement Research Initiative (QUERI) model to analyze end-to-end implementation of ERAS in colorectal surgery across multiple sites within a single health system. The ultimate intent of this work is to allow for the development of a model for spread, scale, and sustainability of ERAS in Alberta Health Services (AHS). ERAS for colorectal surgery was implemented at two sites and then spread to four additional sites. The ERAS Interactive Audit System (EIAS) was used to assess compliance with the guidelines, length of stay, readmissions, and complications. Data sources informing knowledge translation included surveys, focus groups, interviews, and other qualitative data sources such as minutes and status updates. The QUERI model and TDF were used to thematically analyze 189 documents with 2188 quotes meeting the inclusion criteria. Data sources were analyzed for barriers or enablers, organized into a framework that included individual to organization impact, and areas of focus for guideline implementation. Compliance with the evidence-based guidelines for ERAS in colorectal surgery at baseline was 40%. Post implementation compliance, consistent with adoption of best practice, improved to 65%. Barriers and enablers were categorized as clinical practice (22%), individual provider (26%), organization (19%), external environment (7%), and patients (25%). In the Alberta context, 26% of barriers and enablers to ERAS implementation occurred at the site and unit levels, with a provider focus 26% of the time, a patient focus 26% of the time, and a system focus 22% of the time. Using the ERAS care system and applying the QUERI model and TDF allow for identification of strategies that can support diffusion and sustainment of innovation of Enhanced Recovery After Surgery across multiple sites within a health care system.

A sediment record of barrier estuary behaviour at the mesoscale: Interpreting high-resolution particle size analysis

NASA Astrophysics Data System (ADS)

Clarke, David W.; Boyle, John F.; Chiverrell, Richard C.; Lario, Javier; Plater, Andrew J.

2014-09-01

At present, limited understanding of mesoscale (years-decades-centuries) back-barrier lagoon, barrier estuary behaviour is a critical shortcoming for resource managers and decision makers. In this paper, high-resolution particle size analysis of a sediment core from an intermittently open and closed barrier estuary is utilised to reconstruct a history of back-barrier environmental change at mesoscale temporal resolution. Sediments from Pescadero Marsh, California, were analysed for their particle size distribution at consecutive 2-mm intervals down-core. Site selection, informed by a time series of maps and aerial photographs coupled with a robust core chronology, ensured that the particle size data primarily reflect changing hydrodynamics of the back-barrier area over the European-American era (1850 to the present). Following more traditional plotting of particle size data and summary statistics, and statistical analysis of particle size end-members, visual analysis and categorisation of particle size distribution curves (PSDCs) provide an effective basis for the identification of recurring modal sizes and subpopulations. These particle size windows (PSWs) are interpreted as reflecting different modes of sediment transport and deposition, i.e., suspension and saltation loads, the varying prominence of which is interpreted as being modified by barrier integrity. When considered together, the down-core mean particle size (MPS) trend and individual PSDCs offer considerable insight into mesoscale system behaviour at subannual resolution over multiple years. This behaviour is expressed in the recurrence of characteristic barrier estuarine environments (closed lagoon, tidal lagoon, tidal marsh, and open estuary) and the overall barrier regime, and their persistence over the last c. 150 years. Subannual and multiannual fluctuations in back-barrier environmental configuration are seen to be superimposed on a longer-term quasi-stable barrier regime, demonstrating the value of the applied methodology with regard to bridging the estuarine evolution (long-term, stratigraphic) and process (short-term, geomorphic) knowledge bases. The documented behaviour suggests a level of innate morphological resilience in the system over the long term despite episodic disturbance by high-energy storms. Such empirical demonstrations of resilient behaviour in coastal environments are rare at the mesoscale.

An Integrated and Collaborative Approach for NASA Earth Science Data

NASA Technical Reports Server (NTRS)

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

2012-01-01

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

A comparative study of wood highway sound barriers

Treesearch

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

2002-01-01

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

Reusable cryogenic foam insulation for advanced aerospace vehicles

NASA Technical Reports Server (NTRS)

Mcauliffe, Patrick S.; Taylor, Allan H.; Sparks, Larry L.; Dube, William P.

1991-01-01

Future high-speed aircraft and aerospace vehicles using cryogenic propellants will require an advanced reusable insulation system for the propellant tank structure. This cryogenic insulation system must be lightweight, structurally and thermally efficient, and capable of multiple reuse without cracking or degraded performance. This paper presents recent progress in the development of a reusable cryogenic foam insulation system having a maximum service temperature of 400 F. The system consists of preshaped, precut blocks of rigid polymethacrylimide foam insulation, wrapped with a high-temperature Kapton and aluminum foil vapor barrier which is adhesively bonded to the propellant tank wall.

Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview.

PubMed

Nair, Manisha; Yoshida, Sachiyo; Lambrechts, Thierry; Boschi-Pinto, Cynthia; Bose, Krishna; Mason, Elizabeth Mary; Mathai, Matthews

2014-05-22

Conduct a global situational analysis to identify the current facilitators and barriers to improving quality of care (QoC) for pregnant women, newborns and children. Metareview of published and unpublished systematic reviews and meta-analyses conducted between January 2000 and March 2013 in any language. Assessment of Multiple Systematic Reviews (AMSTAR) is used to assess the methodological quality of systematic reviews. Health systems of all countries. Study outcome: QoC measured using surrogate indicators--effective, efficient, accessible, acceptable/patient centred, equitable and safe. Conducted in two phases (1) qualitative synthesis of extracted data to identify and group the facilitators and barriers to improving QoC, for each of the three population groups, into the six domains of WHO's framework and explore new domains and (2) an analysis grid to map the common facilitators and barriers. We included 98 systematic reviews with 110 interventions to improve QoC from countries globally. The facilitators and barriers identified fitted the six domains of WHO's framework--information, patient-population engagement, leadership, regulations and standards, organisational capacity and models of care. Two new domains, 'communication' and 'satisfaction', were generated. Facilitators included active and regular interpersonal communication between users and providers; respect, confidentiality, comfort and support during care provision; engaging users in decision-making; continuity of care and effective audit and feedback mechanisms. Key barriers identified were language barriers in information and communication; power difference between users and providers; health systems not accounting for user satisfaction; variable standards of implementation of standard guidelines; shortage of resources in health facilities and lack of studies assessing the role of leadership in improving QoC. These were common across the three population groups. The barriers to good-quality healthcare are common for pregnant women, newborns and children; thus, interventions targeted to address them will have uniform beneficial effects. Adopting the identified facilitators would help countries strengthen their health systems and ensure high-quality care for all. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Facilitators and barriers to quality of care in maternal, newborn and child health: a global situational analysis through metareview

PubMed Central

Nair, Manisha; Yoshida, Sachiyo; Lambrechts, Thierry; Boschi-Pinto, Cynthia; Bose, Krishna; Mason, Elizabeth Mary; Mathai, Matthews

2014-01-01

Objective Conduct a global situational analysis to identify the current facilitators and barriers to improving quality of care (QoC) for pregnant women, newborns and children. Study design Metareview of published and unpublished systematic reviews and meta-analyses conducted between January 2000 and March 2013 in any language. Assessment of Multiple Systematic Reviews (AMSTAR) is used to assess the methodological quality of systematic reviews. Settings Health systems of all countries. Study outcome: QoC measured using surrogate indicators––effective, efficient, accessible, acceptable/patient centred, equitable and safe. Analysis Conducted in two phases (1) qualitative synthesis of extracted data to identify and group the facilitators and barriers to improving QoC, for each of the three population groups, into the six domains of WHO's framework and explore new domains and (2) an analysis grid to map the common facilitators and barriers. Results We included 98 systematic reviews with 110 interventions to improve QoC from countries globally. The facilitators and barriers identified fitted the six domains of WHO's framework––information, patient–population engagement, leadership, regulations and standards, organisational capacity and models of care. Two new domains, ‘communication’ and ‘satisfaction’, were generated. Facilitators included active and regular interpersonal communication between users and providers; respect, confidentiality, comfort and support during care provision; engaging users in decision-making; continuity of care and effective audit and feedback mechanisms. Key barriers identified were language barriers in information and communication; power difference between users and providers; health systems not accounting for user satisfaction; variable standards of implementation of standard guidelines; shortage of resources in health facilities and lack of studies assessing the role of leadership in improving QoC. These were common across the three population groups. Conclusions The barriers to good-quality healthcare are common for pregnant women, newborns and children; thus, interventions targeted to address them will have uniform beneficial effects. Adopting the identified facilitators would help countries strengthen their health systems and ensure high-quality care for all. PMID:24852300

Fission Meter Information Barrier Attribute Measurement System - NA-243 FNI/UKC FY2017 Task 1-2 Report

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

Kerr, P. L.; Decman, D.; Prasad, M.

An SNM attribute Information Barrier (IB) system was developed for a 2011 US/UK Exercise. The system was modified and extensively tested in a 2013-2014 US-UK Measurement Campaign. This work demonstrated rapid deployment of an IB system for potential treaty use. The system utilizes an Ortec Fission Meter neutron multiplicity counter and custom computer code. The system demonstrates a proof-of-principle automated Pu-240 mass determination with an information barrier. After a software start command is issued, the system automatically acquires and downloads data, performs an analysis, and displays the results. This system conveys the results of a Pu mass threshold measurements inmore » a way the does not reveal sensitive information. In full IB mode, only the pass/fail result is displayed as a “Mass <= Threshold Amount” or “Mass >= Threshold Amount” as shown in Figure 4. This can easily be adapted to a red/green “lights” display similar to the Detective IB system for Pu isotopics as shown in Figure 6. In test mode, more detailed information is displayed. The code can also read in, analyze, and display results from previously acquired or simulated data. Because the equipment is commercial-off-the-shelf (COTS), the system demonstrates a low-cost short-lead-time technology for treaty SNM attribute measurements. A deployed system will likely require integration of additional authentication and tamper-indicating technologies. This will be discussed for the project in this and future progress reports.« less

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

PubMed

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

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

Caring for pregnant refugee women in a turbulent policy landscape: perspectives of health care professionals in Calgary, Alberta.

PubMed

Winn, Anika; Hetherington, Erin; Tough, Suzanne

2018-06-26

Female refugees can be a vulnerable population, often having suffered through traumatic events that pose risks to their health, especially during pregnancy. Pregnancy can be an entry point into the health care system, providing health care professionals the opportunity to gain women's trust, connect refugees with resources, and optimize the health of mother and child. Policies surrounding the provision and funding of health care services to refugees can impact access to and quality of care. The aim of our study was to understand the experiences of health care professionals caring for pregnant refugee women in Calgary, AB, taking into consideration recent contextual changes to the refugee landscape in Canada. We conducted ten semi-structured interviews with health care professionals who provided regular care for pregnant refugee women at a refugee health clinic and major hospital in Calgary, Alberta. Interviews were recorded, transcribed, and analyzed using an interpretive description methodology. Health care providers described several barriers when caring for pregnant refugees, including language barriers, difficulty navigating the health care system, and cultural barriers such as managing traditional gender dynamics, only wanting a female provider and differences in medical practices. Providers managed these barriers through strategies including using a team-based approach to care, coordinating the patient's care with other services, and addressing both the medical and social needs of the patient. The federal funding cuts added additional challenges, as many refugees were left without adequate health coverage and the system was complicated to understand. Health care providers developed creative strategies to maximize coverage for their patients including paying out of pocket or relying on donations to care for uninsured refugees. Finally, the recent Syrian refugee influx has increased the demand on service providers and further strained already limited resources. Health care providers caring for pregnant refugee women faced complex cultural and system-level barriers, and used multiple strategies to address these barriers. Additional system strains add extra pressure on health care professionals, requiring them to quickly adjust and accommodate for new demands.

Understanding Barriers and Facilitators to the use of Clinical Information Systems for Intensive Care Units and Anesthesia Record Keeping: A Rapid Ethnography

PubMed Central

Saleem, Jason J.; Plew, William R.; Speir, Ross C.; Herout, Jennifer; Wilck, Nancy R.; Ryan, Dale Marie; Cullen, Theresa A.; Scott, Jean M.; Beene, Murielle S.; Phillips, Toni

2017-01-01

Objective This study evaluated the current use of commercial-off-the-shelf Clinical Information Systems (CIS) for intensive care units (ICU) and Anesthesia Record Keeping (ARK) for operating rooms and post-anesthesia care recovery settings at three Veterans Affairs Medical Centers (VAMCs). Clinicians and administrative staff use these applications at bedside workstations, in operating rooms, at nursing stations, in physician’s rooms, and in other various settings. The intention of a CIS or an ARK system is to facilitate creation of electronic records of data, assessments, and procedures from multiple medical devices. The US Department of Veterans Affairs (VA) Office of the Chief of Nursing Informatics sought to understand usage barriers and facilitators to optimize these systems in the future. Therefore, a human factors study was carried out to observe the CIS and ARK systems in use at three VAMCs in order to identify best practices and suggested improvements to currently implemented CIS and ARK systems. Methods We conducted a rapid ethnographic study of clinical end-users interacting with the CIS and ARK systems in the critical care and anesthesia care areas in each of three geographically distributed VAMCs. Two observers recorded interactions and/or interview responses from 88 CIS and ARK end-users. We coded and sorted into logical categories field notes from 69 shadowed participants. The team transcribed and combined data from key informant interviews with 19 additional participants with the observation data. We then integrated findings across observations into meaningful patterns and abstracted the data into themes, which translated directly to barriers to effective adoption and optimization of the CIS and ARK systems. Results Effective optimization of the CIS and ARK systems was impeded by: (1) integration issues with other software systems; (2) poor usability; (3) software challenges; (4) hardware challenges; (5) training concerns; (6) unclear roles and lack of coordination among stakeholders; and (7) insufficient technical support. Many of these barriers are multi-faceted and have associated sub-barriers, which are described in detail along with relevant quotes from participants. In addition, regionalized purchases of different CIS and ARK systems, as opposed to enterprise level purchases, contributed to some of the identified barriers. Facilitators to system use included (1) automation and (2) a dedicated facility-level CIS-ARK coordinator. Conclusions We identified barriers that explain some of the challenges with the optimization of the CIS and ARK commercial systems across the Veterans Health Administration (VHA). To help address these barriers, and evolve them into facilitators, we categorized report findings as (1) interface and system-level changes that vendors or VA healthcare systems can implement; (2) implementation factors under VA control and not under VA control; and (3) factors that may be used to inform future application purchases. We outline several recommendations for improved adoption of CIS and ARK systems and further recommend that human factors engineering and usability requirements become an integral part of VA health information technology (HIT) application procurement, customization, and implementation in order to help eliminate or mitigate some of the barriers of use identified in this study. Human factors engineering methods can be utilized to apply a user-centered approach to application requirements specification, application evaluation, system integration, and application implementation. PMID:25843931

Understanding barriers and facilitators to the use of Clinical Information Systems for intensive care units and Anesthesia Record Keeping: A rapid ethnography.

PubMed

Saleem, Jason J; Plew, William R; Speir, Ross C; Herout, Jennifer; Wilck, Nancy R; Ryan, Dale Marie; Cullen, Theresa A; Scott, Jean M; Beene, Murielle S; Phillips, Toni

2015-07-01

This study evaluated the current use of commercial-off-the-shelf Clinical Information Systems (CIS) for intensive care units (ICUs) and Anesthesia Record Keeping (ARK) for operating rooms and post-anesthesia care recovery settings at three Veterans Affairs Medical Centers (VAMCs). Clinicians and administrative staff use these applications at bedside workstations, in operating rooms, at nursing stations, in physician's rooms, and in other various settings. The intention of a CIS or an ARK system is to facilitate creation of electronic records of data, assessments, and procedures from multiple medical devices. The US Department of Veterans Affairs (VA) Office of the Chief of Nursing Informatics sought to understand usage barriers and facilitators to optimize these systems in the future. Therefore, a human factors study was carried out to observe the CIS and ARK systems in use at three VAMCs in order to identify best practices and suggested improvements to currently implemented CIS and ARK systems. We conducted a rapid ethnographic study of clinical end-users interacting with the CIS and ARK systems in the critical care and anesthesia care areas in each of three geographically distributed VAMCs. Two observers recorded interactions and/or interview responses from 88 CIS and ARK end-users. We coded and sorted into logical categories field notes from 69 shadowed participants. The team transcribed and combined data from key informant interviews with 19 additional participants with the observation data. We then integrated findings across observations into meaningful patterns and abstracted the data into themes, which translated directly to barriers to effective adoption and optimization of the CIS and ARK systems. Effective optimization of the CIS and ARK systems was impeded by: (1) integration issues with other software systems; (2) poor usability; (3) software challenges; (4) hardware challenges; (5) training concerns; (6) unclear roles and lack of coordination among stakeholders; and (7) insufficient technical support. Many of these barriers are multi-faceted and have associated sub-barriers, which are described in detail along with relevant quotes from participants. In addition, regionalized purchases of different CIS and ARK systems, as opposed to enterprise level purchases, contributed to some of the identified barriers. Facilitators to system use included (1) automation and (2) a dedicated facility-level CIS-ARK Coordinator. We identified barriers that explain some of the challenges with the optimization of the CIS and ARK commercial systems across the Veterans Health Administration (VHA). To help address these barriers, and evolve them into facilitators, we categorized report findings as (1) interface and system-level changes that vendors or VA healthcare systems can implement; (2) implementation factors under VA control and not under VA control; and (3) factors that may be used to inform future application purchases. We outline several recommendations for improved adoption of CIS and ARK systems and further recommend that human factors engineering and usability requirements become an integral part of VA health information technology (HIT) application procurement, customization, and implementation in order to help eliminate or mitigate some of the barriers of use identified in this study. Human factors engineering methods can be utilized to apply a user-centered approach to application requirements specification, application evaluation, system integration, and application implementation. Published by Elsevier Ireland Ltd.

Manufacturing Aids

NASA Astrophysics Data System (ADS)

1983-01-01

Contractor's work for Lewis Research Center on "thermal barrier" coatings designed to improve aircraft engine efficiency resulted in two related but separate spinoffs. The Materials and Manufacturing Technology Center of TRW, Inc. invented a robotic system for applying the coating, and in the course of that research found it necessary to develop a new, extremely accurate type of optical gage that offers multiple improvements in controlling the quality of certain manufactured parts.

Global report on preterm birth and stillbirth (4 of 7): delivery of interventions

PubMed Central

2010-01-01

Background The efficacious interventions identified in the previous article of this report will fail unless they are delivered at high and equitable coverage. This article discusses critical delivery constraints and strategies. Barriers to scaling up interventions Achieving universal coverage entails addressing major barriers at many levels. An overarching constraint is the lack of political will, resulting from the dearth of preterm birth and stillbirth data and the lack of visibility. Other barriers exist at the household and community levels, such as insufficient demand for interventions or sociocultural barriers; at the health services level, such as a lack of resources and trained healthcare providers; and at the health sector policy and management level, such as poorly functioning, centralized systems. Additional constraints involve weak governance and accountability, political instability, and challenges in the physical environment. Strategies and examples Scaling up maternal, newborn and child health interventions requires strengthening health systems, but there is also a role for focused, targeted interventions. Choosing a strategy involves identifying appropriate channels for reaching high coverage, which depends on many factors such as access to and attendance at healthcare facilities. Delivery channels vary, and may include facility- and community-based healthcare providers, mass media campaigns, and community-based approaches and marketing strategies. Issues related to scaling up are discussed in the context of four interventions that may be given to mothers at different stages throughout pregnancy or to newborns: (1) detection and treatment of syphilis; (2) emergency Cesarean section; (3) newborn resuscitation; and (4) kangaroo mother care. Systematic reviews of the literature and large-scale implementation studies are analyzed for each intervention. Conclusion Equitable and successful scale-up of preterm birth and stillbirth interventions will require addressing multiple barriers, and utilizing multiple delivery approaches and channels. Another important need is developing strategies to discontinue ineffective or harmful interventions. Preterm birth and stillbirth interventions must also be placed in the broader maternal, newborn and child health context to identify and prioritize those that will help improve several outcomes at the same time. The next article discusses advocacy challenges and opportunities. PMID:20233385

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

USGS Publications Warehouse

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

2010-01-01

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

Barriers to 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.

Place Matters in Non-Traditional Migration Areas: Exploring Barriers to Healthcare for Latino Immigrants by Region, Neighborhood, and Community Health Center.

PubMed

Topmiller, Michael; Zhen-Duan, Jenny; Jacquez, Farrah J; Vaughn, Lisa M

2017-12-01

This paper identifies differences in adult Latino immigrant barriers to healthcare in the Cincinnati area in Hamilton County, OH, on three levels: by region, by neighborhood, and by community health center. Secondary data analysis was performed on 439 surveys. Respondents were aggregated by the geographic regions and neighborhoods where they live and by two community health centers where they receive care. Outcome measures included pragmatic and skill barrier indices adapted from the Barriers to Care Questionnaire (BCQ); the pragmatics index consists logistical barriers, including transportation and cost; the skills index is made up of items related to navigating the healthcare system, including communicating with physicians and completing paperwork. The results indicate that immigrant Latinos living in western Cincinnati and northern Hamilton County face significantly higher pragmatic barriers to care, while Latino immigrants going to a community health center in western Cincinnati have significantly fewer pragmatic and skill barriers than immigrants utilizing a nearby community health center. Because healthcare options for undocumented immigrants do not improve with the Affordable Care Act, community health centers will continue to serve as their primary source of care. This is particularly true in non-traditional migration areas, where immigrants tend to be isolated and lack resources. Efforts to improve access to healthcare for immigrant Latinos require place-based approaches that allow for targeted resources to improve care in these locations. This study helps to fill that need by identifying variation in barriers to care on multiple levels and offering strategies to alleviate these barriers.

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

DTIC Science & Technology

2011-08-01

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

Coherent anti-Stokes Raman scattering microscopy: overcoming technical barriers for clinical translation

PubMed Central

Tu, Haohua; Boppart, Stephen A.

2015-01-01

Clinical translation of coherent anti-Stokes Raman scattering microscopy is of great interest because of the advantages of noninvasive label-free imaging, high sensitivity, and chemical specificity. For this to happen, we have identified and review the technical barriers that must be overcome. Prior investigations have developed advanced techniques (features), each of which can be used to effectively overcome one particular technical barrier. However, the implementation of one or a small number of these advanced features in previous attempts for clinical translation has often introduced more tradeoffs than benefits. In this review, we outline a strategy that would integrate multiple advanced features to overcome all the technical barriers simultaneously, effectively reduce tradeoffs, and synergistically optimize CARS microscopy for clinical translation. The operation of the envisioned system incorporates coherent Raman micro-spectroscopy for identifying vibrational biomolecular markers of disease and single-frequency (or hyperspectral) Raman imaging of these specific biomarkers for real-time in vivo diagnostics and monitoring. An optimal scheme of clinical CARS micro-spectroscopy for thin ex vivo tissues. PMID:23674234

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

ERIC Educational Resources Information Center

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

2007-01-01

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

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

PubMed

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

2018-01-01

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

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

PubMed Central

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

2017-01-01

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

Barriers to evidence-based acute stroke care in Ghana: a qualitative study on the perspectives of stroke care professionals

PubMed Central

Baatiema, Leonard; de-Graft Aikins, Ama; Sav, Adem; Mnatzaganian, George; Chan, Carina K Y; Somerset, Shawn

2017-01-01

Objective Despite major advances in research on acute stroke care interventions, relatively few stroke patients benefit from evidence-based care due to multiple barriers. Yet current evidence of such barriers is predominantly from high-income countries. This study seeks to understand stroke care professionals’ views on the barriers which hinder the provision of optimal acute stroke care in Ghanaian hospital settings. Design A qualitative approach using semistructured interviews. Both thematic and grounded theory approaches were used to analyse and interpret the data through a synthesis of preidentified and emergent themes. Setting A multisite study, conducted in six major referral acute hospital settings (three teaching and three non-teaching regional hospitals) in Ghana. Participants A total of 40 participants comprising neurologists, emergency physician specialists, non-specialist medical doctors, nurses, physiotherapists, clinical psychologists and a dietitian. Results Four key barriers and 12 subthemes of barriers were identified. These include barriers at the patient (financial constraints, delays, sociocultural or religious practices, discharge against medical advice, denial of stroke), health system (inadequate medical facilities, lack of stroke care protocol, limited staff numbers, inadequate staff development opportunities), health professionals (poor collaboration, limited knowledge of stroke care interventions) and broader national health policy (lack of political will) levels. Perceived barriers varied across health professional disciplines and hospitals. Conclusion Barriers from low/middle-income countries differ substantially from those in high-income countries. For evidence-based acute stroke care in low/middle-income countries such as Ghana, health policy-makers and hospital managers need to consider the contrasts and uniqueness in these barriers in designing quality improvement interventions to optimise patient outcomes. PMID:28450468

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

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

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

2013-05-13

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

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

PubMed

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

2013-08-19

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

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

PubMed Central

2013-01-01

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

Permeability of the blood-brain barrier to the neurotensin8-13 analog NT1.

PubMed

Banks, W A; Wustrow, D J; Cody, W L; Davis, M D; Kastin, A J

1995-10-09

Neurotensin (NT) has been suggested to be a neuropeptide with therapeutic potential. We used multiple-time regression analysis to measure the unidirectional influx constant (Ki) of a tritiated analog of NT8-13, NT1, with improved metabolic stability. The Ki of [3H]NT1 across the blood-brain barrier (BBB) was 5.12(10(-4)) ml/g-min and was decreased 66% by unlabeled NT1 system. The amount of NT1 crossing the BBB, 0.087% of the injected dose per gram of brain, is consistent with its exerting central effects after peripheral administration. The stable [3H]NT1 crossed the BBB in intact form as assessed by HPLC and completely crossed the endothelial cells that comprise the BBB as assessed by the capillary depletion method. The presence of a transport system could be important for the development of NT analogs.

Molecular mechanisms of CRISPR-mediated microbial immunity.

PubMed

Gasiunas, Giedrius; Sinkunas, Tomas; Siksnys, Virginijus

2014-02-01

Bacteriophages (phages) infect bacteria in order to replicate and burst out of the host, killing the cell, when reproduction is completed. Thus, from a bacterial perspective, phages pose a persistent lethal threat to bacterial populations. Not surprisingly, bacteria evolved multiple defense barriers to interfere with nearly every step of phage life cycles. Phages respond to this selection pressure by counter-evolving their genomes to evade bacterial resistance. The antagonistic interaction between bacteria and rapidly diversifying viruses promotes the evolution and dissemination of bacteriophage-resistance mechanisms in bacteria. Recently, an adaptive microbial immune system, named clustered regularly interspaced short palindromic repeats (CRISPR) and which provides acquired immunity against viruses and plasmids, has been identified. Unlike the restriction–modification anti-phage barrier that subjects to cleavage any foreign DNA lacking a protective methyl-tag in the target site, the CRISPR–Cas systems are invader-specific, adaptive, and heritable. In this review, we focus on the molecular mechanisms of interference/immunity provided by different CRISPR–Cas systems.

Kangaroo mother care: a systematic review of barriers and enablers

PubMed Central

Labar, Amy S; Wall, Stephen; Atun, Rifat

2016-01-01

Abstract Objective To investigate factors influencing the adoption of kangaroo mother care in different contexts. Methods We searched PubMed, Embase, Scopus, Web of Science and the World Health Organization’s regional databases, for studies on “kangaroo mother care” or “kangaroo care” or “skin-to-skin care” from 1 January 1960 to 19 August 2015, without language restrictions. We included programmatic reports and hand-searched references of published reviews and articles. Two independent reviewers screened articles and extracted data on carers, health system characteristics and contextual factors. We developed a conceptual model to analyse the integration of kangaroo mother care in health systems. Findings We screened 2875 studies and included 112 studies that contained qualitative data on implementation. Kangaroo mother care was applied in different ways in different contexts. The studies show that there are several barriers to implementing kangaroo mother care, including the need for time, social support, medical care and family acceptance. Barriers within health systems included organization, financing and service delivery. In the broad context, cultural norms influenced perceptions and the success of adoption. Conclusion Kangaroo mother care is a complex intervention that is behaviour driven and includes multiple elements. Success of implementation requires high user engagement and stakeholder involvement. Future research includes designing and testing models of specific interventions to improve uptake. PMID:26908962

Kangaroo mother care: a systematic review of barriers and enablers.

PubMed

Chan, Grace J; Labar, Amy S; Wall, Stephen; Atun, Rifat

2016-02-01

To investigate factors influencing the adoption of kangaroo mother care in different contexts. We searched PubMed, Embase, Scopus, Web of Science and the World Health Organization's regional databases, for studies on "kangaroo mother care" or "kangaroo care" or "skin-to-skin care" from 1 January 1960 to 19 August 2015, without language restrictions. We included programmatic reports and hand-searched references of published reviews and articles. Two independent reviewers screened articles and extracted data on carers, health system characteristics and contextual factors. We developed a conceptual model to analyse the integration of kangaroo mother care in health systems. We screened 2875 studies and included 112 studies that contained qualitative data on implementation. Kangaroo mother care was applied in different ways in different contexts. The studies show that there are several barriers to implementing kangaroo mother care, including the need for time, social support, medical care and family acceptance. Barriers within health systems included organization, financing and service delivery. In the broad context, cultural norms influenced perceptions and the success of adoption. Kangaroo mother care is a complex intervention that is behaviour driven and includes multiple elements. Success of implementation requires high user engagement and stakeholder involvement. Future research includes designing and testing models of specific interventions to improve uptake.

Expression of thyroid hormone transporters and deiodinases at the brain barriers in the embryonic chicken: Insights into the regulation of thyroid hormone availability during neurodevelopment.

PubMed

Van Herck, Stijn L J; Delbaere, Joke; Bourgeois, Nele M A; McAllan, Bronwyn M; Richardson, Samantha J; Darras, Veerle M

2015-04-01

Thyroid hormones (THs) are key regulators in the development of the vertebrate brain. Therefore, TH access to the developing brain needs to be strictly regulated. The brain barriers separate the central nervous system from the rest of the body and impose specific transport mechanisms on the exchange of molecules between the general circulation and the nervous system. As such they form ideal structures for regulating TH exchange between the blood and the brain. To investigate the mechanism by which the developing brain regulates TH availability, we investigated the ontogenetic expression profiles of TH transporters, deiodinases and the TH distributor protein transthyretin (TTR) at the brain barriers during embryonic and early postnatal development using the chicken as a model. In situ hybridisation revealed expression of the TH transporters monocarboxylate transporter 8 (MCT8) and 10 (MCT10), organic anion transporting polypeptide 1C1 (OATP1C1) and L-type amino acid transporter 1 (LAT1) and the inactivating type 3 deiodinase (D3) in the choroid plexus which forms the blood-cerebrospinal fluid barrier. This was confirmed by quantitative PCR which additionally indicated strongly increasing expression of TTR as well as detectable expression of the activating type 2 deiodinase (D2) and the (in)activating type 1 deiodinase (D1). In the brain capillaries forming the blood-brain barrier in situ hybridisation showed exclusive expression of LAT1 and D2. The combined presence of LAT1 and D2 in brain capillaries suggests that the blood-brain barrier forms the main route for receptor-active T3 uptake into the embryonic chicken brain. Expression of multiple transporters, deiodinases and TTR in the choroid plexus indicates that the blood-cerebrospinal fluid barrier is also important in regulating early TH availability. The impact of these barrier systems can be deduced from the clear difference in T3 and T4 levels as well as the T3/T4 ratio between the developing brain and the general circulation. We conclude that the tight regulation of TH exchange at the brain barriers from early embryonic stages is one of the factors needed to allow the brain to develop within a relative microenvironment. Copyright © 2015 Elsevier Inc. All rights reserved.

A stepped pressure profile model for internal transport barriers

NASA Astrophysics Data System (ADS)

Hole, Matthew; Hudson, Stuart; Dewar, Robert

2007-11-01

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

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

PubMed

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

2015-05-01

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

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

PubMed

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

2014-05-29

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

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

PubMed

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

2018-05-02

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

Barriers to Sexuality for Individuals with Intellectual and Developmental Disabilities: A Literature Review

ERIC Educational Resources Information Center

Sinclair, James; Unruh, Deanne; Lindstrom, Lauren; Scanlon, David

2015-01-01

Individuals with intellectual and developmental disabilities (ID/DD) experience multiple barriers that may prevent them from understanding and exploring their own sexuality. These barriers prevent them from achieving the same autonomy and quality of life as their peers. This research synthesis focuses on 13 articles published between 2000 and 2013…

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…

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.

Envisioning an America Without Sexual Orientation Inequities in Adolescent Health

PubMed Central

Birkett, Michelle; Greene, George J.; Hatzenbuehler, Mark L.; Newcomb, Michael E.

2014-01-01

This article explicates a vision for social change throughout multiple levels of society necessary to eliminate sexual orientation health disparities in youths. We utilized the framework of Bronfenbrenner’s ecological theory of development, a multisystemic model of development that considers direct and indirect influences of multiple levels of the environment. Within this multisystem model we discuss societal and political influences, educational systems, neighborhoods and communities, romantic relationships, families, and individuals. We stress that continued change toward equity in the treatment of lesbian, gay, and bisexual youths across these levels will break down the barriers for these youths to achieve healthy development on par with their heterosexual peers. PMID:24328618

Applications of Business Analytics in Healthcare.

PubMed

Ward, Michael J; Marsolo, Keith A; Froehle, Craig M

2014-09-01

The American healthcare system is at a crossroads, and analytics, as an organizational skill, figures to play a pivotal role in its future. As more healthcare systems capture information electronically and as they begin to collect more novel forms of data, such as human DNA, how will we leverage these resources and use them to improve human health at a manageable cost? In this article, we argue that analytics will play a fundamental role in the transformation of the American healthcare system. However, there are numerous challenges to the application and use of analytics, namely the lack of data standards, barriers to the collection of high-quality data, and a shortage of qualified personnel to conduct such analyses. There are also multiple managerial issues, such as how to get end users of electronic data to employ it consistently for improving healthcare delivery, and how to manage the public reporting and sharing of data. In this article, we explore applications of analytics in healthcare, barriers and facilitators to its widespread adoption, and how analytics can help us achieve the goals of the modern healthcare system: high-quality, responsive, affordable, and efficient care.

Applications of Business Analytics in Healthcare

PubMed Central

Ward, Michael J.; Marsolo, Keith A.

2014-01-01

The American healthcare system is at a crossroads, and analytics, as an organizational skill, figures to play a pivotal role in its future. As more healthcare systems capture information electronically and as they begin to collect more novel forms of data, such as human DNA, how will we leverage these resources and use them to improve human health at a manageable cost? In this article, we argue that analytics will play a fundamental role in the transformation of the American healthcare system. However, there are numerous challenges to the application and use of analytics, namely the lack of data standards, barriers to the collection of high-quality data, and a shortage of qualified personnel to conduct such analyses. There are also multiple managerial issues, such as how to get end users of electronic data to employ it consistently for improving healthcare delivery, and how to manage the public reporting and sharing of data. In this article, we explore applications of analytics in healthcare, barriers and facilitators to its widespread adoption, and how analytics can help us achieve the goals of the modern healthcare system: high-quality, responsive, affordable, and efficient care. PMID:25429161

Rapid evolution of reproductive isolation between incipient outcrossing and selfing Clarkia species.

PubMed

Briscoe Runquist, Ryan D; Chu, Eric; Iverson, Justin L; Kopp, Jason C; Moeller, David A

2014-10-01

A major goal of speciation research is to understand the processes involved in the earliest stages of the evolution of reproductive isolation (RI). One important challenge has been to identify systems where lineages have very recently diverged and opportunities for hybridization are present. We conducted a comprehensive examination of the components of RI across the life cycle of two subspecies of Clarkia xantiana, which diverged recently (ca. 65,000 bp). One subspecies is primarily outcrossing, but self-compatible, whereas the other is primarily selfing. The subspecies co-occur in a zone of sympatry but hybrids are rarely observed. Premating barriers resulted in nearly complete isolation in both subspecies with flowering time and pollinator preference (for the outcrosser over the selfer) as the strongest barriers. We found that the outcrosser had consistently more competitive pollen, facilitating hybridization in one direction, but no evidence for pollen-pistil interactions as an isolating barrier. Surprisingly, postzygotic isolation was detected at the stage of hybrid seed development, but in no subsequent life stages. This crossing barrier was asymmetric with crosses from the selfer to outcrosser most frequently failing. Collectively, the results provide evidence for rapid evolution of multiple premating and postzygotic barriers despite a very recent divergence time. © 2014 The Author(s). Evolution © 2014 The Society for the Study of Evolution.

Operational Overview for UAS Integration in the NAS Project Flight Test Series 3

NASA Technical Reports Server (NTRS)

Valkov, Steffi B.; Sternberg, Daniel; Marston, Michael

2018-01-01

The National Aeronautics and Space Administration Unmanned Aircraft Systems Integration in the National Airspace System Project has conducted a series of flight tests intended to support the reduction of barriers that prevent unmanned aircraft from flying without the required waivers from the Federal Aviation Administration. The 2015 Flight Test Series 3, supported two separate test configurations. The first configuration investigated the timing of Detect and Avoid alerting thresholds using a radar equipped unmanned vehicle and multiple live intruders flown at varying encounter geometries.

Systems for implementing best practice for a chronic disease: management of osteoarthritis of the hip and knee.

PubMed

Brand, C; Cox, S

2006-03-01

Effective implementation of evidence-based care has been associated with better health outcomes; however, evidence-based clinical practice guidelines have been used with varying success. This study aimed to develop integrative tools to support implementation of best practice recommendations for nonsurgical management of osteoarthritis (OA) of the hip and knee and to identify barriers to effective implementation. Published, peer reviewed clinical practice guidelines were updated and translated into an OA care pathway. Key decision nodes in the pathway were identified by a Multidisciplinary Working Group. Qualitative research methods were used to inform pathway development and to identify barriers and enablers for pathway implementation. Qualitative components included purposively selected stakeholder focus groups, key informant interviews and patient process mapping of 10 patient journeys in different settings over a 3-month period. All interviews, facilitated by a trained project officer, were semistructured, recorded, then thematically analysed and summarized. An OA care pathway, clinician and patient toolkits were developed that met the needs of multidisciplinary end-users. Several system- and setting-specific barriers to pathway implementation were identified. Opportunities to improve patient access, interprofessional communication, patient information and education and continuity of care processes were identified. Integrative tools for implementation of best evidence care for patients with OA of the hip and knee were tailored to end-user needs and preferences. Multiple barriers exist that potentially limit effective implementation of best evidence. Comprehensive assessment of barriers and enablers to effective guideline or pathway implementation is recommended before implementation and evaluation.

Barriers and Facilitators of Transition from Pediatric to Adult Long-Term Follow-Up Care in Childhood Cancer Survivors.

PubMed

Rosenberg-Yunger, Zahava R S; Klassen, Anne F; Amin, Leila; Granek, Leeat; D'Agostino, Norma M; Boydell, Katherine M; Greenberg, Mark; Barr, Ronald D; Nathan, Paul C

2013-09-01

Despite the risk for late effects in adult survivors of cancer in childhood or adolescence, many survivors fail to transition from pediatric to adult long-term follow-up (LTFU) care. The purpose of this study was to identify the barriers and facilitators of transition from pediatric to adult LTFU care. In this qualitative study, 38 Canadian survivors of cancer in childhood or adolescence, currently aged 15-26 years, were interviewed using semi-structured, open-ended questions. Participants belonged to one of four groups: pre-transition (n=10), successful transition (n=11), failed to transition (n=7), and transitioned to an adult center but then dropped out of adult care (n=10). A constructivist grounded theory approach was used to analyze the interview data. This approach consisted of coding transcripts line by line to develop categories and using constant comparison to examine relationships within and across codes and categories. Interviewing continued until saturation was reached. Three interrelated themes were identified that affected the transition process: micro-level patient factors (e.g., due diligence, anxiety), meso-level support factors (e.g., family, friends), and macro-level system factors (e.g., appointments, communication, healthcare providers). Factors could act as facilitators to transition (e.g., family support), barriers to transition (e.g., difficulty booking appointments), or as both a barrier and a facilitator (e.g., anxiety). This study illustrates the interaction between multiple factors that facilitate and/or prevent transition from pediatric to adult LTFU cancer care. A number of recommendations are presented to address potential macro-level system barriers to successful transition.

Acceptance and barriers pertaining to a general practice decision support system for multiple clinical conditions: A mixed methods evaluation.

PubMed

Arts, Derk L; Medlock, Stephanie K; van Weert, Henk C P M; Wyatt, Jeremy C; Abu-Hanna, Ameen

2018-01-01

Many studies have investigated the use of clinical decision support systems as a means to improve care, but have thus far failed to show significant effects on patient-related outcomes. We developed a clinical decision support system that attempted to address issues that were identified in these studies. The system was implemented in Dutch general practice and was designed to be both unobtrusive and to respond in real time. Despite our efforts, usage of the system was low. In the current study we perform a mixed methods evaluation to identify remediable barriers which led to disappointing usage rates for our system. A mixed methods evaluation employing an online questionnaire and focus group. The focus group was organized to clarify free text comments and receive more detailed feedback from general practitioners. Topics consisted of items based on results from the survey and additional open questions. The response rate for the questionnaire was 94%. Results from the questionnaire and focus group can be summarized as follows: The system was perceived as interruptive, despite its design. Participants felt that there were too many recommendations and that the relevance of the recommendations varied. Demographic based recommendations (e.g. age) were often irrelevant, while specific risk-based recommendations (e.g. diagnosis) were more relevant. The other main barrier to use was lack of time during the patient visit. These results are likely to be useful to other researchers who are attempting to address the problems of interruption and alert fatigue in decision support.

Leachate breakthrough mechanism and key pollutant indicator of municipal solid waste landfill barrier systems: Centrifuge and numerical modeling approach.

PubMed

Shu, Shi; Zhu, Wei; Wang, Shengwei; Ng, Charles Wang Wai; Chen, Yunmin; Chiu, Abraham Chung Fai

2018-01-15

Groundwater pollution by leachate leakage is one of the most common environmental hazards associated with municipal solid waste (MSW) landfill sites. However, landfill leachate contains a large variety of pollutants with widely different concentrations and biotoxicity. Thus, selecting leachate pollutant indicators and levels for identifying breakthrough of barrier systems are key factors in assessing their breakthrough times. This study investigated the transport behavior of leachate pollutants through landfill barrier systems using centrifuge tests and numerical modeling. The overall objective of this study is to investigate breakthrough mechanism to facilitate the establishment of a consistent pollutant threshold concentration for use as a groundwater pollution alert. The specific objective of the study is to identify which pollutant and breakthrough threshold concentration should be used as an indicator in the transport of multiple pollutants through a landfill barrier system. The threshold concentration from the Chinese groundwater quality standards was used in the analysis of the properties of leachates from many landfill sites in China. The time for the chemical oxygen demand (COD) to reach the breakthrough threshold concentration at the bottom of a 2m compacted clay liner was 1.51years according to centrifuge tests, and 1.81years according to numerical modeling. The COD breakthrough times for single and double composite liners were within the range of 16 and 36.58years. Of all the pollutants, COD was found to consistently reach the breakthrough threshold first. Therefore, COD can be selected as the key indicator for pollution alerts and used to assess the environmental risk posed by MSW landfill sites. Copyright © 2017. Published by Elsevier B.V.

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.

Two-Electron Transfer Pathways.

PubMed

Lin, Jiaxing; Balamurugan, D; Zhang, Peng; Skourtis, Spiros S; Beratan, David N

2015-06-18

The frontiers of electron-transfer chemistry demand that we develop theoretical frameworks to describe the delivery of multiple electrons, atoms, and ions in molecular systems. When electrons move over long distances through high barriers, where the probability for thermal population of oxidized or reduced bridge-localized states is very small, the electrons will tunnel from the donor (D) to acceptor (A), facilitated by bridge-mediated superexchange interactions. If the stable donor and acceptor redox states on D and A differ by two electrons, it is possible that the electrons will propagate coherently from D to A. While structure-function relations for single-electron superexchange in molecules are well established, strategies to manipulate the coherent flow of multiple electrons are largely unknown. In contrast to one-electron superexchange, two-electron superexchange involves both one- and two-electron virtual intermediate states, the number of virtual intermediates increases very rapidly with system size, and multiple classes of pathways interfere with one another. In the study described here, we developed simple superexchange models for two-electron transfer. We explored how the bridge structure and energetics influence multielectron superexchange, and we compared two-electron superexchange interactions to single-electron superexchange. Multielectron superexchange introduces interference between singly and doubly oxidized (or reduced) bridge virtual states, so that even simple linear donor-bridge-acceptor systems have pathway topologies that resemble those seen for one-electron superexchange through bridges with multiple parallel pathways. The simple model systems studied here exhibit a richness that is amenable to experimental exploration by manipulating the multiple pathways, pathway crosstalk, and changes in the number of donor and acceptor species. The features that emerge from these studies may assist in developing new strategies to deliver multiple electrons in condensed-phase redox systems, including multiple-electron redox species, multimetallic/multielectron redox catalysts, and multiexciton excited states.

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

NASA Astrophysics Data System (ADS)

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

2018-02-01

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

Ultrascalable petaflop parallel supercomputer

DOEpatents

Blumrich, Matthias A [Ridgefield, CT; Chen, Dong [Croton On Hudson, NY; Chiu, George [Cross River, NY; Cipolla, Thomas M [Katonah, NY; Coteus, Paul W [Yorktown Heights, NY; Gara, Alan G [Mount Kisco, NY; Giampapa, Mark E [Irvington, NY; Hall, Shawn [Pleasantville, NY; Haring, Rudolf A [Cortlandt Manor, NY; Heidelberger, Philip [Cortlandt Manor, NY; Kopcsay, Gerard V [Yorktown Heights, NY; Ohmacht, Martin [Yorktown Heights, NY; Salapura, Valentina [Chappaqua, NY; Sugavanam, Krishnan [Mahopac, NY; Takken, Todd [Brewster, NY

2010-07-20

A massively parallel supercomputer of petaOPS-scale includes node architectures based upon System-On-a-Chip technology, where each processing node comprises a single Application Specific Integrated Circuit (ASIC) having up to four processing elements. The ASIC nodes are interconnected by multiple independent networks that optimally maximize the throughput of packet communications between nodes with minimal latency. The multiple networks may include three high-speed networks for parallel algorithm message passing including a Torus, collective network, and a Global Asynchronous network that provides global barrier and notification functions. These multiple independent networks may be collaboratively or independently utilized according to the needs or phases of an algorithm for optimizing algorithm processing performance. The use of a DMA engine is provided to facilitate message passing among the nodes without the expenditure of processing resources at the node.

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

PubMed

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

2011-01-01

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

Free Energy Calculations using a Swarm-Enhanced Sampling Molecular Dynamics Approach.

PubMed

Burusco, Kepa K; Bruce, Neil J; Alibay, Irfan; Bryce, Richard A

2015-10-26

Free energy simulations are an established computational tool in modelling chemical change in the condensed phase. However, sampling of kinetically distinct substates remains a challenge to these approaches. As a route to addressing this, we link the methods of thermodynamic integration (TI) and swarm-enhanced sampling molecular dynamics (sesMD), where simulation replicas interact cooperatively to aid transitions over energy barriers. We illustrate the approach by using alchemical alkane transformations in solution, comparing them with the multiple independent trajectory TI (IT-TI) method. Free energy changes for transitions computed by using IT-TI grew increasingly inaccurate as the intramolecular barrier was heightened. By contrast, swarm-enhanced sampling TI (sesTI) calculations showed clear improvements in sampling efficiency, leading to more accurate computed free energy differences, even in the case of the highest barrier height. The sesTI approach, therefore, has potential in addressing chemical change in systems where conformations exist in slow exchange. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Alternating-Composition Layered Ceramic Barrier Coatings

NASA Technical Reports Server (NTRS)

Miller, Robert A.; Zhu, Dongming

2008-01-01

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

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

PubMed Central

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

2013-01-01

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

[Barriers to implementing screening, brief intervention and referral to treatment for substance use in HIV/AIDS health services in Peru].

PubMed

Hoffman, Kim A; Beltrán, Jessica; Ponce, Javier; García-Fernandez, Lisset; Calderón, María; Muench, John; Benites, Carlos; Soto, Leslie; McCarty, Dennis; Fiestas, Fabián

2016-01-01

Screening and treatment for substance use among people living with HIV/AIDS (PLWHA) is highly recommended. Nevertheless, in Peru healthcare for PLWHA does not include a standardized or systematic assessment to identify substance use. The aim of this study was to assess the feasibility of implementing screening, brief intervention and referral to treatment (SBIRT) in healthcare settings attending people living with PLWHA. After providing training in SBIRT for PLWHA's healthcare personnel (including nurses and physicians) focus groups were conducted to explore knowledge, beliefs and perceived barriers to implementation and interviews were conducted to assess the barriers and facilitators of two tertiary hospitals in Lima, Peru. focus groups and interviews' thematic coding revealed three dimensions: 1) the unknown extent of substance use within PLWHA, 2) space and time limitations hinder completion of brief interventions during routine visits, and 3) insufficient access to substance use treatment appropriate for HIV patients. Multiple barriers, including lack of awareness of substance use problems, limited space and time of providers, and lack of specialized services to refer patients for treatment make it difficult to implement SBIRT in the Peruvian healthcare system.

EMS Provider Perceptions on Termination of Resuscitation in a Large, Urban EMS System.

PubMed

Tataris, Katie L; Richards, Christopher T; Stein-Spencer, Leslee; Ryan, Stephanie; Lazzara, Pete; Weber, Joseph M

2017-01-01

Despite the value of out-of-hospital Termination of Resuscitation (TOR) and the scientific evidence in favor of this practice, TOR has not been uniformly adopted or consistently practiced in EMS systems. Previous focus group studies have identified multiple barriers to implementation of out of hospital TOR but existing literature on EMS provider perceptions is limited. We sought to identify EMS providers' perceived barriers to performing out-of-hospital TOR in a large urban EMS system. The Chicago EMS System is a regional collaborative of EMS physicians, nurses and provider agencies, including the Chicago Fire Department (CFD), which provides exclusive emergency response for 9-1-1 calls in Chicago. CFD is an urban, fire-based EMS agency with a tiered response, with fire-fighter EMTs and paramedics providing initial care, and single role paramedics providing supplemental care and transport. A 2-page written survey was distributed to understand providers' experiences with managing OHCA and perceived barriers to TOR to inform subsequent improvements in protocol development and education. Of 3500 EMS providers that received the survey, 2309 were completed (66%). Survey respondent demographics were fire-fighter/EMTB (69%), fire-fighter/paramedic (14%), and single role paramedic (17%). The most frequent barrier to field TOR was scene safety (86%). The most common safety issue identified was family reaction to TOR (68%) and many providers felt threatened by family when trying to perform TOR (38%). Providers with a higher career numbers of OHCA were more likely to have felt threatened by the family (OR 6.70, 95% CI 2.99-15.00) and single role paramedics were more likely than FF/EMTBs to have felt threatened (OR 3.34, 95% CI 2.65-4.22). Barriers to delivering a death notification after TOR, include being uncomfortable or threatened with possible family reaction (52%) and family asking to continue the resuscitation (45%). There was lack of formal prior death notification training, the majority learned from colleagues through on the job training. Our study identifies scene safety, death notification delivery, and lack of formal training in death notification as barriers that EMS providers face while performing TOR in a large urban EMS system. These findings informed educational and operational initiatives to overcome the identified provider level issues and improve compliance with TOR policies.

In-Space Propulsion Assessment Processes and Criteria for Affordable Systems

NASA Technical Reports Server (NTRS)

Zapata, Edgar; Rhodes, Russel

1999-01-01

In a world of high launch costs to Low Earth Orbit (LEO), and of costs nearly twice as high to Geosynchronous Earth Orbit (GEO), it is clear that processes and criteria are required which will surface the path to greater affordability. Further, with propulsion systems making up a major part of the systems placed into multiple orbits, or beyond, it is clear that addressing propulsion systems for in-space propulsion (ISP) is a key part to breaking the barriers to affordable systems. While multitudes of Earth to Orbit transportation system efforts focus on reduced costs, the often neglected costs and related interactions of the in-space system equally require improvements that will enable broad end-to end customer affordability.

Recent advances in ophthalmic drug delivery

PubMed Central

Kompella, Uday B; Kadam, Rajendra S; Lee, Vincent HL

2011-01-01

Topical ocular drug bioavailability is notoriously poor, in the order of 5% or less. This is a consequence of effective multiple barriers to drug entry, comprising nasolacrimal drainage, epithelial drug transport barriers and clearance from the vasculature in the conjunctiva. While sustained drug delivery to the back of the eye is now feasible with intravitreal implants such as Vitrasert™ (~6 months), Retisert™ (~3 years) and Iluvien™ (~3 years), currently there are no marketed delivery systems for long-term drug delivery to the anterior segment of the eye. The purpose of this article is to summarize the resurgence in interest to prolong and improve drug entry from topical administration. These approaches include mucoadhesives, viscous polymer vehicles, transporter-targeted prodrug design, receptor-targeted functionalized nanoparticles, iontophoresis, punctal plug and contact lens delivery systems. A few of these delivery systems might be useful in treating diseases affecting the back of the eye. Their effectiveness will be compared against intravitreal implants (upper bound of effectiveness) and trans-scleral systems (lower bound of effectiveness). Refining the animal model by incorporating the latest advances in microdialysis and imaging technology is key to expanding the knowledge central to the design, testing and evaluation of the next generation of innovative ocular drug delivery systems. PMID:21399724

Double barrier system for an in situ conversion process

DOEpatents

McKinzie, Billy John [Houston, TX; Vinegar, Harold J [Bellaire, TX; Cowan, Kenneth Michael [Sugar land, TX; Deeg, Wolfgang Friedrich Johann [Houston, TX; Wong, Sau-Wai [Rijswijk, NL

2009-05-05

A barrier system for a subsurface treatment area is described. The barrier system includes a first barrier formed around at least a portion of the subsurface treatment area. The first barrier is configured to inhibit fluid from exiting or entering the subsurface treatment area. A second barrier is formed around at least a portion of the first barrier. A separation space exists between the first barrier and the second barrier.

From the "little brain" gastrointestinal infection to the "big brain" neuroinflammation: a proposed fast axonal transport pathway involved in multiple sclerosis.

PubMed

Deretzi, Georgia; Kountouras, Jannis; Grigoriadis, Nikolaos; Zavos, Christos; Chatzigeorgiou, Stavros; Koutlas, Evangelos; Tsiptsios, Iakovos

2009-11-01

The human central nervous system (CNS) is targeted by different pathogens which, apart from pathogens' intranasal inoculation or trafficking into the brain through infected blood cells, may use a distinct pathway to bypass the blood-brain barrier by using the gastrointestinal tract (GIT) retrograde axonal transport through sensory or motor fibres. The recent findings regarding the enteric nervous system (often called the "little brain") similarities with CNS and GIT axonal transport of infections resulting in CNS neuroinflammation are mainly reviewed in this article. We herein propose that the GIT is the vulnerable area through which pathogens (such as Helicobacter pylori) may influence the brain and induce multiple sclerosis pathologies, mainly via the fast axonal transport by the afferent neurones connecting the GIT to brain.

Barriers and facilitators to implementing a patient-centered model of contraceptive provision in community health centers.

PubMed

Politi, Mary C; Estlund, Amy; Milne, Anne; Buckel, Christina M; Peipert, Jeffrey F; Madden, Tessa

2016-01-01

The Contraceptive CHOICE Project developed a patient-centered model for contraceptive provision including: (1) structured, evidence-based counseling; (2) staff and health care provider education; and (3) removal of barriers such as cost and multiple appointments to initiate contraception. In preparation for conducting a research study of the CHOICE model in three community health settings, we sought to identify potential barriers and facilitators to implementation. Using a semi-structured interview guide guided by a framework of implementation research, we conducted 31 qualitative interviews with female patients, staff, and health care providers assessing attitudes, beliefs, and barriers to receiving contraception. We also asked about current contraceptive provision and explored organizational practices relevant to implementing the CHOICE model. We used a grounded theory approach to identify major themes. Many participants felt that current contraceptive provision could be improved by the CHOICE model. Potential facilitators included agreement about the necessity for improved contraceptive knowledge among patients and staff; importance of patient-centered contraceptive counseling; and benefits to same-day insertion of long-acting reversible contraception (LARC). Potential barriers included misconceptions about contraception held by staff and providers; resistance to new practices; costs associated with LARC; and scheduling challenges required for same-day insertion of LARC. In addition to staff and provider training, implementing a patient-centered model of contraceptive provision needs to be supplemented by strategies to manage patient and system-level barriers. Community health center staff, providers, and patients support patient-centered contraceptive counseling to improve contraception provision if organizations can address these barriers.

Effects of depression and antidepressant use on goal setting and barrier identification among patients with type 2 diabetes.

PubMed

Chen, Hsiang-Yu; Ruppert, Kristine; Charron-Prochownik, Denise; Noullet, William V; Zgibor, Janice C

2011-01-01

The purpose of this study was to examine the effects of depression and antidepressant use on goal setting and barrier identification in patients with type 2 diabetes. In a large diabetes education network, 778 patients with type 2 diabetes were enrolled in the American Association of Diabetes Educators (AADE) Outcomes System as part of their routine diabetes education between 2005 and 2008. Self-reported depression, 7 self-identified behavior change goals, and 13 barriers to diabetes self-care were collected from the Diabetes Self-Management Assessment Report Tool (D-SMART(®)); antidepressant use was documented from the Diabetes Educator Tool (D-ET(®)). Multiple linear regression was used to evaluate the effects of depression or antidepressant use on the number of goals or the number of barriers while controlling for relevant covariates. Among 778 patients (507 nondepressed, 181 depressed with antidepressant use, 90 depressed without antidepressant use), median age was 58, 60.9% were female, and 85.9% were Caucasian. Patients with and without depression had a similar number of self-identified behavior change goals, whereas patients with depression had 1 additional barrier to diabetes self-care compared with those without depression. In the depressed subgroup, antidepressant use had no association with the number of goals that the subjects set or the number of barriers they identified. Among patients with type 2 diabetes, depression was associated with a slightly greater number of barriers, which may support the importance of depression screening and depression treatment in patients with diabetes.

Migrant tuberculosis patient needs and health system response along the Thailand-Myanmar border.

PubMed

Tschirhart, Naomi; Nosten, Francois; Foster, Angel M

2017-10-01

This article aims to identify how the health system in Tak province, Thailand has responded to migrants' barriers to tuberculosis (TB) treatment. Our qualitatively driven multi-methods project utilized focus group discussions, key informant interviews, and a survey of community health volunteers to collect data in 2014 from multiple perspectives. Migrants identified legal status and transportation difficulties as the primary barriers to seeking TB treatment. Lack of financial resources and difficulties locating appropriate and affordable health services in other Thai provinces or across the border in Myanmar further contributed to migrants' challenges. TB care providers responded to barriers to treatment by bringing care out into the community, enhancing patient mobility, providing supportive services, and reaching out to potential patients. Interventions to improve migrant access and adherence to TB treatment necessarily extend outside of the health system and require significant resources to expand equitable access to treatment. Although this research is specific to the Thailand-Myanmar border, we anticipate that the findings will contribute to broader conversations around the inputs that are necessary to address disparities and inequities. Our study suggests that migrants need to be provided with resources that help stabilize their financial situation and overcome difficulties associated with their legal status in order to access and continue TB treatment. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Natural hybridization and genetic and morphological variation between two epiphytic bromeliads

PubMed Central

Neri, Jordana; Wendt, Tânia

2018-01-01

Abstract Reproductive isolation is of fundamental importance for maintaining species boundaries in sympatry. Here, we examine the genetic and morphological differences between two closely related bromeliad species: Vriesea simplex and Vriesea scalaris. Furthermore, we examined the occurrence of natural hybridization and discuss the action of reproductive isolation barriers. Nuclear genomic admixture suggests hybridization in sympatric populations, although interspecific gene flow is low among species in all sympatric zones (Nem < 0.5). Thus, morphological and genetic divergence (10.99 %) between species can be maintained despite ongoing natural hybridization. Cross-evaluation of our genetic and morphological data suggests that species integrity is maintained by the simultaneous action of multiple barriers, such as divergent reproductive systems among species, differences in floral traits and low hybrid seed viability. PMID:29308124

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

PubMed

Lajoie, Jason M; Shusta, Eric V

2015-01-01

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

[Challenges of the right to health in the Colombian model].

PubMed

Bernal, Oscar; Barbosa, Samuel

2015-01-01

Health in Colombia is now a fundamental right that has to be provided and protected by the government. We evaluated the strengths and difficulties of the health system with respect to the statutory law enacted in February 2015, using methodologies for analysis of health systems proposed by the WHO and the World Bank. The challenges include the fragmentation and specialization of services, access barriers and incentives that are not aligned with the quality, weak governance, multiple actors with little coordination and information system that does not measure results. The government needs to find a necessary social agreement, a balance between the particular and the collective benefit.

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

PubMed

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

2016-01-01

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

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

PubMed

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

2013-01-01

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

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

PubMed Central

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

2013-01-01

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

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

NASA Astrophysics Data System (ADS)

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

2018-06-01

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

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

PubMed

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

2012-06-01

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

Psychologists and the Transition From Pediatrics to Adult Health Care.

PubMed

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

2015-11-01

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

Farmer Participation in U.S. Farm Bill Conservation Programs

NASA Astrophysics Data System (ADS)

Reimer, Adam P.; Prokopy, Linda S.

2014-02-01

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

Diabetes self-management in a low-income population: impacts of social support and relationships with the health care system

PubMed Central

Vest, Bonnie M; Kahn, Linda S; Danzo, Andrew; Tumiel-Berhalter, Laurene; Schuster, Roseanne C; Karl, Renée; Taylor, Robert; Glaser, Kathryn; Danakas, Alexandra; Fox, Chester H

2014-01-01

Objectives This article reports on results of a qualitative study of social supports and institutional resources utilized by individuals living with diabetes in a high-poverty urban setting. The goal was to examine how access to social capital among low-income populations facilitates and impedes their self-efficacy in diabetes self-management. Methods Semi-structured interviews were conducted with 34 patients with diabetes from a safety net primary care practice in Buffalo, New York. Results Facilitators and barriers to successful self-management were identified in three broad areas: (1) the influence of social support networks; (2) the nature of the doctor-patient relationship; and (3) the nature of patient-health care system relationship. Patients' unmet needs were also highlighted across these three areas. Discussion Participants identified barriers to effective diabetes self-management directly related to their low-income status, such as inadequate insurance, and mistrust of the medical system. It may be necessary for patients to activate social capital from multiple social spheres to achieve the most effective diabetes management. PMID:23585634

Implementing evidence-based practice in community mental health agencies: a multiple stakeholder analysis.

PubMed

Aarons, Gregory A; Wells, Rebecca S; Zagursky, Karen; Fettes, Danielle L; Palinkas, Lawrence A

2009-11-01

We sought to identify factors believed to facilitate or hinder evidence-based practice (EBP) implementation in public mental health service systems as a step in developing theory to be tested in future studies. Focusing across levels of an entire large public sector mental health service system for youths, we engaged participants from 6 stakeholder groups: county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. Participants generated 105 unique statements identifying implementation barriers and facilitators. Participants rated each statement on importance and changeability (i.e., the degree to which each barrier or facilitator is considered changeable). Data analyses distilled statements into 14 factors or dimensions. Descriptive analyses suggest that perceptions of importance and changeability varied across stakeholder groups. Implementation of EBP is a complex process. Cross-system-level approaches are needed to bring divergent and convergent perspectives to light. Examples include agency and program directors facilitating EBP implementation by supporting staff, actively sharing information with policymakers and administrators about EBP effectiveness and fit with clients' needs and preferences, and helping clinicians to present and deliver EBPs and address consumer concerns.

Emittance and absorptance of the National Aeronautics and Space Administration ceramic thermal barrier coating. [for gas turbine engine components

NASA Technical Reports Server (NTRS)

Liebert, C. H.

1978-01-01

The spectral emittance of a NASA developed zirconia ceramic thermal barrier coating system, consisting of a metal substrate, a layer of Ni-Cr-Al-Y bond material and a layer of yttria-stabilized zirconia ceramic material, is analyzed. The emittance, needed for evaluation of radiant heat loads on cooled coated gas turbine components, was measured over a range of temperatures that would be typical of its use on such components. Emittance data were obtained with a spectrometer, a reflectometer and a radiation pyrometer at a single bond coating thickness of 0.010 cm and at a ceramic coating thickness of 0-0.076 cm. The data were transformed into the hemispherical total emittance and were correlated to the ceramic coating thickness and temperature using multiple-regression curve-fitting techniques. The system was found to be highly reflective, and, consequently, capable of significantly reducing radiation heat loads on cooled gas turbine engine components.

The impact of aging on epithelial barriers.

PubMed

Parrish, Alan R

2017-10-02

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

Evaluation of virus reduction efficiency in wastewater treatment unit processes as a credit value in the multiple-barrier system for wastewater reclamation and reuse.

PubMed

Ito, Toshihiro; Kato, Tsuyoshi; Hasegawa, Makoto; Katayama, Hiroyuki; Ishii, Satoshi; Okabe, Satoshi; Sano, Daisuke

2016-12-01

The virus reduction efficiency of each unit process is commonly determined based on the ratio of virus concentration in influent to that in effluent of a unit, but the virus concentration in wastewater has often fallen below the analytical quantification limit, which does not allow us to calculate the concentration ratio at each sampling event. In this study, left-censored datasets of norovirus (genogroup I and II), and adenovirus were used to calculate the virus reduction efficiency in unit processes of secondary biological treatment and chlorine disinfection. Virus concentration in influent, effluent from the secondary treatment, and chlorine-disinfected effluent of four municipal wastewater treatment plants were analyzed by a quantitative polymerase chain reaction (PCR) approach, and the probabilistic distributions of log reduction (LR) were estimated by a Bayesian estimation algorithm. The mean values of LR in the secondary treatment units ranged from 0.9 and 2.2, whereas those in the free chlorine disinfection units were from -0.1 and 0.5. The LR value in the secondary treatment was virus type and unit process dependent, which raised the importance for accumulating the data of virus LR values applicable to the multiple-barrier system, which is a global concept of microbial risk management in wastewater reclamation and reuse.

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

PubMed

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

2018-01-01

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

Creating Livable Communities

ERIC Educational Resources Information Center

Oberlink, Mia R.

2006-01-01

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

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

PubMed

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

2003-04-21

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

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

NASA Astrophysics Data System (ADS)

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

2011-04-01

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

Challenges of using new and repurposed drugs for the treatment of multidrug-resistant tuberculosis in children.

PubMed

Schaaf, H Simon; Garcia-Prats, Anthony J; McKenna, Lindsay; Seddon, James A

2018-03-01

New and repurposed antituberculosis drugs are urgently needed to more safely and effectively treat multidrug-resistant (MDR) tuberculosis (TB) in children. Multiple challenges limit timely access to new MDR-TB treatments in children. Areas covered: Diagnosis of MDR-TB in children remains a barrier, with few children with MDR-TB diagnosed and treated. Other barriers to timely access to new and repurposed drugs are discussed, and include delayed initiation of paediatric trials, limited funding for paediatric drug development, fragmented regulatory systems and operational challenges. The status of access to current repurposed and novel drugs is presented. Expert commentary: More timely initiation of paediatric trials is needed and paediatric work should happen and be funded in parallel with each phase of adult trials. Better quality data, increased regulator resources and expertise, harmonization of regulatory requirements across borders/organisations and registration fee waivers would improve registration timelines. Improved diagnosis, recording and reporting will establish better demand. Improved systems for procurement and supply chain management would reduce in-country operational barriers to getting medications to children. The challenges must be addressed to ensure timely and equitable access to new drugs and regimens that are urgently needed for effective, safe and shorter treatment of children with MDR-TB.

nRGD modified lycobetaine and octreotide combination delivery system to overcome multiple barriers and enhance anti-glioma efficacy.

PubMed

Chen, Tijia; Song, Xu; Gong, Ting; Fu, Yao; Yang, Liuqing; Zhang, Zhirong; Gong, Tao

2017-08-01

For glioma as one of the most common and lethal primary brain tumors, the presence of BBB, BBTB, vasculogenic mimicry (VM) channels and tumor-associated macrophages (TAMs) are key biological barriers. Here, a novel drug delivery system which could efficiently deliver drugs to glioma by overcoming multi-barriers and increase antitumor efficacy through multi-therapeutic mechanisms was well developed. In this study, a multi-target peptide nRGD was used to transport across the BBB, mediate tumor penetration and target TAMs. Lycobetaine (LBT) was adopted to kill glioma cells and octreotide (OCT) was co-delivered to inhibit VM channels and prevent angiogenesis. LBT-OCT liposomes (LPs) showed controlled release profile in vitro, increased uptake efficiency, improved inhibitory effect against glioma cells and VM formation, and enhanced BBB-crossing capability. The median survival time of glioma-bearing mice administered with LBT-OCT LPs-nRGD was significantly longer than LBT-OCT LPs (P<0.01). Besides, nRGD achieved a stronger inhibitory effect against tumor associated macrophages (TAMs) compared to LPs-iRGD treatment groups in vivo. Thus, LPs-nRGD represented a promising versatile delivery platform for combination drug therapy in glioma treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

Global report on preterm birth and stillbirth (4 of 7): delivery of interventions.

PubMed

Victora, Cesar G; Rubens, Craig E

2010-02-23

The efficacious interventions identified in the previous article of this report will fail unless they are delivered at high and equitable coverage. This article discusses critical delivery constraints and strategies. Achieving universal coverage entails addressing major barriers at many levels. An overarching constraint is the lack of political will, resulting from the dearth of preterm birth and stillbirth data and the lack of visibility. Other barriers exist at the household and community levels, such as insufficient demand for interventions or sociocultural barriers; at the health services level, such as a lack of resources and trained healthcare providers; and at the health sector policy and management level, such as poorly functioning, centralized systems. Additional constraints involve weak governance and accountability, political instability, and challenges in the physical environment. Scaling up maternal, newborn and child health interventions requires strengthening health systems, but there is also a role for focused, targeted interventions. Choosing a strategy involves identifying appropriate channels for reaching high coverage, which depends on many factors such as access to and attendance at healthcare facilities. Delivery channels vary, and may include facility- and community-based healthcare providers, mass media campaigns, and community-based approaches and marketing strategies. Issues related to scaling up are discussed in the context of four interventions that may be given to mothers at different stages throughout pregnancy or to newborns: (1) detection and treatment of syphilis; (2) emergency Cesarean section; (3) newborn resuscitation; and (4) kangaroo mother care. Systematic reviews of the literature and large-scale implementation studies are analyzed for each intervention. Equitable and successful scale-up of preterm birth and stillbirth interventions will require addressing multiple barriers, and utilizing multiple delivery approaches and channels. Another important need is developing strategies to discontinue ineffective or harmful interventions. Preterm birth and stillbirth interventions must also be placed in the broader maternal, newborn and child health context to identify and prioritize those that will help improve several outcomes at the same time. The next article discusses advocacy challenges and opportunities.

Multilayer thermal barrier coating systems

DOEpatents

Vance, Steven J.; Goedjen, John G.; Sabol, Stephen M.; Sloan, Kelly M.

2000-01-01

The present invention generally describes multilayer thermal barrier coating systems and methods of making the multilayer thermal barrier coating systems. The thermal barrier coating systems comprise a first ceramic layer, a second ceramic layer, a thermally grown oxide layer, a metallic bond coating layer and a substrate. The thermal barrier coating systems have improved high temperature thermal and chemical stability for use in gas turbine applications.

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

PubMed

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

2018-05-09

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

Minimizing Barriers in Learning for On-Call Radiology Residents-End-to-End Web-Based Resident Feedback System.

PubMed

Choi, Hailey H; Clark, Jennifer; Jay, Ann K; Filice, Ross W

2018-02-01

Feedback is an essential part of medical training, where trainees are provided with information regarding their performance and further directions for improvement. In diagnostic radiology, feedback entails a detailed review of the differences between the residents' preliminary interpretation and the attendings' final interpretation of imaging studies. While the on-call experience of independently interpreting complex cases is important to resident education, the more traditional synchronous "read-out" or joint review is impossible due to multiple constraints. Without an efficient method to compare reports, grade discrepancies, convey salient teaching points, and view images, valuable lessons in image interpretation and report construction are lost. We developed a streamlined web-based system, including report comparison and image viewing, to minimize barriers in asynchronous communication between attending radiologists and on-call residents. Our system provides real-time, end-to-end delivery of case-specific and user-specific feedback in a streamlined, easy-to-view format. We assessed quality improvement subjectively through surveys and objectively through participation metrics. Our web-based feedback system improved user satisfaction for both attending and resident radiologists, and increased attending participation, particularly with regards to cases where substantive discrepancies were identified.

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

PubMed Central

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

2016-01-01

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

Towards self-correcting quantum memories

NASA Astrophysics Data System (ADS)

Michnicki, Kamil

This thesis presents a model of self-correcting quantum memories where quantum states are encoded using topological stabilizer codes and error correction is done using local measurements and local dynamics. Quantum noise poses a practical barrier to developing quantum memories. This thesis explores two types of models for suppressing noise. One model suppresses thermalizing noise energetically by engineering a Hamiltonian with a high energy barrier between code states. Thermalizing dynamics are modeled phenomenologically as a Markovian quantum master equation with only local generators. The second model suppresses stochastic noise with a cellular automaton that performs error correction using syndrome measurements and a local update rule. Several ways of visualizing and thinking about stabilizer codes are presented in order to design ones that have a high energy barrier: the non-local Ising model, the quasi-particle graph and the theory of welded stabilizer codes. I develop the theory of welded stabilizer codes and use it to construct a code with the highest known energy barrier in 3-d for spin Hamiltonians: the welded solid code. Although the welded solid code is not fully self correcting, it has some self correcting properties. It has an increased memory lifetime for an increased system size up to a temperature dependent maximum. One strategy for increasing the energy barrier is by mediating an interaction with an external system. I prove a no-go theorem for a class of Hamiltonians where the interaction terms are local, of bounded strength and commute with the stabilizer group. Under these conditions the energy barrier can only be increased by a multiplicative constant. I develop cellular automaton to do error correction on a state encoded using the toric code. The numerical evidence indicates that while there is no threshold, the model can extend the memory lifetime significantly. While of less theoretical importance, this could be practical for real implementations of quantum memories. Numerical evidence also suggests that the cellular automaton could function as a decoder with a soft threshold.

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

PubMed

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

2018-03-12

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

Approximation-Based Adaptive Neural Tracking Control of Nonlinear MIMO Unknown Time-Varying Delay Systems With Full State Constraints.

PubMed

Li, Da-Peng; Li, Dong-Juan; Liu, Yan-Jun; Tong, Shaocheng; Chen, C L Philip

2017-10-01

This paper deals with the tracking control problem for a class of nonlinear multiple input multiple output unknown time-varying delay systems with full state constraints. To overcome the challenges which cause by the appearances of the unknown time-varying delays and full-state constraints simultaneously in the systems, an adaptive control method is presented for such systems for the first time. The appropriate Lyapunov-Krasovskii functions and a separation technique are employed to eliminate the effect of unknown time-varying delays. The barrier Lyapunov functions are employed to prevent the violation of the full state constraints. The singular problems are dealt with by introducing the signal function. Finally, it is proven that the proposed method can both guarantee the good tracking performance of the systems output, all states are remained in the constrained interval and all the closed-loop signals are bounded in the design process based on choosing appropriate design parameters. The practicability of the proposed control technique is demonstrated by a simulation study in this paper.

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

PubMed

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

2016-01-01

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

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

PubMed

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

2017-07-01

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

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

PubMed

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

2011-08-03

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

The "Gut Feeling": Breaking Down the Role of Gut Microbiome in Multiple Sclerosis.

PubMed

Freedman, Samantha N; Shahi, Shailesh K; Mangalam, Ashutosh K

2018-01-01

Multiple sclerosis (MS) is a chronic neuroinflammatory disease of the central nervous system with unknown etiology. Recently, the gut microbiota has emerged as a potential factor in the development of MS, with a number of studies having shown that patients with MS exhibit gut dysbiosis. The gut microbiota helps the host remain healthy by regulating various functions, including food metabolism, energy homeostasis, maintenance of the intestinal barrier, inhibition of colonization by pathogenic organisms, and shaping of both mucosal and systemic immune responses. Alteration of the gut microbiota, and subsequent changes in its metabolic network that perturb this homeostasis, may lead to intestinal and systemic disorders such as MS. Here we discuss the findings of recent MS microbiome studies and potential mechanisms through which gut microbiota can predispose to, or protect against, MS. These findings highlight the need of an improved understanding of the interactions between the microbiota and host for developing therapies based on gut commensals with which to treat MS.

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

DOEpatents

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

1991-01-01

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

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

PubMed

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

2018-02-01

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

Glucocorticoid Induction of Occludin Expression and Endothelial Barrier Requires Transcription Factor p54 NONO

PubMed Central

Keil, Jason M.; Liu, Xuwen; Antonetti, David A.

2013-01-01

Purpose. Glucocorticoids (GCs) effectively reduce retinal edema and induce vascular barrier properties but possess unwanted side effects. Understanding GC induction of barrier properties may lead to more effective and specific therapies. Previous work identified the occludin enhancer element (OEE) as a GC-responsive cis-element in the promoters of multiple junctional genes, including occludin, claudin-5, and cadherin-9. Here, we identify two OEE-binding factors and determine their contribution to GC induction of tight junction (TJ) gene expression and endothelial barrier properties. Methods. OEE-binding factors were isolated from human retinal endothelial cells (HREC) using DNA affinity purification followed by MALDI-TOF MS/MS. Chromatin immunoprecipitation (ChIP) assays determined in situ binding. siRNA was used to evaluate the role of trans-acting factors in transcription of TJ genes in response to GC stimulation. Paracellular permeability was determined by quantifying flux through a cell monolayer, whereas transendothelial electrical resistance (TER) was measured using the ECIS system. Results. MS/MS analysis of HREC nuclear extracts identified the heterodimer of transcription factors p54/NONO (p54) and polypyrimidine tract-binding protein-associated splicing factor (PSF) as OEE-binding factors, which was confirmed by ChIP assay from GC-treated endothelial cells and rat retina. siRNA knockdown of p54 demonstrated that this factor is necessary for GC induction of occludin and claudin-5 expression. Further, p54 knockdown ablated the pro-barrier effects of GC treatment. Conclusions. p54 is essential for GC-mediated expression of occludin, claudin-5, and barrier induction, and the p54/PSF heterodimer may contribute to normal blood-retinal barrier (BRB) induction in vivo. Understanding the mechanism of GC induction of BRB properties may provide novel therapies for macular edema. PMID:23640037

Glucocorticoid induction of occludin expression and endothelial barrier requires transcription factor p54 NONO.

PubMed

Keil, Jason M; Liu, Xuwen; Antonetti, David A

2013-06-12

Glucocorticoids (GCs) effectively reduce retinal edema and induce vascular barrier properties but possess unwanted side effects. Understanding GC induction of barrier properties may lead to more effective and specific therapies. Previous work identified the occludin enhancer element (OEE) as a GC-responsive cis-element in the promoters of multiple junctional genes, including occludin, claudin-5, and cadherin-9. Here, we identify two OEE-binding factors and determine their contribution to GC induction of tight junction (TJ) gene expression and endothelial barrier properties. OEE-binding factors were isolated from human retinal endothelial cells (HREC) using DNA affinity purification followed by MALDI-TOF MS/MS. Chromatin immunoprecipitation (ChIP) assays determined in situ binding. siRNA was used to evaluate the role of trans-acting factors in transcription of TJ genes in response to GC stimulation. Paracellular permeability was determined by quantifying flux through a cell monolayer, whereas transendothelial electrical resistance (TER) was measured using the ECIS system. MS/MS analysis of HREC nuclear extracts identified the heterodimer of transcription factors p54/NONO (p54) and polypyrimidine tract-binding protein-associated splicing factor (PSF) as OEE-binding factors, which was confirmed by ChIP assay from GC-treated endothelial cells and rat retina. siRNA knockdown of p54 demonstrated that this factor is necessary for GC induction of occludin and claudin-5 expression. Further, p54 knockdown ablated the pro-barrier effects of GC treatment. p54 is essential for GC-mediated expression of occludin, claudin-5, and barrier induction, and the p54/PSF heterodimer may contribute to normal blood-retinal barrier (BRB) induction in vivo. Understanding the mechanism of GC induction of BRB properties may provide novel therapies for macular edema.

Liposome-based glioma targeted drug delivery enabled by stable peptide ligands.

PubMed

Wei, Xiaoli; Gao, Jie; Zhan, Changyou; Xie, Cao; Chai, Zhilan; Ran, Danni; Ying, Man; Zheng, Ping; Lu, Weiyue

2015-11-28

The treatment of glioma is one of the most challenging tasks in clinic. As an intracranial tumor, glioma exhibits many distinctive characteristics from other tumors. In particular, various barriers including enzymatic barriers in the blood and brain capillary endothelial cells, blood-brain barrier (BBB) and blood-brain tumor barrier (BBTB) rigorously prevent drug and drug delivery systems from reaching the tumor site. To tackle this dilemma, we developed a liposomal formulation to circumvent multiple-barriers by modifying the liposome surface with proteolytically stable peptides, (D)CDX and c(RGDyK). (D)CDX is a D-peptide ligand of nicotine acetylcholine receptors (nAChRs) on the BBB, and c(RGDyK) is a ligand of integrin highly expressed on the BBTB and glioma cells. Lysosomal compartments of brain capillary endothelial cells are implicated in the transcytosis of those liposomes. However, both peptide ligands displayed exceptional stability in lysosomal homogenate, ensuring that intact ligands could exert subsequent exocytosis from brain capillary endothelial cells and glioma targeting. In the cellular uptake studies, dually labeled liposomes could target both brain capillary endothelial cells and tumor cells, effectively traversing the BBB and BBTB monolayers, overcoming enzymatic barrier and targeting three-dimensional tumor spheroids. Its targeting ability to intracranial glioma was further verified in vivo by ex vivo imaging and histological studies. As a result, doxorubicin liposomes modified with both (D)CDX and c(RGDyK) presented better anti-glioma effect with prolonged median survival of nude mice bearing glioma than did unmodified liposomes and liposomes modified with individual peptide ligand. In conclusion, the liposome suggested in the present study could effectively overcome multi-barriers and accomplish glioma targeted drug delivery, validating its potential value in improving the therapeutic efficacy of doxorubicin for glioma. Copyright © 2015 Elsevier B.V. All rights reserved.

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.

"Birth Control can Easily Take a Back Seat": Challenges Providing IUDs in Community Health Care Settings.

PubMed

Biggs, M Antonia; Kaller, Shelly; Harper, Cynthia C; Freedman, Lori; Mays, Aisha R

2018-01-01

To assess community health centers' (CHCs) capacity to offer streamlined intrauterine devices (IUDs) services. Prior to implementing a contraceptive training project, we surveyed health care staff (N=97) from 11 CHC sites that offer IUDs onsite. Twenty interviews with clinicians explored more deeply their challenges offering IUDs in the CHC setting. Most practices required multiple visits for IUD placement, most (66%) clinician survey respondents had placed an IUD and 19% had placed an IUD as emergency contraception. Need for screening tests, scheduling challenges, pressures to meet patient quotas, and lack of priority given to women's health hindered streamlined IUD provision. Although access to IUDs has increased, significant barriers to provision in CHC settings persist. Clinic policies may need to address a variety of system and provider-level barriers to meet the needs of patients.

Atopic eczema and the filaggrin story.

PubMed

Brown, Sara J; Irvine, Alan D

2008-06-01

The discovery that null mutations in the filaggrin gene (FLG) are associated with atopic eczema represents the single most significant breakthrough in understanding the genetic basis of this complex disorder. The association has been replicated in multiple independent studies during the past 2 years with the use of various methodologies, from populations in Europe, the United States, and Japan. Filaggrin plays a key role in epidermal barrier function, and its association with atopic eczema emphasizes the importance of barrier dysfunction in eczema pathogenesis. This review aims to summarize the current state of knowledge regarding the role of FLG mutations in ichthyosis vulgaris, atopic eczema, and other skin disorders, with an emphasis on potential clinical applications. Further research is needed to clarify the precise role of filaggrin in skin and systemic atopic disease, to pave the way for novel therapeutic interventions.

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

NASA Astrophysics Data System (ADS)

Qiu, Xuejun; Lv, Qiang; Cao, Zhenzhou

2018-05-01

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

Memristive switching of MgO based magnetic tunnel junctions

NASA Astrophysics Data System (ADS)

Krzysteczko, Patryk; Reiss, Günter; Thomas, Andy

2009-09-01

Here we demonstrate that both, tunnel magnetoresistance (TMR) and resistive switching (RS), can be observed simultaneously in nanoscale magnetic tunnel junctions. The devices show bipolar RS of 6% and TMR ratios of about 100%. For each magnetic state, multiple resistive states are created depending on the bias history, which provides a method for multibit data storage and logic. The electronic transport measurements are discussed in the framework of a memristive system. Differently prepared MgO barriers are compared to gain insight into the switching mechanism.

Tacit Knowledge Barriers within Franchise Organizations

ERIC Educational Resources Information Center

Cumberland, Denise M.; Githens, Rod P.

2010-01-01

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

Through-barrier electromagnetic imaging with an atomic magnetometer.

PubMed

Deans, Cameron; Marmugi, Luca; Renzoni, Ferruccio

2017-07-24

We demonstrate the penetration of thick metallic and ferromagnetic barriers for imaging of conductive targets underneath. Our system is based on an 85 Rb radio-frequency atomic magnetometer operating in electromagnetic induction imaging modality in an unshielded environment. Detrimental effects, including unpredictable magnetic signatures from ferromagnetic screens and variations in the magnetic background, are automatically compensated by active compensation coils controlled by servo loops. We exploit the tunability and low-frequency sensitivity of the atomic magnetometer to directly image multiple conductive targets concealed by a 2.5 mm ferromagnetic steel shield and/or a 2.0 mm aluminium shield, in a single scan. The performance of the atomic magnetometer allows imaging without any prior knowledge of the barriers or the targets, and without the need of background subtraction. A dedicated edge detection algorithm allows automatic estimation of the targets' size within 3.3 mm and of their position within 2.4 mm. Our results prove the feasibility of a compact, sensitive and automated sensing platform for imaging of concealed objects in a range of applications, from security screening to search and rescue.

Multiple etiologies of equine recurrent uveitis--A natural model for human autoimmune uveitis: A brief review.

PubMed

Witkowski, Lucjan; Cywinska, Anna; Paschalis-Trela, Katarzyna; Crisman, Mark; Kita, Jerzy

2016-02-01

Equine recurrent uveitis (ERU) has various etiologies, with Leptospira infection and genetic predisposition being the leading risk factors. Regardless of etiology, expression of ocular proteins associated with maintenance of the blood-ocular barrier is impaired in ERU. The recurring-remitting cycle of ERU repeatedly disrupts the blood-ocular barrier, allowing the previously immune-privileged ocular environment to become the site of a progressive local autoimmune pathology that ultimately results in tissue destruction and vision loss. The immune-mediated process involves humoral and cellular mechanisms. Intraocular antibodies either produced in the eye or that leak through the blood-ocular barrier, are often present at higher levels than in serum and react with antigens in ocular tissue of horses with ERU. Ocular infiltration of auto-aggressive lymphocytes occurs with each uveitis episode and is the most crucial contributor to inflammation and eye damage. Recurring uveitis episodes may be initiated when epitopes of an ocular antigen become visible to the immune system (intramolecular spreading) or another autoantigen (intermolecular spreading), resulting in a new inflammatory reaction. Copyright © 2015 Elsevier Ltd. All rights reserved.

Information management for aged care provision in Australia: development of an aged care minimum dataset and strategies to improve quality and continuity of care.

PubMed

Davis, Jenny; Morgans, Amee; Burgess, Stephen

2016-04-01

Efficient information systems support the provision of multi-disciplinary aged care and a variety of organisational purposes, including quality, funding, communication and continuity of care. Agreed minimum data sets enable accurate communication across multiple care settings. However, in aged care multiple and poorly integrated data collection frameworks are commonly used for client assessment, government reporting and funding purposes. To determine key information needs in aged care settings to improve information quality, information transfer, safety, quality and continuity of care to meet the complex needs of aged care clients. Modified Delphi methods involving five stages were employed by one aged care provider in Victoria, Australia, to establish stakeholder consensus for a derived minimum data set and address barriers to data quality. Eleven different aged care programs were identified; with five related data dictionaries, three minimum data sets, five program standards or quality frameworks. The remaining data collection frameworks related to diseases classification, funding, service activity reporting, and statistical standards and classifications. A total of 170 different data items collected across seven internal information systems were consolidated to a derived set of 60 core data items and aligned with nationally consistent data collection frameworks. Barriers to data quality related to inconsistencies in data items, staff knowledge, workflow, system access and configuration. The development an internal aged care minimum data set highlighted the critical role of primary data quality in the upstream and downstream use of client information; and presents a platform to build national consistency across the sector.

What helps or hinders the transformation from a major tertiary center to a major trauma center? Identifying barriers and enablers using the Theoretical Domains Framework.

PubMed

Roberts, Neil; Lorencatto, Fabiana; Manson, Joanna; Brundage, Susan I; Jansen, Jan O

2016-03-12

Major Trauma Centers (MTCs), as part of a trauma system, improve survival and functional outcomes from injury. Developing such centers from current teaching hospitals is likely to generate diverse beliefs amongst staff. These may act as barriers or enablers. Prior identification of these may make the service development process more efficient. The importance of applying theory to systematically identify barriers and enablers to changing clinical practice in emergency medicine has been emphasized. This study systematically explored theory-based barriers and enablers towards implementing the transformation of a tertiary hospital into a MTC. Our goal was to demonstrate the use of a replicable method to identify targets that could be addressed to achieve a successful transformation from an organization evolved to provide a particular type of clinical care into a clinical system with different demands, requirements and expectations. The Theoretical Domains Framework (TDF) is a tool designed to elicit and analyze beliefs affecting behavior. Semi-structured interviews based around the TDF were conducted in a major tertiary hospital in Scotland due to become a MTC with a purposive sample of major stakeholders including clinicians and nurses from specialties involved in trauma care, clinical managers and administration. Belief statements were identified through qualitative analysis, and assessed for importance according to prevalence, discordance and evidence base. 1728 utterances were recorded and coded into 91 belief statements. 58 were classified as important barriers/enablers. There were major concerns about resource demands, with optimism conditional on these being met. Distracting priorities abound within the Emergency Department. Better communication is needed. Staff motivation is high and they should be engaged in skills development and developing performance improvement processes. This study presents a systematic and replicable method of identifying theory-based barriers and enablers towards complex service development. It identifies multiple barriers/enablers that may serve as a basis for developing an implementation intervention to enhance the development of MTCs. This method can be used to address similar challenges in developing specialist centers or implementing clinical practice change in emergency care across both developing and developed countries.

Analysis of shoreline and geomorphic change for Breton Island, Louisiana, from 1869 to 2014

USGS Publications Warehouse

Terrano, Joseph F.; Flocks, James G.; Smith, Kathryn E. L.

2016-04-19

Many barrier islands in the United States are eroding and losing elevation substantively because of storm surge, waves, and sea-level changes. This is particularly true for the deltaic barrier system in Louisiana. Breton Island is near the mouth of the Mississippi River at the southern end of the Chandeleur barrier island chain in southeast Louisiana. This report expands on previous geomorphic studies of Breton Island by incorporating additional historic and recent datasets. Multiple analyses focus on longand short-term shoreline change, as well as episodic events and anthropogenic modification. Analyses periods include long term (1869–2014), long-term historic (1869–1950), post-Mississippi River-Gulf Outlet (1950–2014), pre/post-Hurricane Katrina (2004–5), and recent (2005–14). In addition to shoreline change, barrier island geomorphology is evaluated using island area, elevation, and sediment volume change. In the long term (1869–2014), Breton Island was affected by landward transgression, island narrowing, and elevation loss. Major storm events exacerbated the long-term trends. In the recent period (2005–14), Breton Island eroded at a slower rate than in the long-term and gained area and total sediment volume. The recent accretion is likely because of the lack of major storms since Hurricane Katrina in 2005.

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

PubMed

Jain, Parul; Krieger, Janice L

2011-07-01

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

Consumer Mobile Health Apps: Current State, Barriers, and Future Directions.

PubMed

Kao, Cheng-Kai; Liebovitz, David M

2017-05-01

This paper discusses the current state, barriers, and future directions of consumer-facing applications (apps). There are currently more than 165,000 mobile health apps publicly available in major app stores, the vast majority of which are designed for patients. The top 2 categories are wellness management and disease management apps, whereas other categories include self-diagnosis, medication reminder, and electronic patient portal apps. Apps specific to physical medicine and rehabilitation also are reviewed. These apps have the potential to provide low-cost, around-the-clock access to high-quality, evidence-based health information to end users on a global scale. However, they have not yet lived up to their potential due to multiple barriers, including lack of regulatory oversight, limited evidence-based literature, and concerns of privacy and security. The future directions may consist of improving data integration into the health care system, an interoperable app platform allowing access to electronic health record data, cloud-based personal health record across health care networks, and increasing app prescription by health care providers. For consumer mobile health apps to fully contribute value to health care delivery and chronic disease management, all stakeholders within the ecosystem must collaborate to overcome the significant barriers. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Rapid equilibrium sampling initiated from nonequilibrium data.

PubMed

Huang, Xuhui; Bowman, Gregory R; Bacallado, Sergio; Pande, Vijay S

2009-11-24

Simulating the conformational dynamics of biomolecules is extremely difficult due to the rugged nature of their free energy landscapes and multiple long-lived, or metastable, states. Generalized ensemble (GE) algorithms, which have become popular in recent years, attempt to facilitate crossing between states at low temperatures by inducing a random walk in temperature space. Enthalpic barriers may be crossed more easily at high temperatures; however, entropic barriers will become more significant. This poses a problem because the dominant barriers to conformational change are entropic for many biological systems, such as the short RNA hairpin studied here. We present a new efficient algorithm for conformational sampling, called the adaptive seeding method (ASM), which uses nonequilibrium GE simulations to identify the metastable states, and seeds short simulations at constant temperature from each of them to quantitatively determine their equilibrium populations. Thus, the ASM takes advantage of the broad sampling possible with GE algorithms but generally crosses entropic barriers more efficiently during the seeding simulations at low temperature. We show that only local equilibrium is necessary for ASM, so very short seeding simulations may be used. Moreover, the ASM may be used to recover equilibrium properties from existing datasets that failed to converge, and is well suited to running on modern computer clusters.

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.

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

PubMed Central

Avgar, Tal; Fryxell, John M.

2017-01-01

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

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

PubMed

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

2018-06-01

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

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

PubMed

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

2012-11-15

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

Self-reported use of an implanted FES hand system by adolescents with tetraplegia.

PubMed

Davis, S E; Mulcahey, M J; Smith, B T; Betz, R R

1998-07-01

The Freehand System, an eight-channel functional electrical stimulation (FES) system, was implanted in five adolescents with C-5 or C-6 tetraplegia to provide stimulated lateral pinch and palmar grasp. Following completion of inpatient training on how to use the Freehand System for predefined and self-selected activities of daily living (ADL), the adolescents were discharged to use their Freehand systems at home and school. A telephone survey was administered on a weekly basis to obtain information on the type of ADL performed with the Freehand System, reasons for not using the Freehand System, and perceived barriers and motivators to FES use. Twenty surveys were obtained on each adolescent, resulting in a total of 100 surveys. The most common type of activity performed with the Freehand System was self-care, which included tasks such as eating, grooming, and brushing teeth. The Freehand System was also used for productivity activities defined as writing, socialization, and manipulation of school and household objects. Motivators to Freehand System use included perceived need and importance to perform an ADL in an independent fashion, physical ease of using the Freehand System, and availability of social supports that facilitated Freehand System use. While there were several reported barriers to Freehand System use, incompatibility with multiple transfers to and from the wheelchair and lack of physical assistance during morning care to don the system were perceived as two of the more common reasons for nonuse.

High-throughput optofluidic system for the laser microsurgery of oocytes

NASA Astrophysics Data System (ADS)

Chandsawangbhuwana, Charlie; Shi, Linda Z.; Zhu, Qingyuan; Alliegro, Mark C.; Berns, Michael W.

2012-01-01

This study combines microfluidics with optical microablation in a microscopy system that allows for high-throughput manipulation of oocytes, automated media exchange, and long-term oocyte observation. The microfluidic component of the system transports oocytes from an inlet port into multiple flow channels. Within each channel, oocytes are confined against a microfluidic barrier using a steady fluid flow provided by an external computer-controlled syringe pump. This allows for easy media replacement without disturbing the oocyte location. The microfluidic and optical-laser microbeam ablation capabilities of the system were validated using surf clam (Spisula solidissima) oocytes that were immobilized in order to permit ablation of the 5 μm diameter nucleolinus within the oocyte nucleolus. Oocytes were the followed and assayed for polar body ejection.

Parasol: An Architecture for Cross-Cloud Federated Graph Querying

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

Lieberman, Michael; Choudhury, Sutanay; Hughes, Marisa

2014-06-22

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

Installation of Multiple Application X-ray Imaging Undulator Microscope (MAXIMUM) at ALS: Final report, 8/15/95-8/15/96

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

NONE

1996-12-31

MAXIMUM is short for Multiple Application X-ray IMaging Undulator Microscope, a project started in 1988 by our group at the Synchrotron Radiation Center of the University of Wisconsin-Madison. It is a scanning x-ray photoemission microscope that uses a multilayer-coated Schwarzschild objective as the focusing element. It was designed primarily for materials science studies of lateral variations in surface chemistry. Suitable problems include: lateral inhomogeneities in Schottky barrier formation, heterojunction formation, patterned samples and devices, insulating samples. Any system which has interesting properties that are not uniform as a function of spatial dimension can potentially be studied with MAXIMUM. 6 figs.,more » 3 tabs.« less

Breaking down barriers in cooperative fault management: Temporal and functional information displays

NASA Technical Reports Server (NTRS)

Potter, Scott S.; Woods, David D.

1994-01-01

At the highest level, the fundamental question addressed by this research is how to aid human operators engaged in dynamic fault management. In dynamic fault management there is some underlying dynamic process (an engineered or physiological process referred to as the monitored process - MP) whose state changes over time and whose behavior must be monitored and controlled. In these types of applications (dynamic, real-time systems), a vast array of sensor data is available to provide information on the state of the MP. Faults disturb the MP and diagnosis must be performed in parallel with responses to maintain process integrity and to correct the underlying problem. These situations frequently involve time pressure, multiple interacting goals, high consequences of failure, and multiple interleaved tasks.

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

PubMed

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

2011-01-01

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

Teaching Systems Thinking in the Context of the Water Cycle

NASA Astrophysics Data System (ADS)

Lee, Tammy D.; Gail Jones, M.; Chesnutt, Katherine

2017-06-01

Complex systems affect every part of our lives from the ecosystems that we inhabit and share with other living organisms to the systems that supply our water (i.e., water cycle). Evaluating events, entities, problems, and systems from multiple perspectives is known as a systems thinking approach. New curriculum standards have made explicit the call for teaching with a systems thinking approach in our science classrooms. However, little is known about how elementary in-service or pre-service teachers understand complex systems especially in terms of systems thinking. This mixed methods study investigated 67 elementary in-service teachers' and 69 pre-service teachers' knowledge of a complex system (e.g., water cycle) and their knowledge of systems thinking. Semi-structured interviews were conducted with a sub-sample of participants. Quantitative and qualitative analyses of content assessment data and questionnaires were conducted. Results from this study showed elementary in-service and pre-service teachers applied different levels of systems thinking from novice to intermediate. Common barriers to complete systems thinking were identified with both in-service and pre-service teachers and included identifying components and processes, recognizing multiple interactions and relationships between subsystems and hidden dimensions, and difficulty understanding the human impact on the water cycle system.

Information Fusion Issues in the UK Environmental Science Community

NASA Astrophysics Data System (ADS)

Giles, J. R.

2010-12-01

The Earth is a complex, interacting system which cannot be neatly divided by discipline boundaries. To gain an holistic understanding of even a component of an Earth System requires researchers to draw information from multiple disciplines and integrate these to develop a broader understanding. But the barriers to achieving this are formidable. Research funders attempting to encourage the integration of information across disciplines need to take into account culture issues, the impact of intrusion of projects on existing information systems, ontologies and semantics, scale issues, heterogeneity and the uncertainties associated with combining information from diverse sources. Culture - There is a cultural dualism in the environmental sciences were information sharing is both rewarded and discouraged. Researchers who share information both gain new opportunities and risk reducing their chances of being first author in an high-impact journal. The culture of the environmental science community has to be managed to ensure that information fusion activities are encouraged. Intrusion - Existing information systems have an inertia of there own because of the intellectual and financial capital invested within them. Information fusion activities must recognise and seek to minimise the potential impact of their projects on existing systems. Low intrusion information fusions systems such as OGC web-service and the OpenMI Standard are to be preferred to whole-sale replacement of existing systems. Ontology and Semantics - Linking information across disciplines requires a clear understanding of the concepts deployed in the vocabulary used to describe them. Such work is a critical first step to creating routine information fusion. It is essential that national bodies, such as geological surveys organisations, document and publish their ontologies, semantics, etc. Scale - Environmental processes operate at scales ranging from microns to the scale of the Solar System and potentially beyond. The many different scales involved provide serious challenges to information fusion which need to be researched. Heterogeneity - Natural systems are heterogeneous, that is a system consisting of multiple components each of which may have considerable internal variation. Modelling Earth Systems requires recognition of the inherent complexity. Uncertainty - Understanding the uncertainties within a single information source can be difficult. Understanding the uncertainties across a system of linked models, each drawn from multiple information resources, represents a considerable challenge that must be addressed. The challenges to overcome appear insurmountable to individual research groups; but the potential rewards, in terms of a fuller scientific understanding of Earth Systems, are significant. A major international effort must be mounted to tackle these barriers and enable routine information fusion.

Functions of an engineered barrier system for a nuclear waste repository in basalt

NASA Astrophysics Data System (ADS)

Coons, W. E.; Moore, E. L.; Smith, M. J.; Kaser, J. D.

1980-01-01

The functions of components selected for an engineered barrier system for a nuclear waste repository in basalt are defined providing a focal point for barrier material research and development by delineating the purpose and operative lifetime of each component of the engineered system. A five component system (comprised of waste form, canister, buffer, overpack, and tailored backfill) is discussed. Redundancy is provided by subsystems of physical and chemical barriers which act in concert with the geology to provide a formidable barrier to transport of hazardous materials to the biosphere. The barrier system is clarified by examples pertinent to storage in basalt, and a technical approach to barrier design and material selection is proposed.

Safety performance evaluation of cable median barriers on freeways in Florida.

PubMed

Alluri, Priyanka; Haleem, Kirolos; Gan, Albert; Mauthner, John

2016-07-03

This article aims to evaluate the safety performance of cable median barriers on freeways in Florida. The safety performance evaluation was based on the percentages of barrier and median crossovers by vehicle type, crash severity, and cable median barrier type (Trinity Cable Safety System [CASS] and Gibraltar system). Twenty-three locations with cable median barriers totaling about 101 miles were identified. Police reports of 6,524 crashes from years 2005-2010 at these locations were reviewed to verify and obtain detailed crash information. A total of 549 crashes were determined to be barrier related (i.e., crashes involving vehicles hitting the cable median barrier) and were reviewed in further detail to identify crossover crashes and the manner in which the vehicles crossed the barriers; that is, by either overriding, underriding, or penetrating the barriers. Overall, 2.6% of vehicles that hit the cable median barrier crossed the median and traversed into the opposite travel lane. Overall, 98.1% of cars and 95.5% of light trucks that hit the barrier were prevented from crossing the median. In other words, 1.9% of cars and 4.5% of light trucks that hit the barrier had crossed the median and encroached on the opposite travel lanes. There is no significant difference in the performance of cable median barrier for cars versus light trucks in terms of crossover crashes. In terms of severity, overrides were more severe compared to underrides and penetrations. The statistics showed that the CASS and Gibraltar systems performed similarly in terms of crossover crashes. However, the Gibraltar system experienced a higher proportion of penetrations compared to the CASS system. The CASS system resulted in a slightly higher percentage of moderate and minor injury crashes compared to the Gibraltar system. Cable median barriers are successful in preventing median crossover crashes; 97.4% of the cable median barrier crashes were prevented from crossing over the median. Of all of the vehicles that hit the barrier, 83.6% were either redirected or contained by the cable barrier system. Barrier crossover crashes were found to be more severe compared to barrier noncrossover crashes. In addition, overrides were found to be more severe compared to underrides and penetrations.

Advanced Thermal Barrier and Environmental Barrier Coating Development at NASA GRC

NASA Technical Reports Server (NTRS)

Zhu, Dongming; Robinson, Craig

2017-01-01

This presentation summarizes NASA's advanced thermal barrier and environmental barrier coating systems, and the coating performance improvements that has recently been achieved and documented in laboratory simulated rig test conditions. One of the emphases has been placed on the toughness and impact resistance enhancements of the low conductivity, defect cluster thermal barrier coating systems. The advances in the next generation environmental barrier coatings for SiCSiC ceramic matrix composites have also been highlighted, particularly in the design of a new series of oxide-silicate composition systems to be integrated with next generation SiC-SiC turbine engine components for 2700F coating applications. Major technical barriers in developing the thermal and environmental barrier coating systems are also described. The performance and model validations in the rig simulated turbine combustion, heat flux, steam and calcium-magnesium-aluminosilicate (CMAS) environments have helped the current progress in improved temperature capability, environmental stability, and long-term fatigue-environment system durability of the advanced thermal and environmental barrier coating systems.

Neutralizing anti-interleukin-1β antibodies modulate fetal blood-brain barrier function after ischemia.

PubMed

Chen, Xiaodi; Sadowska, Grazyna B; Zhang, Jiyong; Kim, Jeong-Eun; Cummings, Erin E; Bodge, Courtney A; Lim, Yow-Pin; Makeyev, Oleksandr; Besio, Walter G; Gaitanis, John; Threlkeld, Steven W; Banks, William A; Stonestreet, Barbara S

2015-01-01

We have previously shown that increases in blood-brain barrier permeability represent an important component of ischemia-reperfusion related brain injury in the fetus. Pro-inflammatory cytokines could contribute to these abnormalities in blood-brain barrier function. We have generated pharmacological quantities of mouse anti-ovine interleukin-1β monoclonal antibody and shown that this antibody has very high sensitivity and specificity for interleukin-1β protein. This antibody also neutralizes the effects of interleukin-1β protein in vitro. In the current study, we hypothesized that the neutralizing anti-interleukin-1β monoclonal antibody attenuates ischemia-reperfusion related fetal blood-brain barrier dysfunction. Instrumented ovine fetuses at 127 days of gestation were studied after 30 min of carotid occlusion and 24h of reperfusion. Groups were sham operated placebo-control- (n=5), ischemia-placebo- (n=6), ischemia-anti-IL-1β antibody- (n=7), and sham-control antibody- (n=2) treated animals. Systemic infusions of placebo (0.154M NaCl) or anti-interleukin-1β monoclonal antibody (5.1±0.6 mg/kg) were given intravenously to the same sham or ischemic group of fetuses at 15 min and 4h after ischemia. Concentrations of interleukin-1β protein and anti-interleukin-1β monoclonal antibody were measured by ELISA in fetal plasma, cerebrospinal fluid, and parietal cerebral cortex. Blood-brain barrier permeability was quantified using the blood-to-brain transfer constant (Ki) with α-aminoisobutyric acid in multiple brain regions. Interleukin-1β protein was also measured in parietal cerebral cortices and tight junction proteins in multiple brain regions by Western immunoblot. Cerebral cortical interleukin-1β protein increased (P<0.001) after ischemia-reperfusion. After anti-interleukin-1β monoclonal antibody infusions, plasma anti-interleukin-1β monoclonal antibody was elevated (P<0.001), brain anti-interleukin-1β monoclonal antibody levels were higher (P<0.03), and interleukin-1β protein concentrations (P<0.03) and protein expressions (P<0.001) were lower in the monoclonal antibody-treated group than in placebo-treated-ischemia-reperfusion group. Monoclonal antibody infusions attenuated ischemia-reperfusion-related increases in Ki across the brain regions (P<0.04), and Ki showed an inverse linear correlation (r= -0.65, P<0.02) with anti-interleukin-1β monoclonal antibody concentrations in the parietal cortex, but had little effect on tight junction protein expression. We conclude that systemic anti-interleukin-1β monoclonal antibody infusions after ischemia result in brain anti-interleukin-1β antibody uptake, and attenuate ischemia-reperfusion-related interleukin-1β protein up-regulation and increases in blood-brain barrier permeability across brain regions in the fetus. The pro-inflammatory cytokine, interleukin-1β, contributes to impaired blood-brain barrier function after ischemia in the fetus. Copyright © 2014 Elsevier Inc. All rights reserved.

Tracking Progress in Improving Diagnosis: A Framework for Defining Undesirable Diagnostic Events.

PubMed

Olson, Andrew P J; Graber, Mark L; Singh, Hardeep

2018-01-29

Diagnostic error is a prevalent, harmful, and costly phenomenon. Multiple national health care and governmental organizations have recently identified the need to improve diagnostic safety as a high priority. A major barrier, however, is the lack of standardized, reliable methods for measuring diagnostic safety. Given the absence of reliable and valid measures for diagnostic errors, we need methods to help establish some type of baseline diagnostic performance across health systems, as well as to enable researchers and health systems to determine the impact of interventions for improving the diagnostic process. Multiple approaches have been suggested but none widely adopted. We propose a new framework for identifying "undesirable diagnostic events" (UDEs) that health systems, professional organizations, and researchers could further define and develop to enable standardized measurement and reporting related to diagnostic safety. We propose an outline for UDEs that identifies both conditions prone to diagnostic error and the contexts of care in which these errors are likely to occur. Refinement and adoption of this framework across health systems can facilitate standardized measurement and reporting of diagnostic safety.

Prevention of experimental autoimmune encephalomyelitis by antibodies against α4βl integrin

NASA Astrophysics Data System (ADS)

Yednock, Ted A.; Cannon, Catherine; Fritz, Lawrence C.; Sanchez-Madrid, Francisco; Steinman, Lawrence; Karin, Nathan

1992-03-01

EXPERIMENTAL autoimmune encephalomyelitis (EAE) is an inflammatory condition of the central nervous system with similarities to multiple sclerosis1,2. In both diseases, circulating leukocytes penetrate the blood-brain barrier and damage myelin, resulting in impaired nerve conduction and paralysis3-5. We sought to identify the adhesion receptors that mediate the attachment of circulating leukocytes to inflamed brain endothelium in EAE, because this interaction is the first step in leukocyte entry into the central nervous system. Using an in vitro adhesion assay on tissue sections, we found that lymphocytes and monocytes bound selectively to inflamed EAE brain vessels. Binding was inhibited by antibodies against the integrin molecule α4βl, but not by antibodies against numerous other adhesion receptors. When tested in vivo, anti-α4 integrin effectively prevented the accumulation of leukocytes in the central nervous system and the development of EAE. Thus, therapies designed to interfere with α4βl integrin may be useful in treating inflammatory diseases of the central nervous system, such as multiple sclerosis.

Predictors of successful acceptance of home telemanagement in veterans with Multiple Sclerosis.

PubMed

Finkelstein, Joseph; Cha, Eunme; Wood, Jeffrey; Wallin, Mitchell T

2013-01-01

Modern telehealth technologies may be instrumental in overcoming the barriers of optimal care delivery for patients with MS. However, the significant potential of telemedicine approaches in improving MS care has not yet been fully explored. The Multiple Sclerosis Centers of Excellence of the Department of Veterans Affairs (VA) has been actively promoting the use of telemedicine in helping veterans with MS. Particular attention was given to the development of cost-effective care coordination solutions which can be easily delivered directly to each veteran home via internet and accessed via a regular computer or a mobile device. In this article, the design of the MS HAT system is introduced and results of the initial feasibility evaluation are presented. The feasibility of the MS HAT system was assessed by (1) analyzing attitudinal surveys of veterans with MS who used the MS HAT system at home for over a month; (2) identifying factors affecting acceptance of the MS HAT system; (3) reviewing adherence of MS HAT users to self-testing regimen; (4) analyzing veteran feedback on MS HAT functionality using semi-structured qualitative interviews.

Inhaled nano- and microparticles for drug delivery

PubMed Central

El-Sherbiny, Ibrahim M.; El-Baz, Nancy M.; Yacoub, Magdi H.

2015-01-01

The 21st century has seen a paradigm shift to inhaled therapy, for both systemic and local drug delivery, due to the lung's favourable properties of a large surface area and high permeability. Pulmonary drug delivery possesses many advantages, including non-invasive route of administration, low metabolic activity, control environment for systemic absorption and avoids first bypass metabolism. However, because the lung is one of the major ports of entry, it has multiple clearance mechanisms, which prevent foreign particles from entering the body. Although these clearance mechanisms maintain the sterility of the lung, clearance mechanisms can also act as barriers to the therapeutic effectiveness of inhaled drugs. This effectiveness is also influenced by the deposition site and delivered dose. Particulate-based drug delivery systems have emerged as an innovative and promising alternative to conventional inhaled drugs to circumvent pulmonary clearance mechanisms and provide enhanced therapeutic efficiency and controlled drug release. The principle of multiple pulmonary clearance mechanisms is reviewed, including mucociliary, alveolar macrophages, absorptive, and metabolic degradation. This review also discusses the current approaches and formulations developed to achieve optimal pulmonary drug delivery systems. PMID:26779496

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

PubMed

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

2017-03-01

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

'It's risky to walk in the city with syringes': understanding access to HIV/AIDS services for injecting drug users in the former Soviet Union countries of Ukraine and Kyrgyzstan

PubMed Central

2011-01-01

Background Despite massive scale up of funds from global health initiatives including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other donors, the ambitious target agreed by G8 leaders in 2005 in Gleneagles to achieve universal access to HIV/AIDS treatment by 2010 has not been reached. Significant barriers to access remain in former Soviet Union (FSU) countries, a region now recognised as a priority area by policymakers. There have been few empirical studies of access to HIV/AIDS services in FSU countries, resulting in limited understanding and implementation of accessible HIV/AIDS interventions. This paper explores the multiple access barriers to HIV/AIDS services experienced by a key risk group-injecting drug users (IDUs). Methods Semi-structured interviews were conducted in two FSU countries-Ukraine and Kyrgyzstan-with clients receiving Global Fund-supported services (Ukraine n = 118, Kyrgyzstan n = 84), service providers (Ukraine n = 138, Kyrgyzstan n = 58) and a purposive sample of national and subnational stakeholders (Ukraine n = 135, Kyrgyzstan n = 86). Systematic thematic analysis of these qualitative data was conducted by country teams, and a comparative synthesis of findings undertaken by the authors. Results Stigmatisation of HIV/AIDS and drug use was an important barrier to IDUs accessing HIV/AIDS services in both countries. Other connected barriers included: criminalisation of drug use; discriminatory practices among government service providers; limited knowledge of HIV/AIDS, services and entitlements; shortages of commodities and human resources; and organisational, economic and geographical barriers. Conclusions Approaches to thinking about universal access frequently assume increased availability of services means increased accessibility of services. Our study demonstrates that while there is greater availability of HIV/AIDS services in Ukraine and Kyrgyzstan, this does not equate with greater accessibility because of multiple, complex, and interrelated barriers to HIV/AIDS service utilisation at the service delivery level. Factors external to, as well as within, the health sector are key to understanding the access deficit in the FSU where low or concentrated HIV/AIDS epidemics are prevalent. Funders of HIV/AIDS programmes need to consider how best to tackle key structural and systemic drivers of access including prohibitionist legislation on drugs use, limited transparency and low staff salaries within the health sector. PMID:21752236

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.

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

PubMed

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

2015-05-02

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

Non-local features of a hydrodynamic pilot-wave system

NASA Astrophysics Data System (ADS)

Nachbin, Andre; Couchman, Miles; Bush, John

2016-11-01

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

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

ERIC Educational Resources Information Center

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

2004-01-01

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

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

ERIC Educational Resources Information Center

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

2010-01-01

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

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

ERIC Educational Resources Information Center

Deutsch, Francine M.; Riffin, Catherine A.

2013-01-01

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

A qualitative study on why did the poorly-educated Chinese elderly fail to attend nurse-led case manager clinic and how to facilitate their attendance.

PubMed

Hung, Susanna Lok Lam; Fu, Sau Nga; Lau, Po Shan; Wong, Samuel Yeung Shan

2015-01-31

This study explored the views, barriers and facilitators of the poorly-educated elderly who were non-attendee of the nurse-led case manager clinic. The case managers provide assessment for diabetes complication screening and can refer patients to the appropriate multidisciplinary team in public outpatient primary care setting. We adopted qualitative research method by individual semi-structured face to face interviews. Nineteen Chinese type 2 diabetes mellitus subjects aged ≥ 60 who failed to attend the nurse-led case manager clinic were interviewed. They all came from a socially deprived urban district in Hong Kong. Content and thematic analysis was performed. Seven men and twelve women aged 60 to 89 were interviewed. Nine of them received no formal education and ten of them attended up to primary school. The reasons for non-attendance included attitude and poor knowledge towards diabetes complication screening and confusion of the nurse-led clinic as an educational talk. Most respondents could not understand the reason for the screening of diabetic complications, the concept of multidisciplinary care and the procedure and outcomes of nurse assessment. Five respondents were unable to follow multiple appointments because they could not read. Other reasons included physical barriers and comorbidity, family and financial constraint. They either had a tight daily schedule because of the need to take care of family members, or the family members who brought them to clinic had difficulty in attending multiple appointments. Enhanced understanding of the importance and procedure of diabetes multidisciplinary management, a flexible appointment system and a single clear appointment sheet may facilitate their attendance. Poorly-educated Chinese elderly with DM and their care givers faced physical, social and psychological barriers when attending the nurse-led case manager clinic. Strategies targeting on their low literacy include effective communication and education by health care professionals to arrive a shared understanding of care plan as well as a flexible appointment and schedule system.

IGF-1 receptor targeted nanoparticles for image-guided therapy of stroma-rich and drug resistant human cancer

NASA Astrophysics Data System (ADS)

Zhou, Hongyu; Qian, Weiping; Uckun, Fatih M.; Zhou, Zhiyang; Wang, Liya; Wang, Andrew; Mao, Hui; Yang, Lily

2016-05-01

Low drug delivery efficiency and drug resistance from highly heterogeneous cancer cells and tumor microenvironment represent major challenges in clinical oncology. Growth factor receptor, IGF-1R, is overexpressed in both human tumor cells and tumor associated stromal cells. The level of IGF-1R expression is further up-regulated in drug resistant tumor cells. We have developed IGF-1R targeted magnetic iron oxide nanoparticles (IONPs) carrying multiple anticancer drugs into human tumors. This IGF-1R targeted theranostic nanoparticle delivery system has an iron core for non-invasive MR imaging, amphiphilic polymer coating to ensure the biocompatibility as well as for drug loading and conjugation of recombinant human IGF-1 as targeting molecules. Chemotherapy drugs, Doxorubicin (Dox), was encapsulated into the polymer coating and/or conjugated to the IONP surface by coupling with the carboxyl groups. The ability of IGF1R targeted theranostic nanoparticles to penetrate tumor stromal barrier and enhance tumor cell killing has been demonstrated in human pancreatic cancer patient tissue derived xenograft (PDX) models. Repeated systemic administrations of those IGF-1R targeted theranostic IONP carrying Dox led to breaking the tumor stromal barrier and improved therapeutic effect. Near infrared (NIR) optical and MR imaging enabled noninvasive monitoring of nanoparticle-drug delivery and therapeutic responses. Our results demonstrated that IGF-1R targeted nanoparticles carrying multiple drugs are promising combination therapy approaches for image-guided therapy of stroma-rich and drug resistant human cancer, such as pancreatic cancer.

Integrated Data Modeling and Simulation on the Joint Polar Satellite System Program

NASA Technical Reports Server (NTRS)

Roberts, Christopher J.; Boyce, Leslye; Smith, Gary; Li, Angela; Barrett, Larry

2012-01-01

The Joint Polar Satellite System is a modern, large-scale, complex, multi-mission aerospace program, and presents a variety of design, testing and operational challenges due to: (1) System Scope: multi-mission coordination, role, responsibility and accountability challenges stemming from porous/ill-defined system and organizational boundaries (including foreign policy interactions) (2) Degree of Concurrency: design, implementation, integration, verification and operation occurring simultaneously, at multiple scales in the system hierarchy (3) Multi-Decadal Lifecycle: technical obsolesce, reliability and sustainment concerns, including those related to organizational and industrial base. Additionally, these systems tend to become embedded in the broader societal infrastructure, resulting in new system stakeholders with perhaps different preferences (4) Barriers to Effective Communications: process and cultural issues that emerge due to geographic dispersion and as one spans boundaries including gov./contractor, NASA/Other USG, and international relationships.

Interface and photoluminescence characteristics of graphene-(GaN/InGaN){sub n} multiple quantum wells hybrid structure

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

Wang, Liancheng, E-mail: wanglc@semi.ac.cn, E-mail: lzq@semi.ac.cn, E-mail: zh.zhang@hebut.edu.cn; Semiconductor Lighting Technology Research and Development Center, Institute of Semiconductors, Chinese Academy of Sciences, Beijing 100083; Mind Star

The effects of graphene on the optical properties of active system, e.g., the InGaN/GaN multiple quantum wells, are thoroughly investigated and clarified. Here, we have investigated the mechanisms accounting for the photoluminescence reduction for the graphene covered GaN/InGaN multiple quantum wells hybrid structure. Compared to the bare multiple quantum wells, the photoluminescence intensity of graphene covered multiple quantum wells showed a 39% decrease after excluding the graphene absorption losses. The responsible mechanisms have been identified with the following factors: (1) the graphene two dimensional hole gas intensifies the polarization field in multiple quantum wells, thus steepening the quantum well bandmore » profile and causing hole-electron pairs to further separate; (2) a lower affinity of graphene compared to air leading to a weaker capability to confine the excited hot electrons in multiple quantum wells; and (3) exciton transfer through non-radiative energy transfer process. These factors are theoretically analysed based on advanced physical models of semiconductor devices calculations and experimentally verified by varying structural parameters, such as the indium fraction in multiple quantum wells and the thickness of the last GaN quantum barrier spacer layer.« less

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

PubMed Central

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

2017-01-01

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

Evaluation of a movable concrete barrier system.

DOT National Transportation Integrated Search

1994-01-01

The movable concrete barrier (MCB) system consists of 1-m-long sections of barrier connected by steel pins in hinges to form a barrier wall that is moved laterally with a transport/transfer vehicle. The MCB system allows for the quick closing and ope...

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

NASA Astrophysics Data System (ADS)

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

2010-12-01

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

Perceived barriers to reporting adverse drug events in hospitals: a qualitative study using theoretical domains framework approach.

PubMed

Mirbaha, Fariba; Shalviri, Gloria; Yazdizadeh, Bahareh; Gholami, Kheirollah; Majdzadeh, Reza

2015-08-07

Adverse drug events (ADEs) are a major source of morbidity and mortality, estimated as the forth to sixth cause of annual deaths in the USA. Spontaneous reporting of suspected ADEs by health care professionals to a national pharmacovigilance system is recognized as a useful method to detect and reduce harm from medicines; however, underreporting is a major drawback. Understanding the barriers to ADE reporting and thereafter design of interventions to increase ADE reporting requires a systematic approach and use of theory. Since multiple theories in behavior change exist that may have conceptually overlapping constructs, a group of experts suggested an integrative framework called theoretical domains framework (TDF). This approach considers a set of 12 domains, came from 33 theories and 128 constructs, covering the main factors influencing practitioner behavior and barriers to behavior change. The aim of this study is to apply TDF approach to establish an evidence-based understanding of barriers associated with ADE reporting among nurses and pharmacists. A total of three focus group discussions were conducted; among them two consisted of nurses and one involved pharmacists. Discussions were guided by questions designed based on TDF. Transcriptions of discussions were then thematically analyzed, and detected barriers to reporting ADEs were categorized based on extracted themes. A total of 34 nurses and pharmacists attended the group discussions. Six domains were identified to be relevant to barriers of ADE reporting in hospitals. These domains included "Knowledge," "Skills," "Beliefs about consequences," "Motivation and goals (intention)," "Social influences (norms)," and "Environmental constraints." We detected several barriers to ADE reporting, such as lack of knowledge of what should be reported, fear of punishment and criticism, lack of time, lack of teamwork, and lack of active support by hospital managements and other colleagues. Based on detected barriers, "Cognitive and behavioral factors," "Motivational factors and teamwork," in addition to "Organizational processes and resources" could be targeted in designing appropriate interventions. Detection of barriers to reporting ADEs is necessary to design appropriate interventions. The TDF is a comprehensive approach that enables us to better understand barriers to behavior change in reporting ADEs.

Factors Influencing the Successful Aging of Iranian Old Adult Women

PubMed Central

Javadi Pashaki, Nazila; Mohammadi, Farahnaz; Jafaraghaee, Fateme; Mehrdad, Neda

2015-01-01

Background: Aging is an irreversible natural process characterized by a decline in both the physical and mental status of individuals. Because of multiple factors, this process and its consequences vary greatly between individuals. A successful aging (SA) is the target of current health policies and well-being of individuals. Knowing the factors that contribute to SA and its barriers would translate in measurements that increase the quality of life of elderly and reduce health costs. Objectives: The aim of this study was to explore barriers and facilitators to Iranian elderly women’s SA. Patients and Methods: A purposive sample of 16 elderly women, aged 61 - 96 years, was recruited for this qualitative content analysis study. Study data were collected during 2012 -.2013 by conducting 16 face-to-face semi-structured in-depth interviews. We continued the data collection until reaching saturation. Study data were analyzed concurrently with data collection, by using the conventional qualitative content analysis approach. Results: Barriers and facilitators to Iranian elderly women’s SA fell into five main categories, including availability of support systems, state of health, personal capabilities, personality characteristics, and lifestyle. Conclusions: Availability of support systems, state of health, personal capabilities, personality characteristics, and lifestyle were the main interrelated factors affecting Iranian elderly women’s SA. Accordingly, providing elderly women with strong educational, emotional, financial, cultural, and social supports can help facilitate their SA. PMID:26421171

Increased capture of pediatric surgical complications utilizing a novel case-log web application to enhance quality improvement.

PubMed

Fisher, Jason C; Kuenzler, Keith A; Tomita, Sandra S; Sinha, Prashant; Shah, Paresh; Ginsburg, Howard B

2017-01-01

Documenting surgical complications is limited by multiple barriers and is not fostered in the electronic health record. Tracking complications is essential for quality improvement (QI) and required for board certification. Current registry platforms do not facilitate meaningful complication reporting. We developed a novel web application that improves accuracy and reduces barriers to documenting complications. We deployed a custom web application that allows pediatric surgeons to maintain case logs. The program includes a module for entering complication data in real time. Reminders to enter outcome data occur at key postoperative intervals to optimize recall of events. Between October 1, 2014, and March 31, 2015, frequencies of surgical complications captured by the existing hospital reporting system were compared with data aggregated by our application. 780 cases were captured by the web application, compared with 276 cases registered by the hospital system. We observed an increase in the capture of major complications when compared to the hospital dataset (14 events vs. 4 events). This web application improved real-time reporting of surgical complications, exceeding the accuracy of administrative datasets. Custom informatics solutions may help reduce barriers to self-reporting of adverse events and improve the data that presently inform pediatric surgical QI. Diagnostic study/Retrospective study. Level III - case control study. Copyright © 2017 Elsevier Inc. All rights reserved.

Drug Delivery Nanosystems for the Localized Treatment of Glioblastoma Multiforme.

PubMed

Nam, L; Coll, C; Erthal, L C S; de la Torre, C; Serrano, D; Martínez-Máñez, R; Santos-Martínez, M J; Ruiz-Hernández, E

2018-05-11

Glioblastoma multiforme is one of the most prevalent and malignant forms of central nervous system tumors. The treatment of glioblastoma remains a great challenge due to its location in the intracranial space and the presence of the blood⁻brain tumor barrier. There is an urgent need to develop novel therapy approaches for this tumor, to improve the clinical outcomes, and to reduce the rate of recurrence and adverse effects associated with present options. The formulation of therapeutic agents in nanostructures is one of the most promising approaches to treat glioblastoma due to the increased availability at the target site, and the possibility to co-deliver a range of drugs and diagnostic agents. Moreover, the local administration of nanostructures presents significant additional advantages, since it overcomes blood⁻brain barrier penetration issues to reach higher concentrations of therapeutic agents in the tumor area with minimal side effects. In this paper, we aim to review the attempts to develop nanostructures as local drug delivery systems able to deliver multiple agents for both therapeutic and diagnostic functions for the management of glioblastoma.

Astrocyte-derived VEGF-A drives blood-brain barrier disruption in CNS inflammatory disease.

PubMed

Argaw, Azeb Tadesse; Asp, Linnea; Zhang, Jingya; Navrazhina, Kristina; Pham, Trinh; Mariani, John N; Mahase, Sean; Dutta, Dipankar J; Seto, Jeremy; Kramer, Elisabeth G; Ferrara, Napoleone; Sofroniew, Michael V; John, Gareth R

2012-07-01

In inflammatory CNS conditions such as multiple sclerosis (MS), current options to treat clinical relapse are limited, and more selective agents are needed. Disruption of the blood-brain barrier (BBB) is an early feature of lesion formation that correlates with clinical exacerbation, leading to edema, excitotoxicity, and entry of serum proteins and inflammatory cells. Here, we identify astrocytic expression of VEGF-A as a key driver of BBB permeability in mice. Inactivation of astrocytic Vegfa expression reduced BBB breakdown, decreased lymphocyte infiltration and neuropathology in inflammatory and demyelinating lesions, and reduced paralysis in a mouse model of MS. Knockdown studies in CNS endothelium indicated activation of the downstream effector eNOS as the principal mechanism underlying the effects of VEGF-A on the BBB. Systemic administration of the selective eNOS inhibitor cavtratin in mice abrogated VEGF-A-induced BBB disruption and pathology and protected against neurologic deficit in the MS model system. Collectively, these data identify blockade of VEGF-A signaling as a protective strategy to treat inflammatory CNS disease.

An Acute Retinal Model for Evaluating Blood Retinal Barrier Breach and Potential Drugs for Treatment.

PubMed

Wu, Hao; Rodriguez, Ana R; Spur, Bernd W; Venkataraman, Venkat

2016-09-13

A low-cost, easy-to-use and powerful model system is established to evaluate potential treatments that could ameliorate blood retinal barrier breach. An inflammatory factor, histamine, is demonstrated to compromise vessel integrity in the cultured retina through positive staining of IgG outside of the blood vessels. The effects of histamine itself and those of candidate drugs for potential treatments, such as lipoxin A4, are assessed using three parameters: blood vessel leakage via IgG immunostaining, activation of Müller cells via GFAP staining and change in neuronal dendrites through staining for MAP2. Furthermore, the layered organization of the retina allows a detailed analysis of the processes of Müller and ganglion cells, such as changes in width and continuity. While the data presented is with swine retinal culture, the system is applicable to multiple species. Thus, the model provides a reliable tool to investigate the early effects of compromised retinal vessel integrity on different cell types and also to evaluate potential drug candidates for treatment.

System-Level Influences on the Sustainability of a Cognitive Therapy Program in a Community Behavioral Health Network.

PubMed

Stirman, Shannon Wiltsey; Matza, Alexis; Gamarra, Jennifer; Toder, Katherine; Xhezo, Regina; Evans, Arthur C; Hurford, Matthew; Beck, Aaron T; Crits-Christoph, Paul; Creed, Torrey

2015-07-01

The purpose of this study was to examine influences on the sustainability of a program to implement an evidence-based psychotherapy in a mental health system. Interviews with program administrators, training consultants, agency administrators, and supervisors (N=24), along with summaries of program evaluation data and program documentation, were analyzed with a directed content-analytic approach. Findings suggested a number of interconnected and interacting influences on sustainability, including alignment with emerging sociopolitical influences and system and organizational priorities; program-level adaptation and evolution; intervention flexibility; strong communication, collaboration, planning, and support; and perceived benefit. These individual factors appeared to mutually influence one another and contribute to the degree of program sustainability achieved at the system level. Although most influences were positive, financial planning and support emerged as potentially both facilitator and barrier, and evaluation of benefits at the patient level remained a challenge. Several factors appeared to contribute to the sustainability of a psychosocial intervention in a large urban mental health system and warrant further investigation. Understanding interconnections between multiple individual facilitators and barriers appears critical to advancing understanding of sustainability in dynamic systems and adds to emerging recommendations for other implementation efforts. In particular, implications of the findings include the importance of implementation strategies, such as long-term planning, coalition building, clarifying roles and expectations, planned adaptation, evaluation, diversification of financing strategies, and incentivizing implementation.

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

NASA Astrophysics Data System (ADS)

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

2016-06-01

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

Barriers to participation in clinical trials: a physician survey.

PubMed

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

2018-04-01

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

A holistic conceptual framework model to describe medication adherence in and guide interventions in diabetes mellitus.

PubMed

Jaam, Myriam; Awaisu, Ahmed; Mohamed Ibrahim, Mohamed Izham; Kheir, Nadir

2018-04-01

Nonadherence to medications in patients with diabetes, which results in poor treatment outcomes and increased healthcare costs, is commonly reported globally. Factors associated with medication adherence have also been widely studied. However, a clear and comprehensive, disease-specific conceptual framework model that captures all possible factors has not been established. This study aimed to develop a conceptual framework that addresses the complex network of barriers to medication adherence in patients with diabetes. Fourteen databases and grey literature sources were systematically searched for systematic reviews reporting barriers to medication adherence in patients with diabetes. A thematic approach was used to categorize all identified barriers from the reviews and to create a matrix representing the complex network and relations of the different barriers. Eighteen systematic reviews were identified and used for the development of the conceptual framework. Overall, six major themes emerged: patient-, medication-, disease-, provider-, system-, and societal-related factors. Each of these themes was further classified into different sub-categories. It was noted that most interactions were identified to be within the patient-related factors, which not only interact with other themes but also within the same theme. Patient's demographics as well as cultural beliefs were the most notable factors in terms of interactions with other categories and themes. The intricate network and interaction of factors identified between different themes and within individual themes indicate the complexity of the problem of adherence. This framework will potentially enhance the understanding of the complex relation between different barriers for medication adherence in diabetes and will facilitate design of more effective interventions. Future interventions for enhancing medication adherence should look at the overall factors and target multiple themes of barriers to improve patient outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Barriers to gene exchange in hybridizing field crickets: the role of male courtship effort and cuticular hydrocarbons.

PubMed

Maroja, Luana S; McKenzie, Zachary M; Hart, Elizabeth; Jing, Joy; Larson, Erica L; Richardson, David P

2014-03-28

Pre-zygotic barriers often involve some form of sexual selection, usually interpreted as female choice, as females are typically the choosier sex. However, males typically show some mate preferences, which are increasingly reported. Here we document previously uncharacterized male courtship behavior (effort and song) and cuticular hydrocarbon (CHC) profiles in the hybridizing crickets Gryllus firmus and G. pennsylvanicus. These two species exhibit multiple barriers to gene exchange that act throughout their life history, including a behavioral barrier that results in increased time to mate in heterospecific pairs. We demonstrated that male mate choice (as courtship effort allocation) plays a more important role in the prezygotic behavioral barrier than previously recognized. In gryllids females ultimately decide whether or not to mate, yet we found males were selective by regulating courtship effort intensity toward the preferred (conspecific) females. Females were also selective by mating with more intensely courting males, which happened to be conspecifics. We report no differences in courtship song between the two species and suggest that the mechanism that allows males to act differentially towards conspecific and heterospecific females is the cuticular hydrocarbon (CHC) composition. CHC profiles differed between males and females of both species, and there were clear differences in CHC composition between female G. firmus and G. pennsylvanicus but not between the males of each species. Although many barriers to gene exchange are known in this system, the mechanism behind the mate recognition leading to reduced heterospecific mating remains unknown. The CHC profiles might be the phenotypic cue that allow males to identify conspecifics and thus to adjust their courtship intensity accordingly, leading to differential mating between species.

Overcoming the Cutaneous Barrier with Microemulsions

PubMed Central

Lopes, Luciana B.

2014-01-01

Microemulsions are fluid and isotropic formulations that have been widely studied as delivery systems for a variety of routes, including the skin. In spite of what the name suggests, microemulsions are nanocarriers, and their use as topical delivery systems derives from their multiple advantages compared to other dermatological formulations, such as ease of preparation, thermodynamic stability and penetration-enhancing properties. Composition, charge and internal structure have been reported as determinant factors for the modulation of drug release and cutaneous and transdermal transport. This manuscript aims at reviewing how these and other characteristics affect delivery and make microemulsions appealing for topical and transdermal administration, as well as how they can be modulated during the formulation design to improve the potential and efficacy of the final system. PMID:24590260

Maximizing information from space data resources: a case for expanding integration across research disciplines.

PubMed

Goswami, Nandu; Batzel, Jerry J; Clément, Gilles; Stein, T Peter; Hargens, Alan R; Sharp, M Keith; Blaber, Andrew P; Roma, Peter G; Hinghofer-Szalkay, Helmut G

2013-07-01

Regulatory systems are affected in space by exposure to weightlessness, high-energy radiation or other spaceflight-induced changes. The impact of spaceflight occurs across multiple scales and systems. Exploring such interactions and interdependencies via an integrative approach provides new opportunities for elucidating these complex responses. This paper argues the case for increased emphasis on integration, systematically archiving, and the coordination of past, present and future space and ground-based analogue experiments. We also discuss possible mechanisms for such integration across disciplines and missions. This article then introduces several discipline-specific reviews that show how such integration can be implemented. Areas explored include: adaptation of the central nervous system to space; cerebral autoregulation and weightlessness; modelling of the cardiovascular system in space exploration; human metabolic response to spaceflight; and exercise, artificial gravity, and physiologic countermeasures for spaceflight. In summary, spaceflight physiology research needs a conceptual framework that extends problem solving beyond disciplinary barriers. Administrative commitment and a high degree of cooperation among investigators are needed to further such a process. Well-designed interdisciplinary research can expand opportunities for broad interpretation of results across multiple physiological systems, which may have applications on Earth.

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

PubMed Central

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

2017-01-01

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

Morphological controls on barrier-island response and recovery following natural and anthropogenic perturbations, northern Chandeleur Islands, Louisiana

NASA Astrophysics Data System (ADS)

Bernier, J.; Miselis, J. L.

2016-02-01

Prevailing oceanographic climate, sediment supply, the magnitude and frequency of storm events, and anthropogenic modifications interact to drive the geomorphic evolution of barrier systems at varying spatial and temporal scales. The Chandeleur Islands east of the Louisiana mainland receive little external sediment input, and alongshore currents generally transport sediment away from the nearshore and littoral system to flanking depositional centers. We analyzed Landsat satellite imagery and lidar datasets from the northern Chandeleur Islands to quantify morphological changes that resulted from storm impacts and human-induced sediment input at intra-annual to decadal time scales. Since 2001, the study area was impacted by multiple tropical systems, including Hurricanes Lili (2002), Katrina (2005), and Isaac (2012). Additionally, between June 2010 and April 2011, in response to the Deepwater Horizon oil spill, the State of Louisiana constructed a 2-m high sand berm extending more than 12 km along the northern Chandeleur Islands platform. Berm emplacement provided a unique opportunity to study how anthropogenic sediment input affects the morphologic response of a naturally evolving barrier system. Land-cover and elevation metrics were utilized to test the hypotheses that (1) island geomorphology, in particular marsh extent, significantly influenced both "instantaneous" and longer term morphologic change and recovery following storm events and (2) redistribution of berm sediment depended on both antecedent morphologic controls as well as spatial variability in berm placement relative to the island platform. Despite the rapid post-construction degradation of the berm, imagery and elevation data suggest that some berm sediment remained in the system. Where the barrier-island was backed by healthy marsh platform, shoreward translation of the berm crest and increased elevations landward of the berm provide evidence of berm sand redistribution onto the emergent island. At the northern end of the study area, new sub-aerial islands were observed on the submerged island platform within the footprint of the pre-Katrina island extent. These data indicate that berm sediment may contribute to continued island recovery under normal climatic conditions.

Input and output constraints-based stabilisation of switched nonlinear systems with unstable subsystems and its application

NASA Astrophysics Data System (ADS)

Chen, Chao; Liu, Qian; Zhao, Jun

2018-01-01

This paper studies the problem of stabilisation of switched nonlinear systems with output and input constraints. We propose a recursive approach to solve this issue. None of the subsystems are assumed to be stablisable while the switched system is stabilised by dual design of controllers for subsystems and a switching law. When only dealing with bounded input, we provide nested switching controllers using an extended backstepping procedure. If both input and output constraints are taken into consideration, a Barrier Lyapunov Function is employed during operation to construct multiple Lyapunov functions for switched nonlinear system in the backstepping procedure. As a practical example, the control design of an equilibrium manifold expansion model of aero-engine is given to demonstrate the effectiveness of the proposed design method.

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

PubMed

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

2011-08-01

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

Multiple kinetic k-essence, phantom barrier crossing and stability

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

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

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

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

PubMed

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

2017-07-19

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

"The Invisible Staff": A Qualitative Analysis of Environmental Service Workers' Perceptions of the VA Clostridium difficile Prevention Bundle Using a Human Factors Engineering Approach.

PubMed

Yanke, Eric; Moriarty, Helene; Carayon, Pascale; Safdar, Nasia

2018-06-11

Using a novel human factors engineering approach, the Systems Engineering Initiative for Patient Safety model, we evaluated environmental service workers' (ESWs) perceptions of barriers and facilitators influencing adherence to the nationally mandated Department of Veterans Affairs Clostridium difficile infection (CDI) prevention bundle. A focus group of ESWs was conducted. Qualitative analysis was performed employing a visual matrix display to identify barrier/facilitator themes related to Department of Veterans Affairs CDI bundle adherence using the Systems Engineering Initiative for Patient Safety work system as a framework. Environmental service workers reported adequate cleaning supplies/equipment and displayed excellent knowledge of CDI hand hygiene requirements. Environmental service workers described current supervisory practices as providing an acceptable amount of time to clean CDI rooms, although other healthcare workers often pressured ESWs to clean rooms more quickly. Environmental service workers reported significant concern for CDI patients' family members as well as suggesting uncertainty regarding the need for family members to follow infection prevention practices. Small and cluttered patient rooms made cleaning tasks more difficult, and ESW cleaning tasks were often interrupted by other healthcare workers. Environmental service workers did not feel comfortable asking physicians for more time to finish cleaning a room nor did ESWs feel comfortable pointing out lapses in physician hand hygiene. Multiple work system components serve as barriers to and facilitators of ESW adherence to the nationally mandated Department of Veterans Affairs CDI bundle. Environmental service workers may represent an underappreciated resource for hospital infection prevention, and further efforts should be made to engage ESWs as members of the health care team.

NASA Fuel Tank Wireless Power and Signal Study

NASA Technical Reports Server (NTRS)

Merrill, Garrick

2015-01-01

Hydro Technologies has developed a custom electronics and mechanical framework for interfacing with off-the-shelf sensors to achieve through barrier sensing solutions. The core project technology relies on Hydro Technologies Wireless Power and Signal Interface (Wi psi) System for transmitting data and power wirelessly using magnetic fields. To accomplish this, Wi psi uses a multi-frequency local magnetic field to produce magnetic fields capable of carrying data and power through almost any material such as metals, seawater, concrete, and air. It will also work through layers of multiple materials.

Finite-Size Effects in Single Chain Magnets: An Experimental and Theoretical Study

NASA Astrophysics Data System (ADS)

Bogani, L.; Caneschi, A.; Fedi, M.; Gatteschi, D.; Massi, M.; Novak, M. A.; Pini, M. G.; Rettori, A.; Sessoli, R.; Vindigni, A.

2004-05-01

The problem of finite-size effects in s=1/2 Ising systems showing slow dynamics of the magnetization is investigated introducing diamagnetic impurities in a Co2+-radical chain. The static magnetic properties have been measured and analyzed considering the peculiarities induced by the ferrimagnetic character of the compound. The dynamic susceptibility shows that an Arrhenius law is observed with the same energy barrier for the pure and the doped compounds while the prefactor decreases, as theoretically predicted. Multiple spin reversal has also been investigated.

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

PubMed

Liu, Zhe; Jiang, Liwei; Zheng, Yisong

2015-02-04

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

Investigating unmet health needs in primary health care services in a representative sample of the Greek population.

PubMed

Pappa, Evelina; Kontodimopoulos, Nick; Papadopoulos, Angelos; Tountas, Yannis; Niakas, Dimitris

2013-05-17

Unmet health care needs are determined as the difference between the services judged necessary and the services actually received, and stem from barriers related to accessibility, availability and acceptability. This study aims to examine the prevalence of unmet needs and to identify the socioeconomic and health status factors that are associated with unmet needs. A cross-sectional study was conducted in Greece in 2010 and involved data from 1,000 consenting subjects (>18 years old). Multiple binary logistic regression analysis was applied to investigate the predictors of unmet needs and to determine the relation between the socio-demographic characteristics and the accessibility, availability and acceptability barriers. Ninety nine participants (9.9%) reported unmet health needs during the 12 months prior to the research. The most frequently self-reported reasons were cost and lack of time. Youth, parenthood, physician consultations, and poor mental health increased the likelihood of unmet needs. Women were less likely to report accessibility and availability than acceptability barriers. Educational differences were evident and individuals with primary and secondary education were associated with significantly more accessibility and availability barriers compared with those with tertiary education. Unmet health needs pose a significant challenge to the health care system, especially given the difficult current financial situation in Greece. It is believed that unmet health needs will continue to increase, which will widen inequalities in health and health care access.

New methods for the condition monitoring of level crossings

NASA Astrophysics Data System (ADS)

García Márquez, Fausto Pedro; Pedregal, Diego J.; Roberts, Clive

2015-04-01

Level crossings represent a high risk for railway systems. This paper demonstrates the potential to improve maintenance management through the use of intelligent condition monitoring coupled with reliability centred maintenance (RCM). RCM combines advanced electronics, control, computing and communication technologies to address the multiple objectives of cost effectiveness, improved quality, reliability and services. RCM collects digital and analogue signals utilising distributed transducers connected to either point-to-point or digital bus communication links. Assets in many industries use data logging capable of providing post-failure diagnostic support, but to date little use has been made of combined qualitative and quantitative fault detection techniques. The research takes the hydraulic railway level crossing barrier (LCB) system as a case study and develops a generic strategy for failure analysis, data acquisition and incipient fault detection. For each barrier the hydraulic characteristics, the motor's current and voltage, hydraulic pressure and the barrier's position are acquired. In order to acquire the data at a central point efficiently, without errors, a distributed single-cable Fieldbus is utilised. This allows the connection of all sensors through the project's proprietary communication nodes to a high-speed bus. The system developed in this paper for the condition monitoring described above detects faults by means of comparing what can be considered a 'normal' or 'expected' shape of a signal with respect to the actual shape observed as new data become available. ARIMA (autoregressive integrated moving average) models were employed for detecting faults. The statistical tests known as Jarque-Bera and Ljung-Box have been considered for testing the model.

Barriers and facilitators to Electronic Medical Record (EMR) use in an urban slum.

PubMed

Jawhari, Badeia; Keenan, Louanne; Zakus, David; Ludwick, Dave; Isaac, Abraam; Saleh, Abdullah; Hayward, Robert

2016-10-01

Rapid urbanization has led to the growth of urban slums and increased healthcare burdens for vulnerable populations. Electronic Medical Records (EMRs) have the potential to improve continuity of care for slum residents, but their implementation is complicated by technical and non-technical limitations. This study sought practical insights about facilitators and barriers to EMR implementation in urban slum environments. Descriptive qualitative method was used to explore staff perceptions about a recent open-source EMR deployment in two primary care clinics in Kibera, Nairobi. Participants were interviewed using open-ended, semi-structured questions. Content analysis was used when exploring transcribed data. Three major themes - systems, software, and social considerations - emerged from content analysis, with sustainability concerns prevailing. Although participants reported many systems (e.g., power, network, Internet, hardware, interoperability) and software (e.g., data integrity, confidentiality, function) challenges, social factors (e.g., identity management, training, use incentives) appeared the most important impediments to sustainability. These findings are consistent with what others have reported, especially the importance of practical barriers to EMR deployments in resource-constrained settings. Other findings contribute unique insights about social determinants of EMR impact in slum settings, including the challenge of multiple-identity management and development of meaningful incentives to staff compliance. This study exposes front-line experiences with opportunities and shortcomings of EMR implementations in urban slum primary care clinics. Although the promise is great, there are a number of unique system, software and social challenges that EMR advocates should address before expecting sustainable EMR use in resource-constrained settings. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Micro heat barrier

DOEpatents

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

2003-08-12

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

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

DOEpatents

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

1999-09-28

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

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

DOEpatents

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

1998-06-16

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

Overcoming research barriers in Chagas disease-designing effective implementation science.

PubMed

Henao-Martínez, Andrés F; Colborn, Kathryn; Parra-Henao, Gabriel

2017-01-01

Chagas disease is a complex tropical parasitic infection. It affects a significant portion of the population in Latin America, especially in areas of poverty and poor access to health care. It also affects immigrants in high-income countries who lack access to health care due to their legal status. Millions of people are at risk of contracting the disease, and approximately 30 % of chronically infected patients will develop cardiomyopathy. The cost of caring for patients that have been infected is substantial. Basic science research has introduced new concepts and knowledge for the parasite and vector biology as well as better understanding of the pathophysiology of the disease. These research findings nevertheless require effective and timely translation into clinical practice. Likewise, the design of new research projects should account for the multiple system-based barriers. Implementation science facilitates the applicability of research findings and identifies barriers to its execution. Creation of implementation science measures to reach and sustain research programs with greater potential to impact Chagas disease are lacking. This point of view proposes opportunities for implementation science in Chagas disease and strategies for researching effective interventions for preventing and treating the disease.

A subset of neurons controls the permeability of the peritrophic matrix and midgut structure in Drosophila adults.

PubMed

Kenmoku, Hiroyuki; Ishikawa, Hiroki; Ote, Manabu; Kuraishi, Takayuki; Kurata, Shoichiro

2016-08-01

The metazoan gut performs multiple physiological functions, including digestion and absorption of nutrients, and also serves as a physical and chemical barrier against ingested pathogens and abrasive particles. Maintenance of these functions and structures is partly controlled by the nervous system, yet the precise roles and mechanisms of the neural control of gut integrity remain to be clarified in Drosophila Here, we screened for GAL4 enhancer-trap strains and labeled a specific subsets of neurons, using Kir2.1 to inhibit their activity. We identified an NP3253 line that is susceptible to oral infection by Gram-negative bacteria. The subset of neurons driven by the NP3253 line includes some of the enteric neurons innervating the anterior midgut, and these flies have a disorganized proventricular structure with high permeability of the peritrophic matrix and epithelial barrier. The findings of the present study indicate that neural control is crucial for maintaining the barrier function of the gut, and provide a route for genetic dissection of the complex brain-gut axis in adults of the model organism Drosophila. © 2016. Published by The Company of Biologists Ltd.

Use of Data Libraries for IAEA Nuclear Security Assessment Methodologies (NUSAM) [section 5.4

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

Shull, D.; Lane, M.

2015-06-23

Data libraries are essential for the characterization of the facility and provide the documented input which enables the facility assessment results and subsequent conclusions. Data Libraries are historical, verifiable, quantified, and applicable collections of testing data on different types of barriers, sensors, cameras, procedures, and/or personnel. Data libraries are developed and maintained as part of any assessment program or process. Data is collected during the initial stages of facility characterization to aid in the model and/or simulation development process. Data library values may also be developed through the use of state testing centers and/or site resources by testing different typesmore » of barriers, sensors, cameras, procedures, and/or personnel. If no data exists, subject matter expert opinion and manufacturer's specifications/ testing values can be the basis for initially assigning values, but are generally less reliable and lack appropriate confidence measures. The use of existing data libraries that have been developed by a state testing organization reduces the assessment costs by establishing standard delay, detection and assessment values for use by multiple sites or facilities where common barriers and alarms systems exist.« less

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

PubMed

Gee, Alison; McGarty, Craig; Banfield, Michelle

2016-06-01

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

Endothelial β-Catenin Signaling Is Required for Maintaining Adult Blood-Brain Barrier Integrity and Central Nervous System Homeostasis.

PubMed

Tran, Khiem A; Zhang, Xianming; Predescu, Dan; Huang, Xiaojia; Machado, Roberto F; Göthert, Joachim R; Malik, Asrar B; Valyi-Nagy, Tibor; Zhao, You-Yang

2016-01-12

The blood-brain barrier (BBB) formed by brain endothelial cells interconnected by tight junctions is essential for the homeostasis of the central nervous system. Although studies have shown the importance of various signaling molecules in BBB formation during development, little is known about the molecular basis regulating the integrity of the adult BBB. Using a mouse model with tamoxifen-inducible endothelial cell-restricted disruption of ctnnb1 (iCKO), we show here that endothelial β-catenin signaling is essential for maintaining BBB integrity and central nervous system homeostasis in adult mice. The iCKO mice developed severe seizures accompanied by neuronal injury, multiple brain petechial hemorrhages, and central nervous system inflammation, and all had postictal death. Disruption of endothelial β-catenin induced BBB breakdown and downregulation of the specific tight junction proteins claudin-1 and -3 in adult brain endothelial cells. The clinical relevance of the data is indicated by the observation of decreased expression of claudin-1 and nuclear β-catenin in brain endothelial cells of hemorrhagic lesions of hemorrhagic stroke patients. These results demonstrate the prerequisite role of endothelial β-catenin in maintaining the integrity of adult BBB. The results suggest that BBB dysfunction secondary to defective β-catenin transcription activity is a key pathogenic factor in hemorrhagic stroke, seizure activity, and central nervous system inflammation. © 2015 American Heart Association, Inc.

Learning about the history of landscape use for the future: consequences for ecological and social systems in Swedish Bergslagen.

PubMed

Angelstam, Per; Andersson, Kjell; Isacson, Maths; Gavrilov, Dmitri V; Axelsson, Robert; Bäckström, Mattias; Degerman, Erik; Elbakidze, Marine; Kazakova-Apkarimova, Elena Yu; Sartz, Lotta; Sädbom, Stefan; Törnblom, Johan

2013-03-01

Barriers and bridges to implement policies about sustainable development and sustainability commonly depend on the past development of social-ecological systems. Production of metals required integration of use of ore, streams for energy, and wood for bioenergy and construction, as well as of multiple societal actors. Focusing on the Swedish Bergslagen region as a case study we (1) describe the phases of natural resource use triggered by metallurgy, (2) the location and spatial extent of 22 definitions of Bergslagen divided into four zones as a proxy of cumulative pressure on landscapes, and (3) analyze the consequences for natural capital and society. We found clear gradients in industrial activity, stream alteration, and amount of natural forest from the core to the periphery of Bergslagen. Additionally, the legacy of top-down governance is linked to today's poorly diversified business sector and thus municipal vulnerability. Comparing the Bergslagen case study with other similar regions in Russia and Germany, we discuss the usefulness of multiple case studies.

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

PubMed

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

2015-01-01

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

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…

Neurotoxicology of the Brain Barrier System: New Implications

PubMed Central

Zheng, Wei

2014-01-01

The concept of a barrier system in the brain has existed for nearly a century. The barrier that separates the blood from the cerebral interstitial fluid is defined as the blood-brain barrier, while the one that discontinues the circulation between the blood and cerebrospinal fluid is named the blood-cerebrospinal fluid barrier. Evidence in the past decades suggests that brain barriers are subject to toxic insults from neurotoxic chemicals circulating in blood. The aging process and some disease states render barriers more vulnerable to insults arising inside and outside the barriers. The implication of brain barriers in certain neurodegenerative diseases is compelling, although the contribution of chemical-induced barrier dysfunction in the etiology of any of these disorders remains poorly understood. This review examines what is currently understood about brain barrier systems in central nervous system disorders by focusing on chemical-induced neurotoxicities including those associated with nitrobenzenes, N-methyl-D-aspartate, cyclosporin A, pyridostigmine bromide, aluminum, lead, manganese, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine, and 3-nitropropionic acid. Contemporary research questions arising from this growing understanding show enormous promises for brain researchers, toxicologists, and clinicians. PMID:11778669

National survey of perspectives of palliative radiation therapy: role, barriers, and needs.

PubMed

McCloskey, Susan A; Tao, May Lin; Rose, Christopher M; Fink, Arlene; Amadeo, Alessandra M

2007-01-01

Despite growth of palliative care programs and evidence on the effectiveness of radiotherapy in palliating cancer symptoms, radiotherapy is probably underused in this setting. Radiation and medical oncologists and palliative medicine specialists were surveyed regarding the perceived role of palliative radiotherapy and barriers to its use. The survey was sent electronically to all physician members of the American Society for Therapeutic Radiology and Oncology (ASTRO) and the American Academy of Hospice and Palliative Medicine (AAHPM) and a random sample of American Society of Clinical Oncology (ASCO) members, with known e-mail addresses. Response rates were 27%, 14% and 26% for ASTRO, ASCO, and AAHPM respondents, respectively. Although most felt radiotherapy is an effective and important option for palliation of some common cancer symptoms, referrals for such therapy may be declining. Most agreed that radiation oncologists should be more involved in palliative care; however, multiple barriers were identified, such as poor reimbursement, emotional burden of care, insufficient training/knowledge, and the sense of unwillingness of others to share delivery of such services. Although multiple barriers limit optimal integration, most agree that there should be greater national and professional society efforts to promote the advancement of radiation oncology in the area of palliative care.

Multiple Family Groups: An Engaging Intervention for Child Welfare-Involved Families

ERIC Educational Resources Information Center

Gopalan, Geetha; Bannon, William; Dean-Assael, Kara; Fuss, Ashley; Gardner, Lauren; LaBarbera, Brooke; McKay, Mary

2011-01-01

Differences between child welfare- and nonchild welfare-involved families regarding barriers to child mental health care, attendance, program satisfaction, and relationship with facilitators are examined for a multiple family group service delivery model aimed at reducing childhood disruptive behaviors. Although child welfare-involved caregivers…

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

PubMed

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

2017-03-01

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

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

PubMed

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

2018-02-01

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

Challenges to Healthy Eating Practices: A Qualitative Study of Non-Hispanic Black Men Living With Diabetes.

PubMed

Lee, Loretta T; Willig, Amanda L; Agne, April A; Locher, Julie L; Cherrington, Andrea L

2016-06-01

The purpose of this study was to explore current dietary practices and perceived barriers to healthy eating in non-Hispanic black men with type 2 diabetes. Four 90-minute focus groups held in September and October 2011 were led by a trained moderator with a written guide to facilitate discussion on dietary practices and barriers to healthy eating. Participants were recruited from the diabetes database at a public safety-net health system in Jefferson County, Alabama. Two-independent reviewers performed content analysis to identify major themes using a combined deductive and inductive approach. There were 34 male participants aged 18 years and older. Mean years living with diabetes was 9.6 ± 5.9. Sixty-two percent of participants perceived themselves to be in fair or poor health. Participants' self-reported eating practices did not always relate to hunger. Internal cues to eat included habit and response to emotions, and external cues to eat included media messaging, medication regimens, and work schedules. Men identified multiple barriers to healthy eating including hard-to-break habits, limited resources and availability of food at home and in neighborhood grocery stores, and perceived poor communication with health care professionals. Non-Hispanic black men acknowledged the importance of healthy eating as part of diabetes self-management but reported various internal and external challenges that present barriers to healthy eating. Tailored strategies to overcome barriers to healthy eating among non-Hispanic black men should be developed and tested for their impact on diabetes self-management. © 2016 The Author(s).

Challenges to healthy eating practices: A qualitative study of non-Hispanic black men living with diabetes

PubMed Central

Lee, Loretta T.; Willig, Amanda L.; Agne, April A.; Locher, Julie L.; Cherrington, Andrea L.

2016-01-01

Purpose The purpose of this study was to explore current dietary practices and perceived barriers to healthy eating in non-Hispanic black men with type 2 diabetes. Methods Four 90-minute focus groups held in September and October, 2011 were led by a trained moderator with a written guide to facilitate discussion on dietary practices and barriers to healthy eating. Participants were recruited from the diabetes database at a public safety-net health system in Jefferson County, Alabama. Two-independent reviewers (LTL and ALW) performed content analysis to identify major themes using a combined deductive and inductive approach. Results There were 34 male participants aged 18 years and older. Mean years living with diabetes was 9.6 ± 5.9. Sixty-two percent of participants perceived themselves to be in fair or poor health. Participants’ self-reported eating practices did not always relate to hunger. Internal cues to eat included habit and response to emotions; and external cues to eat included media messaging, medication regimens, and work schedules. Men identified multiple barriers to healthy eating including hard-to-break habits, limited resources and availability of food at home and in neighborhood grocery stores, and perceived poor health-care professional communication. Conclusion Non-Hispanic black men acknowledged the importance of healthy eating as part of diabetes self-management, but reported various internal and external challenges that present barriers to healthy eating. Tailored strategies to overcome barriers to healthy eating among non-Hispanic black men should be developed and tested for their impact on diabetes self-management. PMID:27036128

Immunology and Oxidative Stress in Multiple Sclerosis: Clinical and Basic Approach

PubMed Central

Ortiz, Genaro G.; Pacheco-Moisés, Fermín P.; Bitzer-Quintero, Oscar K.; Ramírez-Anguiano, Ana C.; Flores-Alvarado, Luis J.; Ramírez-Ramírez, Viridiana; Macias-Islas, Miguel A.; Torres-Sánchez, Erandis D.

2013-01-01

Multiple sclerosis (MS) exhibits many of the hallmarks of an inflammatory autoimmune disorder including breakdown of the blood-brain barrier (BBB), the recruitment of lymphocytes, microglia, and macrophages to lesion sites, the presence of multiple lesions, generally being more pronounced in the brain stem and spinal cord, the predominantly perivascular location of lesions, the temporal maturation of lesions from inflammation through demyelination, to gliosis and partial remyelination, and the presence of immunoglobulin in the central nervous system and cerebrospinal fluid. Lymphocytes activated in the periphery infiltrate the central nervous system to trigger a local immune response that ultimately damages myelin and axons. Pro-inflammatory cytokines amplify the inflammatory cascade by compromising the BBB, recruiting immune cells from the periphery, and activating resident microglia. inflammation-associated oxidative burst in activated microglia and macrophages plays an important role in the demyelination and free radical-mediated tissue injury in the pathogenesis of MS. The inflammatory environment in demyelinating lesions leads to the generation of oxygen- and nitrogen-free radicals as well as proinflammatory cytokines which contribute to the development and progression of the disease. Inflammation can lead to oxidative stress and vice versa. Thus, oxidative stress and inflammation are involved in a self-perpetuating cycle. PMID:24174971

Patient Safety Learning Systems: A Systematic Review and Qualitative Synthesis.

PubMed

2017-01-01

A patient safety learning system (sometimes called a critical incident reporting system) refers to structured reporting, collation, and analysis of critical incidents. To inform a provincial working group's recommendations for an Ontario Patient Safety Event Learning System, a systematic review was undertaken to determine design features that would optimize its adoption into the health care system and would inform implementation strategies. The objective of this review was to address two research questions: (a) what are the barriers to and facilitators of successful adoption of a patient safety learning system reported by health professionals and (b) what design components maximize successful adoption and implementation? To answer the first question, we used a published systematic review. To answer the second question, we used scoping study methodology. Common barriers reported in the literature by health care professionals included fear of blame, legal penalties, the perception that incident reporting does not improve patient safety, lack of organizational support, inadequate feedback, lack of knowledge about incident reporting systems, and lack of understanding about what constitutes an error. Common facilitators included a non-accusatory environment, the perception that incident reporting improves safety, clarification of the route of reporting and of how the system uses reports, enhanced feedback, role models (such as managers) using and promoting reporting, legislated protection of those who report, ability to report anonymously, education and training opportunities, and clear guidelines on what to report. Components of a patient safety learning system that increased successful adoption and implementation were emphasis on a blame-free culture that encourages reporting and learning, clear guidelines on how and what to report, making sure the system is user-friendly, organizational development support for data analysis to generate meaningful learning outcomes, and multiple mechanisms to provide feedback through routes to reporters and the wider community (local meetings, email alerts, bulletins, paper contributions, etc.). The design of a patient safety learning system can be optimized by an awareness of the barriers to and facilitators of successful adoption and implementation identified by health care professionals. Evaluation of the effectiveness of a patient safety learning system is needed to refine its design.

76 FR 56215 - John H. Chafee Coastal Barrier Resources System; Baldwin and Mobile Counties, AL; Availability of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-12

... aquatic habitat. These areas are depicted on a series of maps entitled ``John H. Chafee Coastal Barrier...] John H. Chafee Coastal Barrier Resources System; Baldwin and Mobile Counties, AL; Availability of Draft... availability of a John H. Chafee Coastal Barrier Resources System (CBRS) draft revised map, dated September 22...

Infrared laser driven double proton transfer. An optimal control theory study

NASA Astrophysics Data System (ADS)

Abdel-Latif, Mahmoud K.; Kühn, Oliver

2010-02-01

Laser control of ultrafast double proton transfer is investigated for a two-dimensional model system describing stepwise and concerted transfer pathways. The pulse design has been done by employing optimal control theory in combination with the multiconfiguration time-dependent Hartree wave packet propagation. The obtained laser fields correspond to multiple pump-dump pulse sequences. Special emphasis is paid to the relative importance of stepwise and concerted transfer pathways for the driven wave packet and its dependence on the parameters of the model Hamiltonian as well as on the propagation time. While stepwise transfer is dominating in all cases considered, for high barrier systems concerted transfer proceeding via tunneling can make a contribution.

Testing of candidate waste-package backfill and canister materials for basalt

NASA Astrophysics Data System (ADS)

Wood, M. I.; Anderson, W. J.; Aden, G. D.

1982-09-01

The Basalt Waste Isolation Project (BWIP) is developing a multiple-barrier waste package to contain high-level nuclear waste as part of an overall system (e.g., waste package, repository sealing system, and host rock) designed to isolate the waste in a repository located in basalt beneath the Hanford Site, Richland, Washington. The three basic components of the waste package are the waste form, the canister, and the backfill. An extensive testing program is under way to determine the chemical, physical, and mechanical properties of potential canister and backfill materials. The data derived from this testing program will be used to recommend those materials that most adequately perform the functions assigned to the canister and backfill.

Louisiana Barrier Island Comprehensive Monitoring (BICM) Program Summary Report: Data and Analyses 2006 through 2010

USGS Publications Warehouse

Kindinger, Jack G.; Buster, Noreen A.; Flocks, James G.; Bernier, Julie C.; Kulp, Mark A.

2013-01-01

The Barrier Island Comprehensive Monitoring (BICM) program was implemented under the Louisiana Coastal Area Science and Technology (LCA S&T) office as a component of the System Wide Assessment and Monitoring (SWAMP) program. The BICM project was developed by the State of Louisiana (Coastal Protection Restoration Authority [CPRA], formerly Department of Natural Resources [DNR]) to complement other Louisiana coastal monitoring programs such as the Coastwide Reference Monitoring System-Wetlands (CRMS-Wetlands) and was a collaborative research effort by CPRA, University of New Orleans (UNO), and the U.S. Geological Survey (USGS). The goal of the BICM program was to provide long-term data on the barrier islands of Louisiana that could be used to plan, design, evaluate, and maintain current and future barrier-island restoration projects. The BICM program used both historical and newly acquired (2006 to 2010) data to assess and monitor changes in the aerial and subaqueous extent of islands, habitat types, sediment texture and geotechnical properties, environmental processes, and vegetation composition. BICM datasets included aerial still and video photography (multiple time series) for shoreline positions, habitat mapping, and land loss; light detection and ranging (lidar) surveys for topographic elevations; single-beam and swath bathymetry; and sediment grab samples. Products produced using BICM data and analyses included (but were not limited to) storm-impact assessments, rate of shoreline and bathymetric change, shoreline-erosion and accretion maps, high-resolution elevation maps, coastal-shoreline and barrier-island habitat-classification maps, and coastal surficial-sediment characterization maps. Discussions in this report summarize the extensive data-collection efforts and present brief interpretive analyses for four coastal Louisiana geographic regions. In addition, several coastal-wide and topical themes were selected that integrate the data and analyses within a broader coastal context: (1) barrier-shoreline evolution driven by rapid relative sea-level rise (RSLR), (2) hurricane impacts to the Chandeleur Islands and likelihood of island recovery, (3) impact of tropical storms on barrier shorelines, (4) Barataria Bay tidal-inlet management, and (5) habitat changes related to RSLR. The final theme addresses potential future goals of the BICM program, including rotational annual to semi-decadal monitoring, proposed new-data collection, how to incorporate technological advances with previous data-collection and monitoring protocols, and standardizing methods and quality-control assessments for continued coastal monitoring and restoration.

A qualitative analysis of multi-level barriers to HIV testing among women in Lebanon.

PubMed

Clark, Kirsty A; Keene, Danya E; Pachankis, John E; Fattal, Omar; Rizk, Nesrine; Khoshnood, Kaveh

2017-09-01

While the number of HIV cases in the Middle East and North Africa region is low compared to other regions, recent studies show that incidence is increasing especially among high-risk populations; in particular, little is known about women and HIV in the region. Through semi-structured interviews with sexual healthcare providers and staff at non-governmental organisations, we sought to understand barriers to HIV testing among women in Lebanon. Using snowball sampling, key informants were recruited from greater Beirut (12 physicians, 9 non-governmental organisation staff). Data were analysed using a grounded theory framework. Findings identified barriers to HIV testing among women at each level of an adapted social-ecological model (i.e. social-cultural barriers, policy barriers, interpersonal healthcare provider barriers and intrapersonal barriers). Primary findings include the culture of sex as taboo; lack of sexual health education among women; fear of disclosing HIV testing and diagnosis; financial barriers linked to stigmatising insurance policies; and provider attitudes towards women. Findings can be used to inform HIV-related sexual health interventions at multiple levels for women in Lebanon and the greater region.

Persisting Barriers to Employment for Recently Housed Adults with Mental Illness Who Were Homeless.

PubMed

Poremski, Daniel; Woodhall-Melnik, Julia; Lemieux, Ashley J; Stergiopoulos, Vicky

2016-02-01

Adults with mental illness who are homeless experience multiple barriers to employment, contributing to difficulties securing and maintaining housing. Housing First programs provide quick, low-barrier access to housing and support services for this population, but their success in improving employment outcomes has been limited. Supported employment interventions may augment Housing First programs and address barriers to employment for homeless adults with mental illness. The present paper presents data from qualitative interviews to shed light on the persisting barriers to employment among people formerly homeless. Once housed, barriers to employment persisted, including the following: (1) worries about disclosing sensitive information, (2) fluctuating motivation, (3) continued substance use, and (4) fears about re-experiencing homelessness-related trauma. Nevertheless, participants reported that their experiences of homelessness helped them develop interpersonal strength and resilience. Discussing barriers with an employment specialist helps participants develop strategies to overcome them, but employment specialists must be sensitive to specific homelessness-related experiences that may not be immediately evident. Supported housing was insufficient to help people return to employment. Supported employment may help people return to work by addressing persisting barriers.

Time-dependent behavior in a transport-barrier model for the quasi-single helcity state

NASA Astrophysics Data System (ADS)

Terry, P. W.; Whelan, G. G.

2014-09-01

Time-dependent behavior that follows from a recent theory of the quasi-single-helicity (QSH) state of the reversed field pinch is considered. The theory (Kim and Terry 2012 Phys. Plasmas 19 122304) treats QSH as a core fluctuation structure tied to a tearing mode of the same helicity, and shows that strong magnetic and velocity shears in the structure suppress the nonlinear interaction with other fluctuations. By summing the multiple helicity fluctuation energies over wavenumber, we reduce the theory to a predator-prey model. The suppression of the nonlinear interaction is governed by the single helicity energy, which, for fixed radial structure, controls the magnetic and velocity shearing rates. It is also controlled by plasma current which, in the theory, sets the shearing threshold for suppression. The model shows a limit cycle oscillation in which the system toggles between QSH and multiple helicity states, with the single helicity phase becoming increasingly long-lived relative to the multiple helicity phase as plasma current increases.

Neuronal and BBB damage induced by sera from patients with secondary progressive multiple sclerosis.

PubMed

Proia, Patrizia; Schiera, Gabriella; Salemi, Giuseppe; Ragonese, Paolo; Savettieri, Giovanni; Di Liegro, Italia

2009-12-01

An important component of the pathogenic process of multiple sclerosis (MS) is the blood-brain barrier (BBB) damage. We recently set an in vitro model of BBB, based on a three-cell-type co-culture system, in which rat neurons and astrocytes synergistically induce brain capillary endothelial cells to form a monolayer with permeability properties resembling those of the physiological BBB. Herein we report that the serum from patients with secondary progressive multiple sclerosis (SPMS) has a damaging effect on isolated neurons. This finding suggests that neuronal damaging in MS could be a primary event and not only secondary to myelin damage, as generally assumed. SPMS serum affects the permeability of the BBB model, as indicated by the decrease of the transendothelial electrical resistance (TEER). Moreover, as shown by both immunofluorescence and Western blot analyses, BBB breaking is accompanied by a decrease of the synthesis as well as the peripheral localization of occludin, a structural protein of the tight junctions that are responsible for BBB properties.

Including safety-net providers in integrated delivery systems: issues and options for policymakers.

PubMed

Witgert, Katherine; Hess, Catherine

2012-08-01

Health care reform legislation has spurred efforts to develop integrated health care delivery systems that seek to coordinate the continuum of health services. These systems may be of particular benefit to patients who face barriers to accessing care or have multiple health conditions. But it remains to be seen how safety-net providers, including community health centers and public hospitals--which have long experience in caring for these vulnerable populations--will be included in integrated delivery systems. This issue brief explores key considerations for incorporating safety-net providers into integrated delivery systems and discusses the roles of state and federal agencies in sup­porting and testing models of integrated care delivery. The authors conclude that the most important principles in creating integrated delivery systems for vulnerable populations are: (1) an emphasis on primary care; (2) coordination of all care, including behavioral, social, and public health services; and (3) accountability for population health outcomes.

Noncredit and Credit Divisions in Community Colleges: The Dilemma of Multiple Organizational Identities

ERIC Educational Resources Information Center

Palter Gill, Dianne

2012-01-01

Despite the importance of effective linkages between credit and noncredit divisions, significant barriers interfere with and detract from these units working well together. Community college leaders are challenged to manage these multiple and sometimes competing organizational identities in a complex and rapidly-changing educational landscape.…

SOMOS: Evaluation of an HIV Prevention Intervention for Latino Gay Men

ERIC Educational Resources Information Center

Vega, Miriam Y.; Spieldenner, Andrew R.; DeLeon, Dennis; Nieto, Bolivar X.; Stroman, Carolyn A.

2011-01-01

Latino gay men face multiple barriers to human immunodeficiency virus (HIV) prevention, in particular a lack of intervention programs that integrate prevention messages with cultural norms and address issues of social marginalization from multiple communities (gay community and Latino community), homophobia and racism. In order to address these…

Electronic tunneling through a potential barrier on the surface of a topological insulator

NASA Astrophysics Data System (ADS)

Zhou, Benliang; Zhou, Benhu; Zhou, Guanghui

2016-12-01

We investigate the tunneling transport for electrons on the surface of a topological insulator (TI) through an electrostatic potential barrier. By using the Dirac equation with the continuity conditions for all segments of wave functions at the interfaces between regions inside and outside the barrier, we calculate analytically the transmission probability and conductance for the system. It is demonstrated that, the Klein paradox can also been observed in the system same as in graphene system. Interestingly, the conductance reaches the minimum value when the incident electron energy is equal to the barrier strength. Moreover, with increasing barrier width, the conductance turns up some tunneling oscillation peaks, and larger barrier strength can cause lower conductance, shorter period but larger oscillation amplitude. The oscillation amplitude decreases as the barrier width increases, which is similar as that of the system consisting of the compressive uniaxial strain applied on a TI, but somewhat different from that of graphene system where the oscillation amplitude is a constant. The findings here imply that an electrostatic barrier can greatly influence the electron tunneling transport of the system, and may provide a new way to realize directional filtering of electrons.

Decoupling of magnetic fields in collapsing protostellar envelopes and disc formation and fragmentation

NASA Astrophysics Data System (ADS)

Zhao, Bo; Caselli, Paola; Li, Zhi-Yun; Krasnopolsky, Ruben

2018-02-01

Efficient magnetic braking is a formidable obstacle to the formation of rotationally supported discs (RSDs) around protostars in magnetized dense cores. We have previously shown, through 2D (axisymmetric) non-ideal magnetohydrodynamic simulations, that removing very small grains (VSGs: ∼10 Å to few 100 Å) can greatly enhance ambipolar diffusion and enable the formation of RSDs. Here, we extend the simulations of disc formation enabled by VSG removal to 3D. We find that the key to this scenario of disc formation is that the drift velocity of the magnetic field almost cancels out the infall velocity of the neutrals in the 102-103 au scale 'pseudo-disc' where the field lines are most severely pinched and most of protostellar envelope mass infall occurs. As a result, the bulk neutral envelope matter can collapse without dragging much magnetic flux into the disc-forming region, which lowers the magnetic braking efficiency. We find that the initial discs enabled by VSG removal tend to be Toomre-unstable, which leads to the formation of prominent spiral structures that function as centrifugal barriers. The piling-up of infall material near the centrifugal barrier often produces dense fragments of tens of Jupiter masses, especially in cores that are not too strongly magnetized. Some fragments accrete on to the central stellar object, producing bursts in mass accretion rate. Others are longer lived, although whether they can survive for a long term to produce multiple systems remains to be ascertained. Our results highlight the importance of dust grain evolution in determining the formation and properties of protostellar discs and potentially multiple systems.

The Development of Environmental Barrier Coatings for SiCSiC Ceramic Matrix Composites: Challenges and Opportunities

NASA Technical Reports Server (NTRS)

Zhu, Dongming

2014-01-01

Environmental barrier coatings (EBCs) and SiC/SiC ceramic matrix composites (CMCs) systems will play a crucial role in future turbine engines for hot-section component applications because of their ability to significantly increase engine operating temperatures, reduce engine weight and cooling requirements. The development of prime-reliant environmental barrier coatings is a key to enable the applications of the envisioned CMC components to help achieve next generation engine performance and durability goals. This paper will primarily address the performance requirements and design considerations of environmental barrier coatings for turbine engine applications. The emphasis is placed on current candidate environmental barrier coating systems for SiCSiC CMCs, their performance benefits and design limitations in long-term operation and combustion environments. Major technical barriers in developing advanced environmental barrier coating systems, the coating integrations with next generation CMC turbine components having improved environmental stability, cyclic durability and system performance will be described. The development trends for turbine environmental barrier coating systems by utilizing improved compositions, state-of-the-art processing methods, and simulated environment testing and durability modeling will be discussed.

Fertilisation and early developmental barriers to hybridisation in field crickets.

PubMed

Tyler, Frances; Rodríguez-Muñoz, Rolando; Tregenza, Tom

2013-02-15

Post-mating interactions between the reproductive traits and gametes of mating individuals and among their genes within zygotes are invariably complex, providing multiple opportunities for reproduction to go awry. These interactions have the potential to act as barriers to gene flow between species, and may be important in the process of speciation. There are multiple post-mating barriers to interbreeding between the hybridising field crickets Gryllus bimaculatus and G. campestris. Female G. bimaculatus preferentially store sperm from conspecific males when mated to both conspecific and heterospecific partners. Additionally, conspecific males sire an even greater proportion of offspring than would be predicted from their sperm's representation in the spermatheca. The nature of these post-sperm-storage barriers to hybridisation are unknown. We use a fluorescent staining technique to determine whether barriers occur prior to, or during embryo development. We show that eggs laid by G. bimaculatus females mated to G. campestris males are less likely to begin embryogenesis than eggs from conspecific mating pairs. Of the eggs that are successfully fertilised and start to develop, those from heterospecific mating pairs are more likely to arrest early, prior to blastoderm formation. We find evidence for bimodal variation among egg clutches in the number of developing embryos that subsequently arrest, indicating that there is genetic variation for incompatibility between mating individuals. In contrast to the pattern of early embryonic mortality, those hybrids reaching advanced stages of embryogenesis have survival rates equal to that of embryos from conspecific mating pairs. Post-sperm-storage barriers to hybridisation show evidence of genetic polymorphism. They are sufficiently large, that if the species interbreed where they are sympatric, these barriers could play a role in the maintenance of reproductive isolation between them. The number of eggs that fail to develop represents a substantial cost of hybridization to G. bimaculatus females, and this cost could reinforce the evolution of barriers occurring earlier in the reproductive process.

Multiple-decker phthalocyaninato dinuclear lanthanoid(III) single-molecule magnets with dual-magnetic relaxation processes.

PubMed

Katoh, Keiichi; Horii, Yoji; Yasuda, Nobuhiro; Wernsdorfer, Wolfgang; Toriumi, Koshiro; Breedlove, Brian K; Yamashita, Masahiro

2012-11-28

The SMM behaviour of dinuclear Ln(III)-Pc multiple-decker complexes (Ln = Tb(3+) and Dy(3+)) with energy barriers and slow-relaxation behaviour were explained by using X-ray crystallography and static and dynamic susceptibility measurements. In particular, interactions among the 4f electrons of several dinuclear Ln(III)-Pc type SMMs have never been discussed on the basis of the crystal structure. For dinuclear Tb(III)-Pc complexes, a dual magnetic relaxation process was observed. The relaxation processes are due to the anisotropic centres. Our results clearly show that the two Tb(3+) ion sites are equivalent and are consistent with the crystal structure. On the other hand, the mononuclear Tb(III)-Pc complex exhibited only a single magnetic relaxation process. This is clear evidence that the magnetic relaxation mechanism depends heavily on the dipole-dipole (f-f) interactions between the Tb(3+) ions in the dinuclear systems. Furthermore, the SMM behaviour of dinuclear Dy(III)-Pc type SMMs with smaller energy barriers compared with that of Tb(III)-Pc and slow-relaxation behaviour was explained. Dinuclear Dy(III)-Pc SMMs exhibited single-component magnetic relaxation behaviour. The results indicate that the magnetic relaxation properties of dinuclear Ln(III)-Pc multiple-decker complexes are affected by the local molecular symmetry and are extremely sensitive to tiny distortions in the coordination geometry. In other words, the spatial arrangement of the Ln(3+) ions (f-f interactions) in the crystal is important. Our work shows that the SMM properties can be fine-tuned by introducing weak intermolecular magnetic interactions in a controlled SMM spatial arrangement.

Integrated analysis for population estimation, management impact evaluation, and decision-making for a declining species

USGS Publications Warehouse

Crawford, Brian A.; Moore, Clinton; Norton, Terry M.; Maerz, John C.

2018-01-01

A challenge for making conservation decisions is predicting how wildlife populations respond to multiple, concurrent threats and potential management strategies, usually under substantial uncertainty. Integrated modeling approaches can improve estimation of demographic rates necessary for making predictions, even for rare or cryptic species with sparse data, but their use in management applications is limited. We developed integrated models for a population of diamondback terrapins (Malaclemys terrapin) impacted by road-associated threats to (i) jointly estimate demographic rates from two mark-recapture datasets, while directly estimating road mortality and the impact of management actions deployed during the study; and (ii) project the population using population viability analysis under simulated management strategies to inform decision-making. Without management, population extirpation was nearly certain due to demographic impacts of road mortality, predators, and vegetation. Installation of novel flashing signage increased survival of terrapins that crossed roads by 30%. Signage, along with small roadside barriers installed during the study, increased population persistence probability, but the population was still predicted to decline. Management strategies that included actions targeting multiple threats and demographic rates resulted in the highest persistence probability, and roadside barriers, which increased adult survival, were predicted to increase persistence more than other actions. Our results support earlier findings showing mitigation of multiple threats is likely required to increase the viability of declining populations. Our approach illustrates how integrated models may be adapted to use limited data efficiently, represent system complexity, evaluate impacts of threats and management actions, and provide decision-relevant information for conservation of at-risk populations.

Achieving patient engagement in multiple sclerosis: A perspective from the multiple sclerosis in the 21st Century Steering Group.

PubMed

Rieckmann, Peter; Boyko, Alexey; Centonze, Diego; Elovaara, Irina; Giovannoni, Gavin; Havrdová, Eva; Hommes, Otto; Kesselring, Jurg; Kobelt, Gisela; Langdon, Dawn; LeLorier, Jacques; Morrow, Sarah A; Oreja-Guevara, Celia; Schippling, Sven; Thalheim, Christoph; Thompson, Heidi; Vermersch, Patrick

2015-05-01

While advances in medicine, technology and healthcare services offer promises of longevity and improved quality of life (QoL), there is also increasing reliance on a patient׳s skills and motivation to optimize all the benefits available. Patient engagement in their own healthcare has been described as the 'blockbuster drug of the century'. In multiple sclerosis (MS), patient engagement is vital if outcomes for the patient, society and healthcare systems are to be optimized. The MS in the 21st Century Steering Group devised a set of themes that require action with regard to patient engagement in MS, namely: 1) setting and facilitating engagement by education and confidence-building; 2) increasing the importance placed on QoL and patient concerns through patient-reported outcomes (PROs); 3) providing credible sources of accurate information; 4) encouraging treatment adherence through engagement; and 5) empowering through a sense of responsibility. Group members independently researched and contributed examples of patient engagement strategies from several countries and examined interventions that have worked well in areas of patient engagement in MS, and other chronic illnesses. The group presents their perspective on these programs, discusses the barriers to achieving patient engagement, and suggests practical strategies for overcoming these barriers. With an understanding of the issues that influence patient engagement in MS, we can start to investigate ways to enhance engagement and subsequent health outcomes. Engaging patients involves a broad, multidisciplinary approach. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

Creating organizational value by leveraging the multihospital pharmacy enterprise.

PubMed

Schenkat, Dan; Rough, Steve; Hansen, Amanda; Chen, David; Knoer, Scott

2018-04-01

The results of a survey of multihospital pharmacy leaders are summarized, and a road map for creating organizational value with the pharmacy enterprise is presented. A survey was designed to evaluate the level of integration of pharmacy services across each system's multiple hospitals, determine the most commonly integrated services, determine whether value was quantified when services were integrated, collect common barriers for finding value through integration, and identify strategies for successfully overcoming these barriers. The comprehensive, 59-question survey was distributed electronically in September 2016 to the top pharmacy executive at approximately 160 multihospital systems located throughout the United States. Survey respondents indicated that health systems are taking a wide range of approaches to integrating services systemwide. Several themes emerged from the survey responses: (1) having a system-level pharmacy leader with solid-line reporting across the enterprise increased the likelihood of integrating pharmacy services effectively, (2) integration of pharmacy services across a multihospital system was unlikely to decrease the number of pharmacy full-time equivalents within the enterprise, and (3) significant opportunities exist for creating value for the multihospital health system with the pharmacy enterprise, particularly within 4 core areas: system-level drug formulary and clinical standardization initiatives, supply chain initiatives, electronic health record integration, and specialty and retail pharmacy services. Consistently demonstrating strong organizational leadership, entrepreneurialism, and the ability to create value for the organization will lead to the system-level pharmacy leader and the pharmacy enterprise being well-positioned to achieve positive outcomes for patients, payers, and the broader health system. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

40 CFR 65.112 - Standards: Compressors.

Code of Federal Regulations, 2013 CFR

2013-07-01

... barrier fluid system shall be equipped with a sensor that will detect failure of the seal system, barrier fluid system, or both. Each sensor shall be observed daily or shall be equipped with an alarm unless the... criterion that indicates failure of the seal system, the barrier fluid system, or both. If the sensor...

40 CFR 63.1031 - Compressors standards.

Code of Federal Regulations, 2013 CFR

2013-07-01

... service. Each barrier fluid system shall be equipped with a sensor that will detect failure of the seal system, barrier fluid system, or both. Each sensor shall be observed daily or shall be equipped with an... both. If the sensor indicates failure of the seal system, the barrier fluid system, or both based on...

'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.

Embryonic blood-cerebrospinal fluid barrier formation and function

PubMed Central

Bueno, David; Parvas, Maryam; Hermelo, Ismaïl; Garcia-Fernàndez, Jordi

2014-01-01

During embryonic development and adult life, brain cavities and ventricles are filled with cerebrospinal fluid (CSF). CSF has attracted interest as an active signaling medium that regulates brain development, homeostasis and disease. CSF is a complex protein-rich fluid containing growth factors and signaling molecules that regulate multiple cell functions in the central nervous system (CNS). The composition and substance concentrations of CSF are tightly controlled. In recent years, it has been demonstrated that embryonic CSF (eCSF) has a key function as a fluid pathway for delivering diffusible signals to the developing brain, thus contributing to the proliferation, differentiation and survival of neural progenitor cells, and to the expansion and patterning of the brain. From fetal stages through to adult life, CSF is primarily produced by the choroid plexus. The development and functional activities of the choroid plexus and other blood–brain barrier (BBB) systems in adults and fetuses have been extensively analyzed. However, eCSF production and control of its homeostasis in embryos, from the closure of the anterior neuropore when the brain cavities become physiologically sealed, to the formation of the functional fetal choroid plexus, has not been studied in as much depth and remains open to debate. This review brings together the existing literature, some of which is based on experiments conducted by our research group, concerning the formation and function of a temporary embryonic blood–CSF barrier in the context of the crucial roles played by the molecules in eCSF. PMID:25389383

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

NASA Astrophysics Data System (ADS)

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

2017-07-01

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

T Tank Farm Interim Surface Barrier Demonstration - Vadose Zone Monitoring FY09 Report

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

Zhang, Z. F.; Strickland, Christopher E.; Field, Jim G.

2010-01-01

DOE’s Office of River Protection constructed a temporary surface barrier over a portion of the T Tank Farm as part of the T Farm Interim Surface Barrier Demonstration Project. As part of the demonstration effort, vadose zone moisture is being monitored to assess the effectiveness of the barrier at reducing soil moisture. A solar-powered system was installed to continuously monitor soil water conditions at four locations (i.e., instrument Nests A, B, C, and D) beneath the barrier and outside the barrier footprint as well as site meteorological conditions. Nest A is placed in the area outside the barrier footprint andmore » serves as a control, providing subsurface conditions outside the influence of the surface barrier. Nest B provides subsurface measurements to assess surface-barrier edge effects. Nests C and D are used to assess changes in soil-moisture conditions beneath the interim surface barrier. Each instrument nest is composed of a capacitance probe (CP) with multiple sensors, multiple heat-dissipation units (HDUs), and a neutron probe (NP) access tube. The monitoring results in FY09 are summarized below. The solar panels functioned normally and could provide sufficient power to the instruments. The CP in Nest C after September 20, 2009, was not functional. The CP sensors in Nest B after July 13 and the 0.9-m CP sensor in Nest D before June 10 gave noisy data. Other CPs were functional normally. All the HDUs were functional normally but some pressure-head values measured by HDUs were greater than the upper measurement-limit. The higher-than-upper-limit values might be due to the very wet soil condition and/or measurement error but do not imply the malfunction of the sensors. Similar to FY07 and FY08, in FY09, the soil under natural conditions (Nest A) was generally recharged during the winter period (October-March) and discharged during the summer period (April-September). Soil water conditions above about 1.5-m to 2-m depth from all three types of measurements (i.e., CP, NP and HDU) showed relatively large variation during the seasonal wetting-drying cycle. For the soil below 2-m depth, the seasonal variation of soil water content was relatively small. The construction of the surface barrier was completed in April 2008. In the soil below the surface barrier (Nests C and D), the CP measurements showed that water content at the soil between 0.6-m and 2.3-m depths was very stable, indicating no climatic impacts on soil water condition beneath the barrier. The NP-measured water content showed that soil water drainage seemed occurring in the soil between about 3.4 m (11 ft) and 9.1 m (30 ft) in FY09. The HDU-measured water pressure decreased consistently in the soil above 5-m depth, indicating soil water drainage at these depths of the soil. In the soil below the edge of the surface barrier (Nest B), the CP-measured water content was relatively stable through the year except at the 0.9-m depth; the NP-measured water content showed that soil water drainage was occurring in the soil between about 3.4 m (11 ft) and 9.1 m (30 ft) but at a slightly smaller magnitude than those in Nests C and D; the HDU-measurements show that the pressure head changes in FY09 in Nest B were less than those for C and D but more than those for A. The soil-water-pressure head was more sensitive to soil water regime changes under dry conditions. In the soil beneath the barrier, the theoretical steady-state values of pressure head is equal to the negative of the distance to groundwater table. Hence, it is expected that, in the future, while the water content become stable, the pressure head will keep decreasing for a long time (e.g., many years). These results indicate that the T Tank Farm surface barrier was performing as expected by intercepting the meteoric water from infiltrating into the soil and the soil was becoming drier gradually. The barrier also has some effects on the soil below the barrier edge but at a reduced magnitude.« less

Barriers to development: pushing the boundaries

PubMed Central

Neirotti, Rodolfo A.

2015-01-01

Why some countries have failed to create democracy, wealth and happiness for their people is one of the great questions of our time. This essay encompasses a description of the multiple barriers to development that may have different characteristics, according to the context and the social structures that maintain these conditions. It would be arrogant to pretend to have all the solutions for these problems. PMID:25859874

Stacked Metal Silicide/Silicon Far-Infrared Detectors

NASA Technical Reports Server (NTRS)

Maserjian, Joseph

1988-01-01

Selective doping of silicon in proposed metal silicide/silicon Schottky-barrier infrared photodetector increases maximum detectable wavelength. Stacking layers to form multiple Schottky barriers increases quantum efficiency of detector. Detectors of new type enhance capabilities of far-infrared imaging arrays. Grows by molecular-beam epitaxy on silicon waferscontaining very-large-scale integrated circuits. Imaging arrays of detectors made in monolithic units with image-preprocessing circuitry.

Seasonal thermal energy storage

NASA Astrophysics Data System (ADS)

Minor, J. E.

1980-03-01

The Seasonal Thermal Energy Storage (STES) Program demonstrates the economic storage and retrieval of thermal energy on a seasonal basis, using heat or cold available from waste or other sources during a surplus period to reduce peak period demand, reduce electric utilities peaking problems, and contribute to the establishment of favorable economics for district heating and cooling systems for commercialization of the technology. The STES Program utilizes ground water systems (aquifers) for thermal energy storage. The STES Program is divided into an Aquifer Thermal Energy Storage (ATES) Demonstration Task for demonstrating the commercialization potential of aquifer thermal energy storage technology using an integrated system approach to multiple demonstration projects and a parallel Technical Support Task designed to provide support to the overall STES Program, and to reduce technological and institutional barriers to the development of energy storage systems prior to significant investment in demonstration or commercial facilities.

Communitywide cryptosporidiosis outbreak associated with a surface water-supplied municipal water system--Baker City, Oregon, 2013.

PubMed

DeSilva, M B; Schafer, S; Kendall Scott, M; Robinson, B; Hills, A; Buser, G L; Salis, K; Gargano, J; Yoder, J; Hill, V; Xiao, L; Roellig, D; Hedberg, K

2016-01-01

Cryptosporidium, a parasite known to cause large drinking and recreational water outbreaks, is tolerant of chlorine concentrations used for drinking water treatment. Human laboratory-based surveillance for enteric pathogens detected a cryptosporidiosis outbreak in Baker City, Oregon during July 2013 associated with municipal drinking water. Objectives of the investigation were to confirm the outbreak source and assess outbreak extent. The watershed was inspected and city water was tested for contamination. To determine the community attack rate, a standardized questionnaire was administered to randomly sampled households. Weighted attack rates and confidence intervals (CIs) were calculated. Water samples tested positive for Cryptosporidium species; a Cryptosporidium parvum subtype common in cattle was detected in human stool specimens. Cattle were observed grazing along watershed borders; cattle faeces were observed within watershed barriers. The city water treatment facility chlorinated, but did not filter, water. The community attack rate was 28·3% (95% CI 22·1-33·6), sickening an estimated 2780 persons. Watershed contamination by cattle probably caused this outbreak; water treatments effective against Cryptosporidium were not in place. This outbreak highlights vulnerability of drinking water systems to pathogen contamination and underscores the need for communities to invest in system improvements to maintain multiple barriers to drinking water contamination.

A Navier-Strokes Chimera Code on the Connection Machine CM-5: Design and Performance

NASA Technical Reports Server (NTRS)

Jespersen, Dennis C.; Levit, Creon; Kwak, Dochan (Technical Monitor)

1994-01-01

We have implemented a three-dimensional compressible Navier-Stokes code on the Connection Machine CM-5. The code is set up for implicit time-stepping on single or multiple structured grids. For multiple grids and geometrically complex problems, we follow the 'chimera' approach, where flow data on one zone is interpolated onto another in the region of overlap. We will describe our design philosophy and give some timing results for the current code. A parallel machine like the CM-5 is well-suited for finite-difference methods on structured grids. The regular pattern of connections of a structured mesh maps well onto the architecture of the machine. So the first design choice, finite differences on a structured mesh, is natural. We use centered differences in space, with added artificial dissipation terms. When numerically solving the Navier-Stokes equations, there are liable to be some mesh cells near a solid body that are small in at least one direction. This mesh cell geometry can impose a very severe CFL (Courant-Friedrichs-Lewy) condition on the time step for explicit time-stepping methods. Thus, though explicit time-stepping is well-suited to the architecture of the machine, we have adopted implicit time-stepping. We have further taken the approximate factorization approach. This creates the need to solve large banded linear systems and creates the first possible barrier to an efficient algorithm. To overcome this first possible barrier we have considered two options. The first is just to solve the banded linear systems with data spread over the whole machine, using whatever fast method is available. This option is adequate for solving scalar tridiagonal systems, but for scalar pentadiagonal or block tridiagonal systems it is somewhat slower than desired. The second option is to 'transpose' the flow and geometry variables as part of the time-stepping process: Start with x-lines of data in-processor. Form explicit terms in x, then transpose so y-lines of data are in-processor. Form explicit terms in y, then transpose so z-lines are in processor. Form explicit terms in z, then solve linear systems in the z-direction. Transpose to the y-direction, then solve linear systems in the y-direction. Finally transpose to the x direction and solve linear systems in the x-direction. This strategy avoids inter-processor communication when differencing and solving linear systems, but requires a large amount of communication when doing the transposes. The transpose method is more efficient than the non-transpose strategy when dealing with scalar pentadiagonal or block tridiagonal systems. For handling geometrically complex problems the chimera strategy was adopted. For multiple zone cases we compute on each zone sequentially (using the whole parallel machine), then send the chimera interpolation data to a distributed data structure (array) laid out over the whole machine. This information transfer implies an irregular communication pattern, and is the second possible barrier to an efficient algorithm. We have implemented these ideas on the CM-5 using CMF (Connection Machine Fortran), a data parallel language which combines elements of Fortran 90 and certain extensions, and which bears a strong similarity to High Performance Fortran. We make use of the Connection Machine Scientific Software Library (CMSSL) for the linear solver and array transpose operations.

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

PubMed

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

2017-03-29

This study aimed to identify national dental education research (DER) priorities for the next 3-5 years and to identify barriers and enablers to DER. Scotland. In this two-stage online questionnaire study, we collected data with multiple dental professions (eg, dentistry, dental nursing and dental hygiene) and stakeholder groups (eg, learners, clinicians, educators, managers, researchers and academics). Eighty-five participants completed the Stage 1 qualitative questionnaire and 649 participants the Stage 2 quantitative questionnaire. Eight themes were identified at Stage 1. Of the 24 DER priorities identified, the top three were: role of assessments in identifying competence; undergraduate curriculum prepares for practice and promoting teamwork. Following exploratory factor analysis, the 24 items loaded onto four factors: teamwork and professionalism, measuring and enhancing performance, dental workforce issues and curriculum integration and innovation. Barriers and enablers existed at multiple levels: individual, interpersonal, institutional structures and cultures and technology. This priority setting exercise provides a necessary first step to developing a national DER strategy capturing multiple perspectives. Promoting DER requires improved resourcing alongside efforts to overcome peer stigma and lack of valuing and motivation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

LGBT Populations' Barriers to Cancer Care.

PubMed

Boehmer, Ulrike

2018-02-01

To describe lesbian, gay, bisexual, and transgender (LGBT) individuals' barriers to accessing and receiving quality cancer care. Published data on cancer care and studies of LGBT individuals. There is a clustering of barriers among LGBT individuals, which suggests multiple inequities exist in LGBT individuals' cancer care, although data on disparities along the cancer control continuum are not consistently available. Nurses can make a difference in LGBT individuals' cancer care by obtaining training on LGBT health and their cancer-related needs and by providing a welcoming and respectful relationship with LGBT patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Self-employment as a solution for attitudinal barriers: a case study.

PubMed

Quinton, Melanie C

2014-01-01

This paper uses a case study to examine attitudinal barriers to employment and underemployment. We follow the career path of PR, a woman with multiple physical impairments, as she seeks financial independence through several employment strategies. In these, she faced attitudinal barriers and employment situations without opportunity for advancement. Eventually, PR opens her own business, turning to an alternative loan program to acquire the funds necessary to purchase a ready-made vehicle that matches her needs for accessible transportation. Use of this vehicle to provide delivery services for her business has more than doubled her income.

Deployment Efficiency and Barrier Effectiveness Testing of a Temporary Anti-Personnel (TAP) Barrier System.

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

Allen, David James; Hedrick, Charles D.; Martinez, Ruben

This report documents tests conducted by Sandia National Laboratories (SNL) on behalf of the U.S. Department of State to evaluate a temporary anti-personnel (TAP) barrier system developed by Mitigation Technologies. For this, the SNL Denial and Structural Assessment department developed a test protocol for the evaluation of the TAP barrier system on the basis of deployment efficiency and barrier effectiveness against a riotous/mob attack threat. The test protocol was then executed by SNL personnel and the results of the testing are documented.

Interdisciplinary barriers: An impediment to the effective application of systems engineering

NASA Technical Reports Server (NTRS)

Harrison, E., Jr.

1971-01-01

Interdisciplinary transfer of information and technology does not occur very readily, even for system planners, because of the existence of some very real barriers. These barriers to flow of information and technology between disciplines represent one of the important difficulties associated with the application of systems analysis to many problems. The nature and characteristics of some of these barriers are enumerated and discussed in detail. A number of methodologies and techniques which have been specifically developed to aid in the transfer of technology and information across these interdisciplinary barriers is examined.

Evaluation of Erosion Resistance of Advanced Turbine Thermal Barrier Coatings

NASA Technical Reports Server (NTRS)

Zhu, Dongming; Kuczmarski, Maria A.; Miller, Robert A.; Cuy, Michael D.

2007-01-01

The erosion resistant turbine thermal barrier coating system is critical to aircraft engine performance and durability. By demonstrating advanced turbine material testing capabilities, we will be able to facilitate the critical turbine coating and subcomponent development and help establish advanced erosion-resistant turbine airfoil thermal barrier coatings design tools. The objective of this work is to determine erosion resistance of advanced thermal barrier coating systems under simulated engine erosion and/or thermal gradient environments, validating advanced turbine airfoil thermal barrier coating systems based on nano-tetragonal phase toughening design approaches.

Strategies for Enhanced Drug Delivery to the Central Nervous System

PubMed Central

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

2008-01-01

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

Design of noise barrier inspection system for high-speed railway

NASA Astrophysics Data System (ADS)

Liu, Bingqian; Shao, Shuangyun; Feng, Qibo; Ma, Le; Cholryong, Kim

2016-10-01

The damage of noise barriers will highly reduce the transportation safety of the high-speed railway. In this paper, an online inspection system of noise barrier based on laser vision for the safety of high-speed railway is proposed. The inspection system, mainly consisted of a fast camera and a line laser, installed in the first carriage of the high-speed CIT(Composited Inspection Train).A Laser line was projected on the surface of the noise barriers and the images of the light line were received by the camera while the train is running at high speed. The distance between the inspection system and the noise barrier can be obtained based on laser triangulation principle. The results of field tests show that the proposed system can meet the need of high speed and high accuracy to get the contour distortion of the noise barriers.

Theory of activated transport in bilayer quantum Hall systems.

PubMed

Roostaei, B; Mullen, K J; Fertig, H A; Simon, S H

2008-07-25

We analyze the transport properties of bilayer quantum Hall systems at total filling factor nu=1 in drag geometries as a function of interlayer bias, in the limit where the disorder is sufficiently strong to unbind meron-antimeron pairs, the charged topological defects of the system. We compute the typical energy barrier for these objects to cross incompressible regions within the disordered system using a Hartree-Fock approach, and show how this leads to multiple activation energies when the system is biased. We then demonstrate using a bosonic Chern-Simons theory that in drag geometries current in a single layer directly leads to forces on only two of the four types of merons, inducing dissipation only in the drive layer. Dissipation in the drag layer results from interactions among the merons, resulting in very different temperature dependences for the drag and drive layers, in qualitative agreement with experiment.

The digestive tract as the origin of systemic inflammation.

PubMed

de Jong, Petrus R; González-Navajas, José M; Jansen, Nicolaas J G

2016-10-18

Failure of gut homeostasis is an important factor in the pathogenesis and progression of systemic inflammation, which can culminate in multiple organ failure and fatality. Pathogenic events in critically ill patients include mesenteric hypoperfusion, dysregulation of gut motility, and failure of the gut barrier with resultant translocation of luminal substrates. This is followed by the exacerbation of local and systemic immune responses. All these events can contribute to pathogenic crosstalk between the gut, circulating cells, and other organs like the liver, pancreas, and lungs. Here we review recent insights into the identity of the cellular and biochemical players from the gut that have key roles in the pathogenic turn of events in these organ systems that derange the systemic inflammatory homeostasis. In particular, we discuss the dangers from within the gastrointestinal tract, including metabolic products from the liver (bile acids), digestive enzymes produced by the pancreas, and inflammatory components of the mesenteric lymph.

Competitive testing of health behavior theories: how do benefits, barriers, subjective norm, and intention influence mammography behavior?

PubMed Central

Murphy, Caitlin C.; Vernon, Sally W.; Diamond, Pamela M.; Tiro, Jasmin A.

2013-01-01

Background Competitive hypothesis testing may explain differences in predictive power across multiple health behavior theories. Purpose We tested competing hypotheses of the Health Belief Model (HBM) and Theory of Reasoned Action (TRA) to quantify pathways linking subjective norm, benefits, barriers, intention, and mammography behavior. Methods We analyzed longitudinal surveys of women veterans randomized to the control group of a mammography intervention trial (n=704). We compared direct, partial mediation, and full mediation models with Satorra-Bentler χ2 difference testing. Results Barriers had a direct and indirect negative effect on mammography behavior; intention only partially mediated barriers. Benefits had little to no effect on behavior and intention; however, it was negatively correlated with barriers. Subjective norm directly affected behavior and indirectly affected intention through barriers. Conclusions Our results provide empiric support for different assertions of HBM and TRA. Future interventions should test whether building subjective norm and reducing negative attitudes increases regular mammography. PMID:23868613

Health Care Experiences and Perceived Barriers to Health Care Access: A Qualitative Study Among African Migrants in Guangzhou, Guangdong Province, China

PubMed Central

Brown, Katherine B.; Yu, Fan; Yang, Jingqi; Wang, Jason; Schrock, Joshua M.; Bodomo, Adams B.; Yang, Ligang; Yang, Bin; Nehl, Eric J.; Tucker, Joseph D.; Wong, Frank Y.

2014-01-01

Guangzhou, one of China's largest cities and a main trading port in South China, has attracted many African businessmen and traders migrating to the city for financial gains. Previous research has explored the cultural and economic roles of this newly emerging population; however, little is known about their health care experiences while in China. Semi-structured interviews and focus groups were used to assess health care experiences and perceived barriers to health care access among African migrants in Guangzhou, China. Overall, African migrants experienced various barriers to accessing health care and were dissatisfied with local health services. The principal barriers to care reported included affordability, legal issues, language barriers, and cultural differences. Facing multiple barriers, African migrants have limited access to care in Guangzhou. Local health settings are not accustomed to the African migrant population, suggesting that providing linguistically and culturally appropriate services may improve access to care for the migrants. PMID:25294415

Barriers to physical activity and restorative care for residents in long-term care: a review of the literature.

PubMed

Benjamin, Kathleen; Edwards, Nancy; Ploeg, Jenny; Legault, Frances

2014-01-01

Despite the benefits of physical activity, residents living in long-term care (LTC) are relatively sedentary. Designing successful physical activity and restorative care programs requires a good understanding of implementation barriers. A database search (2002-2013) yielded seven studies (nine articles) that met our inclusion criteria. We also reviewed 31 randomized controlled trials (RCTs) to determine if the authors explicitly discussed the barriers encountered while implementing their interventions. Eleven RCTs (13 articles) included a discussion of the barriers. Hence, a total of 18 studies (22 articles) were included in this review. Barriers occurred at resident (e.g., health status), environmental (e.g., lack of space for physical activity), and organizational (e.g., staffing and funding constraints) levels. These barriers intersect to adversely affect the physical activity of older people living in LTC. Future studies targeting physical activity interventions for residents living in LTC are needed to address these multiple levels of influence.

Methods for fabricating a micro heat barrier

DOEpatents

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

2004-01-06

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

Multiple Personality and the Pathological Dissociation of Self.

ERIC Educational Resources Information Center

Price, Reese E.

This paper considers the condition of Multiple Personality Disorder (MPD), which is defined as a separation of alternating personalities by rigid boundaries and amnestic barriers. It is proposed that MPD represents the end of a continuum of a defensive dissociation of the self that can result when a child employs a dissociative splitting of self…

Active Learning in the Middle Grades Classroom: Overcoming the Barriers to Implementation

ERIC Educational Resources Information Center

Edwards, Susan

2015-01-01

The Association for Middle Level Education advocates for instruction that incorporates active learning and multiple learning approaches in middle grades classrooms. The aim of this qualitative study was to examine middle level teachers who are able to implement active learning and multiple learning approaches within the standardized testing and…

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

NASA Astrophysics Data System (ADS)

Atta, Debasis; Basu, D. N.

2014-12-01

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

Method of recognizing the high-speed railway noise barriers based on the distance image

NASA Astrophysics Data System (ADS)

Ma, Le; Shao, Shuangyun; Feng, Qibo; Liu, Bingqian; Kim, Chol Ryong

2016-10-01

The damage or lack of the noise barriers is one of the important hidden troubles endangering the safety of high-speed railway. In order to obtain the vibration information of the noise barriers, the online detection systems based on laser vision were proposed. The systems capture images of the laser stripe on the noise barriers and export data files containing distance information between the detection systems on the train and the noise barriers. The vibration status or damage of the noise barriers can be estimated depending on the distance information. In this paper, we focused on the method of separating the area of noise barrier from the background automatically. The test results showed that the proposed method is in good efficiency and accuracy.

Use of NASA Satellite Data in Aiding Mississippi Barrier Island Restoration Projects

NASA Technical Reports Server (NTRS)

Giardino, Marco; Spruce, Joseph; Kalcic, Maria; Fletcher, Rose

2009-01-01

This presentation discusses a NASA Stennis Space Center project in which NASA-supported satellite and aerial data is being used to aid state and federal agencies in restoring the Mississippi barrier islands. Led by the Applied Science and Technology Project Office (ASTPO), this project will produce geospatial information products from multiple NASA-supported data sources, including Landsat, ASTER, and MODIS satellite data as well as ATLAS multispectral, CAMS multispectral, AVIRIS hyperspectral, EAARL, and other aerial data. Project objectives include the development and testing of a regional sediment transport model and the monitoring of barrier island restoration efforts through remote sensing. Barrier islands provide invaluable benefits to the State of Mississippi, including buffering the mainland from storm surge impacts, providing habitats for valuable wildlife and fisheries habitat, offering accessible recreational opportunities, and preserving natural environments for educating the public about coastal ecosystems and cultural resources. Unfortunately, these highly valued natural areas are prone to damage from hurricanes. For example, Hurricane Camille in 1969 split Ship Island into East and West Ship Island. Hurricane Georges in 1998 caused additional land loss for the two Ship Islands. More recently, Hurricanes Ivan, Katrina, Rita, Gustav, and Ike impacted the Mississippi barrier islands. In particular, Hurricane Katrina caused major damage to island vegetation and landforms, killing island forest overstories, overwashing entire islands, and causing widespread erosion. In response, multiple state and federal agencies are working to restore damaged components of these barrier islands. Much of this work is being implemented through federally funded Coastal Impact Assessment and Mississippi Coastal Improvement programs. One restoration component involves the reestablishment of the island footprints to that in 1969. Our project will employ NASA remote sensing data and products to support these federally funded efforts on multiple fronts. Landsat and ASTER data is being analyzed to assess changes in barrier island land cover over the last 35 years. ASTER, SRTM, and EAARL terrain products and other NASA airborne imagery are being applied in assessing changes in barrier island geomorphology and geospatial extent. MODIS data is being examined as a tool for sediment transport modeling by supplying geospatial data that quantifies in-water sediment concentrations. MODIS satellite data is being assessed for monitoring changes in the spatial extent of individual barrier islands. Results thus far indicate that NASA data products are useful in assessing barrier island conditions and changes. This value is enhanced with additional historical geospatial data, commercial high resolution satellite data, other non-NASA aerial imagery, and field survey data. The project s products are relevant to the Gulf of Mexico Alliance priority issues, including coastal habitat conservation, restoration and coastal community resilience. Such products will be available to state and federal agencies involved with coastal restoration. Potential end-users of these products include the National Park Service, U.S. Geological Survey, U.S. Army Corps of Engineers, Environmental Protection Agency, Mississippi Department of Environmental Quality, and Mississippi Department of Marine Resources.

Bringing gender sensitivity into healthcare practice: a systematic review.

PubMed

Celik, Halime; Lagro-Janssen, Toine A L M; Widdershoven, Guy G A M; Abma, Tineke A

2011-08-01

Despite the body of literature on gender dimensions and disparities between the sexes in health, practical improvements will not be realized effectively as long as we lack an overview of the ways how to implement these ideas. This systematic review provides a content analysis of literature on the implementation of gender sensitivity in health care. Literature was identified from CINAHL, PsycINFO, Medline, EBSCO and Cochrane (1998-2008) and the reference lists of relevant articles. The quality and relevance of 752 articles were assessed and finally 11 original studies were included. Our results demonstrate that the implementation of gender sensitivity includes tailoring opportunities and barriers related to the professional, organizational and the policy level. As gender disparities are embedded in healthcare, a multiple track approach to implement gender sensitivity is needed to change gendered healthcare systems. Conventional approaches, taking into account one barrier and/or opportunity, fail to prevent gender inequality in health care. For gender-sensitive health care we need to change systems and structures, but also to enhance understanding, raise awareness and develop skills among health professionals. To bring gender sensitivity into healthcare practice, interventions should address a range of factors. Copyright © 2010. Published by Elsevier Ireland Ltd.

Implementing Evidence-Based Practice in Community Mental Health Agencies: A Multiple Stakeholder Analysis

PubMed Central

Wells, Rebecca S.; Zagursky, Karen; Fettes, Danielle L.; Palinkas, Lawrence A.

2009-01-01

Objectives. We sought to identify factors believed to facilitate or hinder evidence-based practice (EBP) implementation in public mental health service systems as a step in developing theory to be tested in future studies. Methods. Focusing across levels of an entire large public sector mental health service system for youths, we engaged participants from 6 stakeholder groups: county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. Results. Participants generated 105 unique statements identifying implementation barriers and facilitators. Participants rated each statement on importance and changeability (i.e., the degree to which each barrier or facilitator is considered changeable). Data analyses distilled statements into 14 factors or dimensions. Descriptive analyses suggest that perceptions of importance and changeability varied across stakeholder groups. Conclusions. Implementation of EBP is a complex process. Cross-system–level approaches are needed to bring divergent and convergent perspectives to light. Examples include agency and program directors facilitating EBP implementation by supporting staff, actively sharing information with policymakers and administrators about EBP effectiveness and fit with clients' needs and preferences, and helping clinicians to present and deliver EBPs and address consumer concerns. PMID:19762654

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

PubMed

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

2014-01-01

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

Resilient actions in the diagnostic process and system performance.

PubMed

Smith, Michael W; Davis Giardina, Traber; Murphy, Daniel R; Laxmisan, Archana; Singh, Hardeep

2013-12-01

Systemic issues can adversely affect the diagnostic process. Many system-related barriers can be masked by 'resilient' actions of frontline providers (ie, actions supporting the safe delivery of care in the presence of pressures that the system cannot readily adapt to). We explored system barriers and resilient actions of primary care providers (PCPs) in the diagnostic evaluation of cancer. We conducted a secondary data analysis of interviews of PCPs involved in diagnostic evaluation of 29 lung and colorectal cancer cases. Cases covered a range of diagnostic timeliness and were analysed to identify barriers for rapid diagnostic evaluation, and PCPs' actions involving elements of resilience addressing those barriers. We rated these actions according to whether they were usual or extraordinary for typical PCP work. Resilient actions and associated barriers were found in 59% of the cases, in all ranges of timeliness, with 40% involving actions rated as beyond typical. Most of the barriers were related to access to specialty services and coordination with patients. Many of the resilient actions involved using additional communication channels to solicit cooperation from other participants in the diagnostic process. Diagnostic evaluation of cancer involves several resilient actions by PCPs targeted at system deficiencies. PCPs' actions can sometimes mitigate system barriers to diagnosis, and thereby impact the sensitivity of 'downstream' measures (eg, delays) in detecting barriers. While resilient actions might enable providers to mitigate system deficiencies in the short run, they can be resource intensive and potentially unsustainable. They complement, rather than substitute for, structural remedies to improve system performance. Measures to detect and fix system performance issues targeted by these resilient actions could facilitate diagnostic safety.

Lost opportunities to prevent early onset type 2 diabetes mellitus after a pregnancy complicated by gestational diabetes

PubMed Central

Bernstein, Judith A; McCloskey, Lois; Gebel, Christina M; Iverson, Ronald E; Lee-Parritz, Aviva

2016-01-01

Objectives Gestational diabetes mellitus (GDM) greatly increases the risk of developing diabetes in the decade after delivery, but few women receive appropriately timed postpartum glucose testing (PPGT) or a referral to primary care (PC) for continued monitoring. This qualitative study was designed to identify barriers and facilitators to testing and referral from patient and providers' perspectives. Methods We interviewed patients and clinicians in depth about knowledge, values, priorities, challenges, and recommendations for increasing PPGT rates and PC linkage. Interviews were coded with NVIVO data analysis software, and analyzed using an implementation science framework. Results Women reported motivation to address GDM for the health of the fetus. Most women did not anticipate future diabetes for themselves, and focused on delivery outcomes rather than future health risks. Patients sought and received reassurance from clinicians, and were unlikely to discuss early onset following GDM or preventive measures. PPGT barriers described by patients included provider not mentioning the test or setting it up, transportation difficulties, work responsibilities, fatigue, concerns about fasting while breastfeeding, and timing of the test after discharge from obstetrics, and no referral to PC for follow-up. Practitioners described limited communication among multiple care providers during pregnancy and delivery, systems issues, and separation of obstetrics from PC. Conclusions Patients' barriers to PPGT included low motivation for self-care, structural obstacles, and competing priorities. Providers reported the need to balance risk with reassurance, and identified systems failures related to test timing, limitations of electronic medical record systems (EMR), lack of referrals to PC, and inadequate communication between specialties. Prevention of early onset has great potential for medical cost savings and improvements in quality of life. PMID:27347422

Lost opportunities to prevent early onset type 2 diabetes mellitus after a pregnancy complicated by gestational diabetes.

PubMed

Bernstein, Judith A; McCloskey, Lois; Gebel, Christina M; Iverson, Ronald E; Lee-Parritz, Aviva

2016-01-01

Gestational diabetes mellitus (GDM) greatly increases the risk of developing diabetes in the decade after delivery, but few women receive appropriately timed postpartum glucose testing (PPGT) or a referral to primary care (PC) for continued monitoring. This qualitative study was designed to identify barriers and facilitators to testing and referral from patient and providers' perspectives. We interviewed patients and clinicians in depth about knowledge, values, priorities, challenges, and recommendations for increasing PPGT rates and PC linkage. Interviews were coded with NVIVO data analysis software, and analyzed using an implementation science framework. Women reported motivation to address GDM for the health of the fetus. Most women did not anticipate future diabetes for themselves, and focused on delivery outcomes rather than future health risks. Patients sought and received reassurance from clinicians, and were unlikely to discuss early onset following GDM or preventive measures. PPGT barriers described by patients included provider not mentioning the test or setting it up, transportation difficulties, work responsibilities, fatigue, concerns about fasting while breastfeeding, and timing of the test after discharge from obstetrics, and no referral to PC for follow-up. Practitioners described limited communication among multiple care providers during pregnancy and delivery, systems issues, and separation of obstetrics from PC. Patients' barriers to PPGT included low motivation for self-care, structural obstacles, and competing priorities. Providers reported the need to balance risk with reassurance, and identified systems failures related to test timing, limitations of electronic medical record systems (EMR), lack of referrals to PC, and inadequate communication between specialties. Prevention of early onset has great potential for medical cost savings and improvements in quality of life.

Temperature Dependence of Photoluminescence in InGaAs/InP Strained MQW Heterostructures

NASA Technical Reports Server (NTRS)

Raisky, O. Y.; Wang, W. B.; Alfano, R. R.; Reynolds, C. L., Jr.; Swaminathan, V.

1996-01-01

Multiple quantum well (MQW) InGaAsP/InP heterostructure systems have been drawn considerable research interest in recent years due to its suitability for long wavelength optoelectronic devices. The performance of such devices is strongly affected by peculiarities of recombination processes in the quantum wells (QW). The goal of this study was to investigate the effect of barrier width on the radiative recombination of carriers. In our study, the photoluminescence spectra from InGaAsP/lnP MQW double heterostructures have been measured in the 77-290 K temperature range with different excitation intensities.

Sensor System Fo4r Buried Waste Containment Sites

DOEpatents

Smith, Ann Marie; Gardner, Bradley M.; Kostelnik, Kevin M.; Partin, Judy K.; Lancaster, Gregory D.; Pfeifer, Mary Catherine

2003-11-18

A sensor system for a buried waste containment site having a bottom wall barrier and sidewall barriers, for containing hazardous waste. The sensor system includes one or more sensor devices disposed in one or more of the barriers for detecting a physical parameter either of the barrier itself or of the physical condition of the surrounding soils and buried waste, and for producing a signal representing the physical parameter detected. Also included is a signal processor for receiving signals produced by the sensor device and for developing information identifying the physical parameter detected, either for sounding an alarm, displaying a graphic representation of a physical parameter detected on a viewing screen and/or a hard copy printout. The sensor devices may be deployed in or adjacent the barriers at the same time the barriers are deployed and may be adapted to detect strain or cracking in the barriers, leakage of radiation through the barriers, the presence and leaking through the barriers of volatile organic compounds, or similar physical conditions.

Sensor system for buried waste containment sites

DOEpatents

Smith, Ann Marie; Gardner, Bradley M.; Kostelnik, Kevin M.; Partin, Judy K.; Lancaster, Gregory D.; Pfeifer, May Catherine

2000-01-01

A sensor system is disclosed for a buried waste containment site having a bottom wall barrier and/or sidewall barriers, for containing hazardous waste. The sensor system includes one or more sensor devices disposed in one or more of the barriers for detecting a physical parameter either of the barrier itself or of the physical condition of the surrounding soils and buried waste, and for producing a signal representing the physical parameter detected. Also included is a signal processor for receiving signals produced by the sensor device and for developing information identifying the physical parameter detected, either for sounding an alarm, displaying a graphic representation of a physical parameter detected on a viewing screen and/or a hard copy printout. The sensor devices may be deployed in or adjacent the barriers at the same time the barriers are deployed and may be adapted to detect strain or cracking in the barriers, leakage of radiation through the barriers, the presence and leaking through the barriers of volatile organic compounds, or similar physical conditions.

Sensor System Fo4r Buried Waste Containment Sites

DOEpatents

Smith, Ann Marie; Gardner, Bradley M.; Kostelnik, Kevin M.; Partin, Judy K.; Lancaster, Gregory D.; Pfeifer, Mary Catherine

2005-09-27

A sensor system for a buried waste containment site having a bottom wall barrier and/or sidewall barriers, for containing hazardous waste. The sensor system includes one or more sensor devices disposed in one or more of the barriers for detecting a physical parameter either of the barrier itself or of the physical condition of the surrounding soils and buried waste, and for producing a signal representing the physical parameter detected. Also included is a signal processor for receiving signals produced by the sensor device and for developing information identifying the physical parameter detected, either for sounding an alarm, displaying a graphic representation of a physical parameter detected on a viewing screen and/or a hard copy printout. The sensor devices may be deployed in or adjacent the barriers at the same time the barriers are deployed and may be adapted to detect strain or cracking in the barriers, leakage of radiation through the barriers, the presence and leaking through the barriers of volatile organic compounds, or similar physical conditions.

Towards Universal Health Coverage via Social Health Insurance in China: Systemic Fragmentation, Reform Imperatives, and Policy Alternatives.

PubMed

He, Alex Jingwei; Wu, Shaolong

2017-12-01

China's remarkable progress in building a comprehensive social health insurance (SHI) system was swift and impressive. Yet the country's decentralized and incremental approach towards universal coverage has created a fragmented SHI system under which a series of structural deficiencies have emerged with negative impacts. First, contingent on local conditions and financing capacity, benefit packages vary considerably across schemes, leading to systematic inequity. Second, the existence of multiple schemes, complicated by massive migration, has resulted in weak portability of SHI, creating further barriers to access. Third, many individuals are enrolled on multiple schemes, which causes inefficient use of government subsidies. Moral hazard and adverse selection are not effectively managed. The Chinese government announced its blueprint for integrating the urban and rural resident schemes in early 2016, paving the way for the ultimate consolidation of all SHI schemes and equal benefits for all. This article proposes three policy alternatives to inform the consolidation: (1) a single-pool system at the prefectural level with significant government subsidies, (2) a dual-pool system at the prefectural level with risk-equalization mechanisms, and (3) a household approach without merging existing pools. Vertical integration to the provincial level is unlikely to happen in the near future. Two caveats are raised to inform this transition towards universal health coverage.

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

PubMed

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

2014-07-01

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

Using a Bayesian network to predict barrier island geomorphologic characteristics

USGS Publications Warehouse

Gutierrez, Ben; Plant, Nathaniel G.; Thieler, E. Robert; Turecek, Aaron

2015-01-01

Quantifying geomorphic variability of coastal environments is important for understanding and describing the vulnerability of coastal topography, infrastructure, and ecosystems to future storms and sea level rise. Here we use a Bayesian network (BN) to test the importance of multiple interactions between barrier island geomorphic variables. This approach models complex interactions and handles uncertainty, which is intrinsic to future sea level rise, storminess, or anthropogenic processes (e.g., beach nourishment and other forms of coastal management). The BN was developed and tested at Assateague Island, Maryland/Virginia, USA, a barrier island with sufficient geomorphic and temporal variability to evaluate our approach. We tested the ability to predict dune height, beach width, and beach height variables using inputs that included longer-term, larger-scale, or external variables (historical shoreline change rates, distances to inlets, barrier width, mean barrier elevation, and anthropogenic modification). Data sets from three different years spanning nearly a decade sampled substantial temporal variability and serve as a proxy for analysis of future conditions. We show that distinct geomorphic conditions are associated with different long-term shoreline change rates and that the most skillful predictions of dune height, beach width, and beach height depend on including multiple input variables simultaneously. The predictive relationships are robust to variations in the amount of input data and to variations in model complexity. The resulting model can be used to evaluate scenarios related to coastal management plans and/or future scenarios where shoreline change rates may differ from those observed historically.

Investigating Unmet Health Needs in Primary Health Care Services in a Representative Sample of the Greek Population †

PubMed Central

Pappa, Evelina; Kontodimopoulos, Nick; Papadopoulos, Angelos; Tountas, Yannis; Niakas, Dimitris

2013-01-01

Unmet health care needs are determined as the difference between the services judged necessary and the services actually received, and stem from barriers related to accessibility, availability and acceptability. This study aims to examine the prevalence of unmet needs and to identify the socioeconomic and health status factors that are associated with unmet needs. A cross-sectional study was conducted in Greece in 2010 and involved data from 1,000 consenting subjects (>18 years old). Multiple binary logistic regression analysis was applied to investigate the predictors of unmet needs and to determine the relation between the socio-demographic characteristics and the accessibility, availability and acceptability barriers. Ninety nine participants (9.9%) reported unmet health needs during the 12 months prior to the research. The most frequently self-reported reasons were cost and lack of time. Youth, parenthood, physician consultations, and poor mental health increased the likelihood of unmet needs. Women were less likely to report accessibility and availability than acceptability barriers. Educational differences were evident and individuals with primary and secondary education were associated with significantly more accessibility and availability barriers compared with those with tertiary education. Unmet health needs pose a significant challenge to the health care system, especially given the difficult current financial situation in Greece. It is believed that unmet health needs will continue to increase, which will widen inequalities in health and health care access. PMID:23685827

Employment barriers for persons with psychiatric disabilities: update of a report for the President's Commission.

PubMed

Cook, Judith A

2006-10-01

A major public policy problem is the extremely low labor force participation of people with severe mental illness coupled with their overrepresentation on the public disability rolls. This situation is especially troubling given the existence of evidence-based practices designed to return them to the labor force. This article reviews research from the fields of disability, economics, health care, and labor studies to describe the nature of barriers to paid work and economic security for people with disabling mental disorders. These barriers include low educational attainment, unfavorable labor market dynamics, low productivity, lack of appropriate vocational and clinical services, labor force discrimination, failure of protective legislation, work disincentives caused by state and federal policies, poverty-level income, linkage of health care access to disability beneficiary status, and ineffective work incentive programs. The article concludes with a discussion of current policy initiatives in health care, mental health, and disability. Recommendations for a comprehensive system of services and supports to address multiple barriers are presented. These include access to affordable health care, including mental health treatment and prescription drug coverage; integrated clinical and vocational services; safe and stable housing that is not threatened by changes in earned income; remedial and postsecondary education and vocational training; benefits counseling and financial literacy education; economic security through asset development; legal aid for dealing with employment discrimination; peer support and self-help to enhance vocational self-image and encourage labor force attachment; and active involvement of U.S. business and employer communities.

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

PubMed

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

2017-03-01

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

Navigating the transition to ecosystem-based management of the Great Barrier Reef, Australia

PubMed Central

Olsson, Per; Folke, Carl; Hughes, Terry P.

2008-01-01

We analyze the strategies and actions that enable transitions toward ecosystem-based management using the recent governance changes of the Great Barrier Reef Marine Park as a case study. The interplay among individual actors, organizations, and institutions at multiple levels is central in such transitions. A flexible organization, the Great Barrier Reef Marine Park Authority, was crucial in initiating the transition to ecosystem-based management. This agency was also instrumental in the subsequent transformation of the governance regime and provided leadership throughout the process. Strategies involved internal reorganization and management innovation, leading to an ability to coordinate the scientific community, to increase public awareness of environmental issues and problems, to involve a broader set of stakeholders, and to maneuver the political system for support at critical times. The transformation process was induced by increased pressure on the Great Barrier Reef (from terrestrial runoff, overharvesting, and global warming) that triggered a new sense of urgency to address these challenges. The focus of governance shifted from protection of selected individual reefs to stewardship of the larger-scale seascape. The study emphasizes the significance of stewardship that can change patterns of interactions among key actors and allow for new forms of management and governance to emerge in response to environmental change. This example illustrates that enabling legislations or other social bounds are essential, but not sufficient for shifting governance toward adaptive comanagement of complex marine ecosystems. PMID:18621698

Barriers to Asthma Management for School Nurses: An Integrative Review.

PubMed

Hanley Nadeau, Ellen; Toronto, Coleen E

2016-04-01

Childhood asthma is a growing health concern. Asthma is the most common chronic illness of childhood and a leading cause of emergency room visits, hospitalizations, and school absenteeism. School nurses play a valuable role in asthma management. The purpose of this integrative review is to examine barriers to asthma management for school nurses in the school setting. Findings revealed multiple barriers school nurses encounter in managing asthma. Six themes emerged that included lack of resources and support, insufficient time, communication challenges, limited knowledge, and lack of awareness of school nurses' expertise. Students, parents, primary care physicians, school administration, staff, and school nurses themselves all play a role in constructing barriers to asthma management. There is a need for school nurses and school nurse leaders to focus efforts to develop strategies to overcome barriers to ensure evidence-based, best practice management of asthma in the school setting. © The Author(s) 2015.

The Role of Structural Barriers in Risky Sexual Behavior, Victimization and Readiness to Change HIV/STI-Related Risk Behavior Among Transgender Women.

PubMed

Raiford, Jerris L; Hall, Grace J; Taylor, Raekiela D; Bimbi, David S; Parsons, Jeffrey T

2016-10-01

This study examines the role of structural barriers experienced by a community-based sample of 63 HIV-positive and negative transgender women that may elevate HIV infection and transmission risks. Separate hierarchical linear multiple regression analyses tested the association between structural barriers (e.g., unemployment, lack of food, shelter) and condomless anal sex acts, abuse, and readiness to change risk behavior, while controlling for other related factors. Among this primarily Hispanic and African-American sample, HIV-positive and negative transgender women experienced a similar number of structural barriers and experiencing structural barriers was significantly associated with an increased number of condomless anal sex acts (p = .002), victimization (p = .000) and a decreased readiness to change HIV-related risk behavior (p = .014). Structural-level interventions are needed to address this elevated risk among this underserved and hard-to-reach population.

Principles of nanoparticle design for overcoming biological barriers to drug delivery

PubMed Central

Blanco, Elvin; Shen, Haifa; Ferrari, Mauro

2016-01-01

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

A Social Constructionist Inquiry Study on the Lived Experiences of Educators with Dyslexia Overcoming Workplace Barriers and Increasing Their Capacity for Success

ERIC Educational Resources Information Center

Taylor, Kathryn R.

2017-01-01

The purpose of this qualitative research is to journey the lives of educators with dyslexia growing up as K-12 students, working in the K-12 educational environment, and the means by which those educators overcome workplace barriers as analyzed by three guidelines under the Universal Design for Learning (UDL) principle, multiple means of…

Establishing Core Mental Health Workforce Attributes for the Effective Mental Health Care of People with an Intellectual Disability and Co-Occurring Mental Ill Health

ERIC Educational Resources Information Center

Weise, Janelle; Fisher, Karen R.; Trollor, Julian N.

2017-01-01

Background: People with intellectual disability experience high rates of mental ill health but multiple barriers to access to quality mental health care. One significant barrier to access is a generalist mental health workforce that lacks capacity, and consensus on what constitutes core workforce competencies in this area. As such, the first step…

Application of Balanced Scorecard in the Evaluation of a Complex Health System Intervention: 12 Months Post Intervention Findings from the BHOMA Intervention: A Cluster Randomised Trial in Zambia

PubMed Central

Mutale, Wilbroad; Stringer, Jeffrey; Chintu, Namwinga; Chilengi, Roma; Mwanamwenge, Margaret Tembo; Kasese, Nkatya; Balabanova, Dina; Spicer, Neil; Lewis, James; Ayles, Helen

2014-01-01

Introduction In many low income countries, the delivery of quality health services is hampered by health system-wide barriers which are often interlinked, however empirical evidence on how to assess the level and scope of these barriers is scarce. A balanced scorecard is a tool that allows for wider analysis of domains that are deemed important in achieving the overall vision of the health system. We present the quantitative results of the 12 months follow-up study applying the balanced scorecard approach in the BHOMA intervention with the aim of demonstrating the utility of the balanced scorecard in evaluating multiple building blocks in a trial setting. Methods The BHOMA is a cluster randomised trial that aims to strengthen the health system in three rural districts in Zambia. The intervention aims to improve clinical care quality by implementing practical tools that establish clear clinical care standards through intensive clinic implementations. This paper reports the findings of the follow-up health facility survey that was conducted after 12 months of intervention implementation. Comparisons were made between those facilities in the intervention and control sites. STATA version 12 was used for analysis. Results The study found significant mean differences between intervention(I) and control (C) sites in the following domains: Training domain (Mean I:C; 87.5.vs 61.1, mean difference 23.3, p = 0.031), adult clinical observation domain (mean I:C; 73.3 vs.58.0, mean difference 10.9, p = 0.02 ) and health information domain (mean I:C; 63.6 vs.56.1, mean difference 6.8, p = 0.01. There was no gender differences in adult service satisfaction. Governance and motivation scores did not differ between control and intervention sites. Conclusion This study demonstrates the utility of the balanced scorecard in assessing multiple elements of the health system. Using system wide approaches and triangulating data collection methods seems to be key to successful evaluation of such complex health intervention. Trial number ClinicalTrials.gov NCT01942278 PMID:24751780

Application of balanced scorecard in the evaluation of a complex health system intervention: 12 months post intervention findings from the BHOMA intervention: a cluster randomised trial in Zambia.

PubMed

Mutale, Wilbroad; Stringer, Jeffrey; Chintu, Namwinga; Chilengi, Roma; Mwanamwenge, Margaret Tembo; Kasese, Nkatya; Balabanova, Dina; Spicer, Neil; Lewis, James; Ayles, Helen

2014-01-01

In many low income countries, the delivery of quality health services is hampered by health system-wide barriers which are often interlinked, however empirical evidence on how to assess the level and scope of these barriers is scarce. A balanced scorecard is a tool that allows for wider analysis of domains that are deemed important in achieving the overall vision of the health system. We present the quantitative results of the 12 months follow-up study applying the balanced scorecard approach in the BHOMA intervention with the aim of demonstrating the utility of the balanced scorecard in evaluating multiple building blocks in a trial setting. The BHOMA is a cluster randomised trial that aims to strengthen the health system in three rural districts in Zambia. The intervention aims to improve clinical care quality by implementing practical tools that establish clear clinical care standards through intensive clinic implementations. This paper reports the findings of the follow-up health facility survey that was conducted after 12 months of intervention implementation. Comparisons were made between those facilities in the intervention and control sites. STATA version 12 was used for analysis. The study found significant mean differences between intervention(I) and control (C) sites in the following domains: Training domain (Mean I:C; 87.5.vs 61.1, mean difference 23.3, p = 0.031), adult clinical observation domain (mean I:C; 73.3 vs.58.0, mean difference 10.9, p = 0.02 ) and health information domain (mean I:C; 63.6 vs.56.1, mean difference 6.8, p = 0.01. There was no gender differences in adult service satisfaction. Governance and motivation scores did not differ between control and intervention sites. This study demonstrates the utility of the balanced scorecard in assessing multiple elements of the health system. Using system wide approaches and triangulating data collection methods seems to be key to successful evaluation of such complex health intervention. ClinicalTrials.gov NCT01942278.

7 CFR 1955.56 - Real property located in Coastal Barrier Resources System (CBRS).

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 14 2010-01-01 2009-01-01 true Real property located in Coastal Barrier Resources... Management of Property § 1955.56 Real property located in Coastal Barrier Resources System (CBRS). (a... Coastal Barrier Resources Act (CBRA). Pursuant to the requirements of the CBRA, and except as specified in...

The Drosophila blood-brain barrier: development and function of a glial endothelium.

PubMed

Limmer, Stefanie; Weiler, Astrid; Volkenhoff, Anne; Babatz, Felix; Klämbt, Christian

2014-01-01

The efficacy of neuronal function requires a well-balanced extracellular ion homeostasis and a steady supply with nutrients and metabolites. Therefore, all organisms equipped with a complex nervous system developed a so-called blood-brain barrier, protecting it from an uncontrolled entry of solutes, metabolites or pathogens. In higher vertebrates, this diffusion barrier is established by polarized endothelial cells that form extensive tight junctions, whereas in lower vertebrates and invertebrates the blood-brain barrier is exclusively formed by glial cells. Here, we review the development and function of the glial blood-brain barrier of Drosophila melanogaster. In the Drosophila nervous system, at least seven morphologically distinct glial cell classes can be distinguished. Two of these glial classes form the blood-brain barrier. Perineurial glial cells participate in nutrient uptake and establish a first diffusion barrier. The subperineurial glial (SPG) cells form septate junctions, which block paracellular diffusion and thus seal the nervous system from the hemolymph. We summarize the molecular basis of septate junction formation and address the different transport systems expressed by the blood-brain barrier forming glial cells.

Factors Related to Breastfeeding Discontinuation Between Hospital Discharge and 2 Weeks Postpartum

PubMed Central

Brand, Elizabeth; Kothari, Catherine; Stark, Mary Ann

2011-01-01

Although breastfeeding is known to be beneficial to both mother and infant, many women encounter barriers to breastfeeding, even after successful breastfeeding initiation, which may put them at greater risk for early cessation of breastfeeding. The objectives of this study were to conduct a secondary analysis of data from a longitudinal study of postpartum depression to (a) examine factors related to very early discontinuation of breastfeeding (at 2 weeks postpartum) following hospital discharge and (b) identify women’s reasons for very early cessation of breastfeeding. The results of this study support findings from previous research. Having a perceived support system, whether it is personal or professional, may have an effect on both the initiation and duration of breastfeeding. Educating expectant and new mothers, especially women who encounter multiple barriers and are at risk for very early cessation of breastfeeding, of the benefits of breastfeeding and supporting them in developing efficient techniques and problem-solving skills can help increase the duration of breastfeeding. PMID:22211058

Fine-scale population structure and the era of next-generation sequencing.

PubMed

Henn, Brenna M; Gravel, Simon; Moreno-Estrada, Andres; Acevedo-Acevedo, Suehelay; Bustamante, Carlos D

2010-10-15

Fine-scale population structure characterizes most continents and is especially pronounced in non-cosmopolitan populations. Roughly half of the world's population remains non-cosmopolitan and even populations within cities often assort along ethnic and linguistic categories. Barriers to random mating can be ecologically extreme, such as the Sahara Desert, or cultural, such as the Indian caste system. In either case, subpopulations accumulate genetic differences if the barrier is maintained over multiple generations. Genome-wide polymorphism data, initially with only a few hundred autosomal microsatellites, have clearly established differences in allele frequency not only among continental regions, but also within continents and within countries. We review recent evidence from the analysis of genome-wide polymorphism data for genetic boundaries delineating human population structure and the main demographic and genomic processes shaping variation, and discuss the implications of population structure for the distribution and discovery of disease-causing genetic variants, in the light of the imminent availability of sequencing data for a multitude of diverse human genomes.

Preparation and Thermoelectric Characteristics of ITO/PtRh:PtRh Thin Film Thermocouple

NASA Astrophysics Data System (ADS)

Zhao, Xiaohui; Wang, Hongmin; Zhao, Zixiang; Zhang, Wanli; Jiang, Hongchuan

2017-12-01

Thin film thermocouples (TFTCs) can provide more precise in situ temperature measurement for aerospace propulsion systems without disturbance of gas flow and surface temperature distribution of the hot components. ITO /PtRh:PtRh TFTC with multilayer structure was deposited on alumina ceramic substrate by magnetron sputtering. After annealing, the TFTC was statically calibrated for multiple cycles with temperature up to 1000 °C. The TFTC with excellent stability and repeatability was realized for the negligible variation of EMF in different calibration cycles. It is believed that owing to oxygen diffusion barriers by the oxidation of top PtRh layer and Schottky barriers formed at the grain boundaries of ITO, the variation of the carrier concentration of ITO film is minimized. Meanwhile, the life time of TFTC is more than 30 h in harsh environment. This makes ITO/PtRh:PtRh TFTC a promising candidate for precise surface temperature measurement of hot components of aeroengines.

Preparation and Thermoelectric Characteristics of ITO/PtRh:PtRh Thin Film Thermocouple.

PubMed

Zhao, Xiaohui; Wang, Hongmin; Zhao, Zixiang; Zhang, Wanli; Jiang, Hongchuan

2017-12-15

Thin film thermocouples (TFTCs) can provide more precise in situ temperature measurement for aerospace propulsion systems without disturbance of gas flow and surface temperature distribution of the hot components. ITO/PtRh:PtRh TFTC with multilayer structure was deposited on alumina ceramic substrate by magnetron sputtering. After annealing, the TFTC was statically calibrated for multiple cycles with temperature up to 1000 °C. The TFTC with excellent stability and repeatability was realized for the negligible variation of EMF in different calibration cycles. It is believed that owing to oxygen diffusion barriers by the oxidation of top PtRh layer and Schottky barriers formed at the grain boundaries of ITO, the variation of the carrier concentration of ITO film is minimized. Meanwhile, the life time of TFTC is more than 30 h in harsh environment. This makes ITO/PtRh:PtRh TFTC a promising candidate for precise surface temperature measurement of hot components of aeroengines.

New Medicaid Enrollees In Oregon Report Health Care Successes And Challenges

PubMed Central

Allen, Heidi; Wright, Bill J.; Baicker, Katherine

2014-01-01

Medicaid expansions will soon cover millions of new enrollees, but insurance alone may not ensure that they receive high-quality care. This study examines health care interactions and the health perceptions of an Oregon cohort three years after they gained Medicaid coverage. During in-depth qualitative interviews, 120 enrollees reported a wide range of interactions with the health care system. Forty percent of the new enrollees sought care infrequently because they were confused about coverage, faced access barriers, had bad interactions with providers, or felt that care was unnecessary. For the 60 percent who had multiple health care interactions, continuity and ease of the provider-patient relationship were critical to improved health. Some newly insured Medicaid enrollees recounted rapid improvements in health. However, most reported that gains came after months or years of working closely and systematically with a provider. Our findings suggest that improving communication with beneficiaries and increasing the availability of coordinated care across settings could reduce the barriers that new enrollees are likely to face. PMID:24493773

Social media in clinical trials.

PubMed

Thompson, Michael A

2014-01-01

Social media has potential in clinical trials for pointing out trial issues, addressing barriers, educating, and engaging multiple groups involved in cancer clinical research. Social media is being used in clinical trials to highlight issues such as poor accrual and barriers; educate potential participants and physicians about clinical trial options; and is a potential indirect or direct method to improve accrual. We are moving from a passive "push" of information to patients to a "pull" of patients requesting information. Patients and advocates are often driving an otherwise reluctant health care system into communication. Online patient communities are creating new information repositories. Potential clinical trial participants are using the Twittersphere and other sources to learn about potential clinical trial options. We are seeing more organized patient-centric and patient-engaged forums with the potential to crowd source to improve clinical trial accrual and design. This is an evolving process that will meet many individual, institutional, and regulatory obstacles as we move forward in a changed research landscape.

Implementation of Teacher Consultation and Coaching in Urban Schools: A Mixed Method Study

PubMed Central

Cappella, Elise; Jackson, Daisy R.; Kim, Ha Yeon; Bilal, Caroline; Holland, Sibyl; Atkins, Marc S.

2015-01-01

Guided by implementation science scholarship and school mental health research, the current study uses qualitative and quantitative data to illuminate the barriers, opportunities, and processes underlying the implementation of a teacher consultation and coaching model (BRIDGE) in urban elementary schools. Data come from five public elementary schools, 12 school mental health staff (BRIDGE consultants), and 18 teachers participating in a classroom-randomized trial of BRIDGE. Findings from directed content analysis of teacher focus group and interview data suggest that aspects of the BRIDGE intervention model, school organization and classroom contexts, and teachers/consultants and their relationship were relevant as implementation facilitators or barriers. In addition, case study analysis of intervention materials and fidelity tools from classrooms with moderate-to-high dosage and adherence suggest variation in consultation and coaching by initial level of observed classroom need. Results illuminate the need for implementation research to extend beyond simple indicators of fidelity to the multiple systems and variation in processes at play across levels of the implementation context. PMID:27293490

Learning Science Through Visualization

NASA Technical Reports Server (NTRS)

Chaudhury, S. Raj

2005-01-01

In the context of an introductory physical science course for non-science majors, I have been trying to understand how scientific visualizations of natural phenomena can constructively impact student learning. I have also necessarily been concerned with the instructional and assessment approaches that need to be considered when focusing on learning science through visually rich information sources. The overall project can be broken down into three distinct segments : (i) comparing students' abilities to demonstrate proportional reasoning competency on visual and verbal tasks (ii) decoding and deconstructing visualizations of an object falling under gravity (iii) the role of directed instruction to elicit alternate, valid scientific visualizations of the structure of the solar system. Evidence of student learning was collected in multiple forms for this project - quantitative analysis of student performance on written, graded assessments (tests and quizzes); qualitative analysis of videos of student 'think aloud' sessions. The results indicate that there are significant barriers for non-science majors to succeed in mastering the content of science courses, but with informed approaches to instruction and assessment, these barriers can be overcome.

Connecting AAC devices to the world of information technology.

PubMed

Caves, Kevin; Shane, Howard C; DeRuyter, Frank

2002-01-01

Modern day information technology (IT) is converging around wireless networks. It is now possible to check E-mail and view information from the World Wide Web from commercially available mobile phones. For individuals with disabilities, the ability to access multiple and different types of information not only promises convenience, but also can help to promote independence and facilitate access to public and private information systems. There are many barriers to access for people with disabilities, including technological hurdles, security, privacy, and access to these emerging wireless technologies. However, legislation, advocacy, standards, and research and development can ensure that users of augmentative and alternative communication (AAC) and assistive technology have access to these technologies. This article provides a historical context for the field of AAC and IT development, a review of the current state of these technologies, a glimpse of the potential of wireless information access for the lives of AAC users, and a description of some of the barriers and enablers to making access available to users of AAC and assistive technologies.

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

NASA Technical Reports Server (NTRS)

Stefanski, Philip L.; Soler-Luna, Adrian

2017-01-01

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

The mechanisms of neurotoxicity and the selective vulnerability of nervous system sites.

PubMed

Maurer, Laura L; Philbert, Martin A

2015-01-01

The spatial heterogeneity of the structure, function, and cellular composition of the nervous system confers extraordinary complexity and a multiplicity of mechanisms of chemical neurotoxicity. Because of its relatively high metabolic demands and functional dependence on postmitotic neurons, the nervous system is vulnerable to a variety of xenobiotics that affect essential homeostatic mechanisms that support function. Despite protection from the neuroglia and blood-brain barrier, the central nervous system is prone to attack from lipophilic toxicants and those that hijack endogenous transport, receptor, metabolic, and other biochemical systems. The inherent predilection of chemicals for highly conserved biochemical systems confers selective vulnerability of the nervous system to neurotoxicants. This chapter discusses selective vulnerability of the nervous system in the context of neuron-specific decrements (axonopathy, myelinopathy, disruption of neurotransmission), and the degree to which neuronal damage is facilitated or ameliorated by surrounding nonneural cells in both the central and peripheral nervous systems. © 2015 Elsevier B.V. All rights reserved.

Highway renewable energy : photovoltaic noise barriers

DOT National Transportation Integrated Search

2017-07-01

Highway photovoltaic noise barriers (PVNBs) represent the combination of noise barrier systems and photovoltaic systems in order to mitigate traffic noise while simultaneously producing renewable energy. First deployed in Switzerland in 1989, PVNBs a...

The blood-brain barrier: an engineering perspective

PubMed Central

Wong, Andrew D.; Ye, Mao; Levy, Amanda F.; Rothstein, Jeffrey D.; Bergles, Dwight E.; Searson, Peter C.

2013-01-01

It has been more than 100 years since Paul Ehrlich reported that various water-soluble dyes injected into the circulation did not enter the brain. Since Ehrlich's first experiments, only a small number of molecules, such as alcohol and caffeine have been found to cross the blood-brain barrier, and this selective permeability remains the major roadblock to treatment of many central nervous system diseases. At the same time, many central nervous system diseases are associated with disruption of the blood-brain barrier that can lead to changes in permeability, modulation of immune cell transport, and trafficking of pathogens into the brain. Therefore, advances in our understanding of the structure and function of the blood-brain barrier are key to developing effective treatments for a wide range of central nervous system diseases. Over the past 10 years it has become recognized that the blood-brain barrier is a complex, dynamic system that involves biomechanical and biochemical signaling between the vascular system and the brain. Here we reconstruct the structure, function, and transport properties of the blood-brain barrier from an engineering perspective. New insight into the physics of the blood-brain barrier could ultimately lead to clinical advances in the treatment of central nervous system diseases. PMID:24009582

Biochemistry of epidermal stem cells.

PubMed

Eckert, Richard L; Adhikary, Gautam; Balasubramanian, Sivaprakasam; Rorke, Ellen A; Vemuri, Mohan C; Boucher, Shayne E; Bickenbach, Jackie R; Kerr, Candace

2013-02-01

The epidermis is an important protective barrier that is essential for maintenance of life. Maintaining this barrier requires continuous cell proliferation and differentiation. Moreover, these processes must be balanced to produce a normal epidermis. The stem cells of the epidermis reside in specific locations in the basal epidermis, hair follicle and sebaceous glands and these cells are responsible for replenishment of this tissue. A great deal of effort has gone into identifying protein epitopes that mark stem cells, in identifying stem cell niche locations, and in understanding how stem cell populations are related. We discuss these studies as they apply to understanding normal epidermal homeostasis and skin cancer. An assortment of stem cell markers have been identified that permit assignment of stem cells to specific regions of the epidermis, and progress has been made in understanding the role of these cells in normal epidermal homeostasis and in conditions of tissue stress. A key finding is the multiple stem cell populations exist in epidermis that give rise to different structures, and that multiple stem cell types may contribute to repair in damaged epidermis. Understanding epidermal stem cell biology is likely to lead to important therapies for treating skin diseases and cancer, and will also contribute to our understanding of stem cells in other systems. This article is part of a Special Issue entitled Biochemistry of Stem Cells. Copyright © 2012 Elsevier B.V. All rights reserved.

Biochemistry of epidermal stem cells☆

PubMed Central

Eckert, Richard L.; Adhikary, Gautam; Balasubramanian, Sivaprakasam; Rorke, Ellen A.; Vemuri, Mohan C.; Boucher, Shayne E.; Bickenbach, Jackie R.; Kerr, Candace

2014-01-01

Background The epidermis is an important protective barrier that is essential for maintenance of life. Maintaining this barrier requires continuous cell proliferation and differentiation. Moreover, these processes must be balanced to produce a normal epidermis. The stem cells of the epidermis reside in specific locations in the basal epidermis, hair follicle and sebaceous glands and these cells are responsible for replenishment of this tissue. Scope of review A great deal of effort has gone into identifying protein epitopes that mark stem cells, in identifying stem cell niche locations, and in understanding how stem cell populations are related. We discuss these studies as they apply to understanding normal epidermal homeostasis and skin cancer. Major conclusions An assortment of stem cell markers have been identified that permit assignment of stem cells to specific regions of the epidermis, and progress has been made in understanding the role of these cells in normal epidermal homeostasis and in conditions of tissue stress. A key finding is the multiple stem cell populations exist in epidermis that give rise to different structures, and that multiple stem cell types may contribute to repair in damaged epidermis. General significance Understanding epidermal stem cell biology is likely to lead to important therapies for treating skin diseases and cancer, and will also contribute to our understanding of stem cells in other systems. This article is part of a Special Issue entitled Biochemistry of Stem Cells. PMID:22820019

The Meninges: New Therapeutic Targets For Multiple Sclerosis

PubMed Central

Russi, Abigail E.; Brown, Melissa A.

2014-01-01

The CNS is largely comprised of non-regenerating cells, including neurons and myelin-producing oligodendrocytes, which are particularly vulnerable to immune cell mediated damage. To protect the CNS, mechanisms exist that normally restrict the transit of peripheral immune cells into the brain and spinal cord, conferring an “immune specialized” status. Thus, there has been a long-standing debate as to how these restrictions are overcome in several inflammatory diseases of the CNS, including multiple sclerosis (MS). In this review, we highlight the role of the meninges, tissues that surround and protect the CNS and enclose the cerebral spinal fluid, in promoting chronic inflammation that leads to neuronal damage. Although the meninges have traditionally been considered structures that provide physical protection for the brain and spinal cord, new data has established these tissues as sites of active immunity. It has been hypothesized that the meninges are important players in normal immunosurveillance of the CNS but also serve as initial sites of anti-myelin immune responses. The resulting robust meningeal inflammation elicits loss of localized blood barrier integrity and facilitates a large-scale influx of immune cells into the CNS parenchyma. We propose that targeting of the cells and molecules mediating these inflammatory responses within the meninges offers promising therapies for MS that are free from the constraints imposed by the blood brain barrier. Importantly, such therapies may avoid the systemic immunosuppression often associated with the existing treatments. PMID:25241937

Cotunneling and polaronic effect in granular systems

NASA Astrophysics Data System (ADS)

Ioselevich, A. S.; Sivak, V. V.

2017-06-01

We theoretically study the conductivity in arrays of metallic grains due to the variable-range multiple cotunneling of electrons with short-range (screened) Coulomb interaction. The system is supposed to be coupled to random stray charges in the dielectric matrix that are only loosely bounded to their spatial positions by elastic forces. The flexibility of the stray charges gives rise to a polaronic effect, which leads to the onset of Arrhenius-type conductivity behavior at low temperatures, replacing conventional Mott variable-range hopping. The effective activation energy logarithmically depends on temperature due to fluctuations of the polaron barrier heights. We present the unified theory that covers both weak and strong polaron effect regimes of hopping in granular metals and describes the crossover from elastic to inelastic cotunneling.

"I'd rather watch TV": an examination of physical activity in adults with mental retardation.

PubMed

Frey, Georgia C; Buchanan, Alice M; Rosser Sandt, Dawn D

2005-08-01

Interpretive ethnography was used as a framework to examine perceptions of physical activity behavior of 12 adults with mild mental retardation. Four parents and two job supervisors also agreed to participate. Multiple data sources included in-depth interviews, diaries, accelerometry, and informal observations. Participants reported many physical activity barriers, benefits, and leisure choices similar to the general population; however, two particularly salient themes related to negative influences and lack of guidance from support systems were apparently unique to this group. Results suggest that (a) adults with mental retardation need specially designed physical activity education and training programs and (b) supports system providers should be educated regarding the importance of physical activity to health for these individuals.

Volumetric analysis of a New England barrier system using ground-penetrating-radar and coring techniques

USGS Publications Warehouse

Van Heteren, S.; FitzGerald, D.M.; Barber, D.C.; Kelley, J.T.; Belknap, D.F.

1996-01-01

Ground-penetrating-radar (GPR) profiles calibrated with core data allow accurate assessments of coastal barrier volumes. We applied this procedure successfully to the barrier system along Saco Bay, Maine (USA), as part of a sediment-budget study that focused on present-day sand volumes in various coastal, shoreface, and inner-shelf lith-osomes, and on sand fluxes that have affected the volume or distribution of sand in these sediment bodies through time. On GPR profiles, the components of the barrier lithosome are readily differentiated from other facies, except where the radar signal is attenuated by brackish or salty groundwater. Significant differences between dielectric properties of the barrier lithosome and other units commonly result in strong boundary reflectors. The mostly sandy barrier sediments allow deep penetration of GPR waves, in contrast to finer-grained strata and till-covered bedrock. Within the Saco Bay barrier system, 22 ??3 x 106 m3 of sediment are unevenly distributed. Two-thirds of the total barrier volume is contained within the northern and southern ends of the study area, in the Pine Point spit and the Ferry Beach/Goosefare complex, respectively. The central area around Old Orchard Beach is locally covered by only a thin veneer of barrier sand, averaging <3 m, that unconformably overlies shallow pre-Holocene facies. The prominence of barrier-spit facies and the distribution pattern of back-barrier sediments indicate that a high degree of segmentation, governed by antecedent topography, has affected the development of the Saco Bay barrier system. The present-day configuration of the barrier and back-barrier region along Saco Bay, however, conceals much of its early compartmentalized character.

A qualitative analysis of interprofessional healthcare team members' perceptions of patient barriers to healthcare engagement.

PubMed

Powell, Rhea E; Doty, Amanda; Casten, Robin J; Rovner, Barry W; Rising, Kristin L

2016-09-20

Healthcare systems increasingly engage interprofessional healthcare team members such as case managers, social workers, and community health workers to work directly with patients and improve population health. This study elicited perspectives of interprofessional healthcare team members regarding patient barriers to health and suggestions to address these barriers. This is a qualitative study employing focus groups and semi-structured interviews with 39 interprofessional healthcare team members in Philadelphia to elicit perceptions of patients' needs and experiences with the health system, and suggestions for positioning health care systems to better serve patients. Themes were identified using a content analysis approach. Three focus groups and 21 interviews were conducted with 26 hospital-based and 13 ambulatory-based participants. Three domains emerged to characterize barriers to care: social determinants, health system factors, and patient trust in the health system. Social determinants included insurance and financial shortcomings, mental health and substance abuse issues, housing and transportation-related limitations, and unpredictability associated with living in poverty. Suggestions for addressing these barriers included increased financial assistance from the health system, and building a workforce to address these determinants directly. Health care system factors included poor care coordination, inadequate communication of hospital discharge instructions, and difficulty navigating complex systems. Suggestions for addressing these barriers included enhanced communication between care sites, patient-centered scheduling, and improved patient education especially in discharge planning. Finally, factors related to patient trust of the health system emerged. Participants reported that patients are often intimidated by the health system, mistrusting of physicians, and fearful of receiving a serious diagnosis or prognosis. A suggestion for mitigating these issues was increased visibility of the health system within communities to foster trust and help providers gain a better understanding of unique community needs. This work explored interprofessional healthcare team members' perceptions of patient barriers to healthcare engagement. Participants identified barriers related to social determinants of health, complex system organization, and patient mistrust of the health system. Participants offered concrete suggestions to address these barriers, with suggestions supporting current healthcare reform efforts that aim at addressing social determinants and improving health system coordination and adding new insight into how systems might work to improve patient and community trust.

Interplay among gut microbiota, intestinal mucosal barrier and enteric neuro-immune system: a common path to neurodegenerative diseases?

PubMed

Pellegrini, Carolina; Antonioli, Luca; Colucci, Rocchina; Blandizzi, Corrado; Fornai, Matteo

2018-05-24

Neurological diseases, such as Parkinson's disease, Alzheimer's disease, amyotrophic lateral sclerosis (ALS) and multiple sclerosis, are often associated with functional gastrointestinal disorders. These gastrointestinal disturbances may occur at all stages of the neurodegenerative diseases, to such an extent that they are now considered an integral part of their clinical picture. Several lines of evidence support the contention that, in central neurodegenerative diseases, changes in gut microbiota and enteric neuro-immune system alterations could contribute to gastrointesinal dysfunctions as well as initiation and upward spreading of the neurologic disorder. The present review has been intended to provide a comprehensive overview of the available knowledge on the role played by enteric microbiota, mucosal immune system and enteric nervous system, considered as an integrated network, in the pathophysiology of the main neurological diseases known to be associated with intestinal disturbances. In addition, based on current human and pre-clinical evidence, our intent was to critically discuss whether changes in the dynamic interplay between gut microbiota, intestinal epithelial barrier and enteric neuro-immune system are a consequence of the central neurodegeneration or might represent the starting point of the neurodegenerative process. Special attention has been paid also to discuss whether alterations of the enteric bacterial-neuro-immune network could represent a common path driving the onset of the main neurodegenerative diseases, even though each disease displays its own distinct clinical features.

Morphology and stratigraphy of small barrier-lagoon systems in Maine

USGS Publications Warehouse

Duffy, W.; Belknap, D.F.; Kelley, J.T.

1989-01-01

The coast of Maine contains over 200 individual barrier-lagoon systems, most quite small, with an aggregate length of nearly 100 km. Although they represent less than 5% of the tidally influenced coastline of Maine, they are widely distributed and occur in a variety of dynamic regimes and physiographic regions. Their morphology and backbarrier stratigraphy are different from better studied coastal plain systems, and provide important clues to the Holocene evolution of the Maine coast. In a study of geomorphic form and backbarrier stratigraphy, inlet processes and Holocene sea-level rise have been identified as the principal controls on coarse-grained barrier stratigraphy. Barriers in Maine are found in five distinct geomorphic forms, identified herein as: barrier spits, pocket barriers, double tombolos, cuspate barriers and looped barriers. The few long sandy beaches in southwestern Maine are mostly barrier spits. The remainder of the barrier types is composed primarily of gravel or mixed sand and gravel. The barriers protect a variety of backbarrier environments: fresh and brackish ponds, lagoons and fresh- and saltwater marshes. The barriers may or may not have inlets. Normal wave action, coarse-grain size and a deeply embayed coast result in barriers with steep, reflective profiles several meters above MHW. Occasional storm events completely wash over the barriers, building steep, lobate gravel fans along their landward margin. Few, if any, extensive storm layers are recognized as extending into the distal backbarrier environments, however. During sea-level rise and landward barrier retreat, this abrupt, storm-generated transition zone inters the backbarrier sediments. Statistical comparisons of barrier morphology, location and backbarrier environment type with backbarrier stratigraphy show that Holocene backbarrier stratigraphy is best predicted by the modern backbarrier environment type. This, in turn, is influenced most by the absence or presence, and long-term stability or instability of a tidal inlet. Geomorphic barrier form and location in coastal geomorphic compartments show little or no correlation with backbarrier stratigraphy. In contrast to previous classifications of barrier-lagoon systems based primarily on sandy, coastal plain examples, in Maine the shape or origin of the backbarrier system is relatively unimportant. The presence or absence of a tidal inlet is of paramount importance in shaping the Holocene stratigraphy of the backbarrier region. ?? 1989.

The impact of financial barriers on access to care, quality of care and vascular morbidity among patients with diabetes and coronary heart disease.

PubMed

Parikh, Puja B; Yang, Jie; Leigh, Steven; Dorjee, Kunchok; Parikh, Roopali; Sakellarios, Nicholas; Meng, Hongdao; Brown, David L

2014-01-01

The prevalence and consequences of financial barriers to health care among patients with multiple chronic diseases are poorly understood. We sought to assess the prevalence of self-reported financial barriers to health care among individuals with diabetes and coronary heart disease (CHD) and to determine their association with access to care, quality of care and clinical outcomes. The 2007 Centers for Disease Control Behavioral Risk Factor Surveillance Survey. Diabetic patients with CHD. Financial barriers to health care were defined by a self-reported time in the past 12 months when the respondent needed to see a doctor but could not because of cost. The primary clinical outcome was vascular morbidity—a composite of stroke, retinopathy, nonhealing foot sores or bilateral foot amputations. Among the 11,274 diabetics with CHD, 1,541 (13.7 %) reported financial barriers to health care. Compared to individuals without financial barriers, those with financial barriers had significantly reduced rates of medical assessments within the past 2 years, hemoglobin (Hgb) A1C measurements in the past year, cholesterol measurements at any time, eye and foot examinations within the past year, diabetic education, antihypertensive treatment, aspirin use and a higher prevalence of vascular morbidity. In multivariable analyses, financial barriers to health care were independently associated with reduced odds of medical checkups (Odds Ratio [OR], 0.61; 95 % Confidence Intervals [CI], 0.55–0.67), Hgb A1C measurement (OR, 0.85; 95 % CI, 0.77–0.94), cholesterol measurement (OR, 0.76; 95 % CI, 0.67–0.86), eye (OR, 0.85; 95 % CI, 0.79–0.92) and foot (OR, 0.92; 95 % CI, 0.84–1.00) examinations, diabetic education (OR, 0.93; 95 % CI, 0.87–0.99), aspirin use (OR, 0.88; 95 % CI, 0.81–0.96) and increased odds of vascular morbidity (OR, 1.23; 95 % CI, 1.14–1.33). In diabetic adults with CHD, financial barriers to health care were associated with impaired access to medical care, inferior quality of care and greater vascular morbidity. Eliminating financial barriers and adherence to guideline-based recommendations may improve the health of individuals with multiple chronic diseases.

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

PubMed

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

2017-04-01

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

Strategies for Implementing and Sustaining Therapeutic Lifestyle Changes as Part of Hypertension Management in African Americans

PubMed Central

Scisney-Matlock, Margaret; Bosworth, Hayden B.; Giger, Joyce Newman; Strickland, Ora L.; Van Harrison, R.; Coverson, Dorothy; Shah, Nirav R.; Dennison, Cheryl R.; Dunbar-Jacob, Jacqueline M.; Jones, Loretta; Ogedegbe, Gbenga; Batts-Turner, Marian L.; Jamerson, Kenneth A.

2009-01-01

African Americans with high blood pressure (BP) can benefit greatly from therapeutic lifestyle changes (TLC) such as diet modification, physical activity, and weight management. However, they and their health care providers face many barriers in modifying health behaviors. A multidisciplinary panel synthesized the scientific data on TLC in African Americans for efficacy in improving BP control, barriers to behavioral change, and strategies to overcome those barriers. Therapeutic lifestyle change interventions should emphasize patient self-management, supported by providers, family, and the community. Interventions should be tailored to an individual’s cultural heritage, beliefs, and behavioral norms. Simultaneously targeting multiple factors that impede BP control will maximize the likelihood of success. The panel cited limited progress with integrating the Dietary Approaches to Stop Hypertension (DASH) eating plan into the African American diet as an example of the need for more strategically developed interventions. Culturally sensitive instruments to assess impact will help guide improved provision of TLC in special populations. The challenge of improving BP control in African Americans and delivery of hypertension care requires changes at the health system and public policy levels. At the patient level, culturally sensitive interventions that apply the strategies described and optimize community involvement will advance TLC in African Americans with high BP. PMID:19491553

Slip maxima at fault junctions and rupturing of barriers during the 2008 Wenchuan earthquake

USGS Publications Warehouse

Shen, Z.-K.; Sun, Jielun; Zhang, P.; Wan, Y.; Wang, M.; Burgmann, R.; Zeng, Y.; Gan, Weijun; Liao, H.; Wang, Q.

2009-01-01

The disastrous 12 May 2008 Wenchuan earthquake in China took the local population as well as scientists by surprise. Although the Longmen Shan fault zonewhich includes the fault segments along which this earthquake nucleatedwas well known, geologic and geodetic data indicate relatively low (<3 mm yr -1) deformation rates. Here we invert Global Positioning System and Interferometric Synthetic Aperture Radar data to infer fault geometry and slip distribution associated with the earthquake. Our analysis shows that the geometry of the fault changes along its length: in the southwest, the fault plane dips moderately to the northwest but becomes nearly vertical in the northeast. Associated with this is a change in the motion along the fault from predominantly thrusting to strike-slip. Peak slip along the fault occurs at the intersections of fault segments located near the towns of Yingxiu, Beichuan and Nanba, where fatalities and damage were concentrated. We suggest that these locations represent barriers that failed in a single event, enabling the rupture to cascade through several fault segments and cause a major moment magnitude (Mw) 7.9 earthquake. Using coseismic slip distribution and geodetic and geological slip rates, we estimate that the failure of barriers and rupture along multiple segments takes place approximately once in 4,000 years. ?? 2009 Macmillan Publishers Limited. All rights reserved.

Delivery of cancer therapeutics to extracellular and intracellular targets: Determinants, barriers, challenges and opportunities.

PubMed

Au, Jessie L-S; Yeung, Bertrand Z; Wientjes, Michael G; Lu, Ze; Wientjes, M Guillaume

2016-02-01

Advances in molecular medicine have led to identification of worthy cellular and molecular targets located in extracellular and intracellular compartments. Effectiveness of cancer therapeutics is limited in part by inadequate delivery and transport in tumor interstitium. Parts I and II of this report give an overview on the kinetic processes in delivering therapeutics to their intended targets, the transport barriers in tumor microenvironment and extracellular matrix (TME/ECM), and the experimental approaches to overcome such barriers. Part III discusses new concepts and findings concerning nanoparticle-biocorona complex, including the effects of TME/ECM. Part IV outlines the challenges in animal-to-human translation of cancer nanotherapeutics. Part V provides an overview of the background, current status, and the roles of TME/ECM in immune checkpoint inhibition therapy, the newest cancer treatment modality. Part VI outlines the development and use of multiscale computational modeling to capture the unavoidable tumor heterogeneities, the multiple nonlinear kinetic processes including interstitial and transvascular transport and interactions between cancer therapeutics and TME/ECM, in order to predict the in vivo tumor spatiokinetics of a therapeutic based on experimental in vitro biointerfacial interaction data. Part VII provides perspectives on translational research using quantitative systems pharmacology approaches. Copyright © 2015 Elsevier B.V. All rights reserved.

Preliminary Test Results of Heshe Hydrogeological Experimental Well Station in Taiwan

NASA Astrophysics Data System (ADS)

Chuang, P.; Liu, C.; Lin, M.; Chan, W.; Lee, T.; Chia, Y.; Teng, M.; Liu, C.

2013-12-01

Safe disposal of radioactive waste is a critical issue for the development of nuclear energy. The design of final disposal system is based on the concept of multiple barriers which integrate the natural barriers and engineering barriers for long-term isolation of radioactive wastes. As groundwater is the major medium that can transport radionuclides to our living environment, it is essential to characterize groundwater flow at the disposal site. Taiwan is located at the boundary between the Eurasian plate and the Philippine Sea plate. Geologic formations are often fractured due to tectonic compression and extension. In this study, a well station for the research and development of hydrogeological techniques was established at the Experimental Forest of the National Taiwan University in central Taiwan. There are 10 testing wells, ranging in depth from 25 m to 100 m, at the station. The bedrock beneath the regolith is highly fractured mudstone. As fracture is the preferential pathway of the groundwater flow, the focus of in-situ tests is to investigate the location of permeable fractures and the connection of permeable fractures. Several field tests have been conducted, including geophysical logging, heat-pulse flowmeter, hydraulic test, tracer test and double packer test, for the development of advanced technologies to detect the preferential groundwater flow in fractured rocks.

Nanoscale drug delivery systems and the blood-brain barrier.

PubMed

Alyautdin, Renad; Khalin, Igor; Nafeeza, Mohd Ismail; Haron, Muhammad Huzaimi; Kuznetsov, Dmitry

2014-01-01

The protective properties of the blood-brain barrier (BBB) are conferred by the intricate architecture of its endothelium coupled with multiple specific transport systems expressed on the surface of endothelial cells (ECs) in the brain's vasculature. When the stringent control of the BBB is disrupted, such as following EC damage, substances that are safe for peripheral tissues but toxic to neurons have easier access to the central nervous system (CNS). As a consequence, CNS disorders, including degenerative diseases, can occur independently of an individual's age. Although the BBB is crucial in regulating the biochemical environment that is essential for maintaining neuronal integrity, it limits drug delivery to the CNS. This makes it difficult to deliver beneficial drugs across the BBB while preventing the passage of potential neurotoxins. Available options include transport of drugs across the ECs through traversing occludins and claudins in the tight junctions or by attaching drugs to one of the existing transport systems. Either way, access must specifically allow only the passage of a particular drug. In general, the BBB allows small molecules to enter the CNS; however, most drugs with the potential to treat neurological disorders other than infections have large structures. Several mechanisms, such as modifications of the built-in pumping-out system of drugs and utilization of nanocarriers and liposomes, are among the drug-delivery systems that have been tested; however, each has its limitations and constraints. This review comprehensively discusses the functional morphology of the BBB and the challenges that must be overcome by drug-delivery systems and elaborates on the potential targets, mechanisms, and formulations to improve drug delivery to the CNS.

Corrosion resistant thermal barrier coating. [protecting gas turbines and other engine parts

NASA Technical Reports Server (NTRS)

Levine, S. R.; Miller, R. A.; Hodge, P. E. (Inventor)

1981-01-01

A thermal barrier coating system for protecting metal surfaces at high temperature in normally corrosive environments is described. The thermal barrier coating system includes a metal alloy bond coating, the alloy containing nickel, cobalt, iron, or a combination of these metals. The system further includes a corrosion resistant thermal barrier oxide coating containing at least one alkaline earth silicate. The preferred oxides are calcium silicate, barium silicate, magnesium silicate, or combinations of these silicates.

The Development of 2700-3000 F Environmental Barrier Coatings for SiC/SiC Ceramic Matrix Composites: Challenges and Opportunities

NASA Technical Reports Server (NTRS)

Zhu, Dongming

2015-01-01

Environmental barrier coatings (EBCs) and SiCSiC ceramic matrix composites (CMCs) systems will play a crucial role in future turbine engines for hot-section component applications because of their ability to significantly increase engine operating temperatures, reduce engine weight and cooling requirements. The development of prime-reliant environmental barrier coatings is a key to enable the applications of the envisioned 2700-3000F EBC - CMC systems to help achieve next generation engine performance and durability goals. This paper will primarily address the performance requirements and design considerations of environmental barrier coatings for turbine engine applications. The emphasis is placed on current NASA candidate environmental barrier coating systems for SiCSiC CMCs, their performance benefits and design limitations in long-term operation and combustion environments. The efforts have been also directed to developing prime-reliant, self-healing 2700F EBC bond coat; and high stability, lower thermal conductivity, and durable EBC top coats. Major technical barriers in developing environmental barrier coating systems, the coating integrations with next generation CMCs having the improved environmental stability, cyclic durability, erosion-impact resistance, and long-term system performance will be described. The research and development opportunities for turbine engine environmental barrier coating systems by utilizing improved compositions, state-of-the-art processing methods, and simulated environment testing and durability modeling will be discussed.

Resilient Actions in the Diagnostic Process and System Performance

PubMed Central

Smith, Michael W.; Giardina, Traber Davis; Murphy, Daniel R.; Laxmisan, Archana; Singh, Hardeep

2013-01-01

Objectives Systemic issues can adversely affect the diagnostic process. Many system-related barriers can be masked by ‘resilient’ actions of frontline providers (ie, actions supporting the safe delivery of care in the presence of pressures that the system cannot readily adapt to). We explored system barriers and resilient actions of primary care providers (PCPs) in the diagnostic evaluation of cancer. Methods We conducted a secondary data analysis of interviews of PCPs involved in diagnostic evaluation of 29 lung and colorectal cancer cases. Cases covered a range of diagnostic timeliness and were analyzed to identify barriers for rapid diagnostic evaluation, and PCPs’ actions involving elements of resilience addressing those barriers. We rated these actions according to whether they were usual or extraordinary for typical PCP work. Results Resilient actions and associated barriers were found in 59% of the cases, in all ranges of timeliness, with 40% involving actions rated as beyond typical. Most of the barriers were related to access to specialty services and coordination with patients. Many of the resilient actions involved using additional communication channels to solicit cooperation from other participants in the diagnostic process. Discussion Diagnostic evaluation of cancer involves several resilient actions by PCPs targeted at system deficiencies. PCPs’ actions can sometimes mitigate system barriers to diagnosis, and thereby impact the sensitivity of ‘downstream’ measures (eg, delays) in detecting barriers. While resilient actions might enable providers to mitigate system deficiencies in the short run, they can be resource intensive and potentially unsustainable. They complement, rather than substitute for, structural remedies to improve system performance. Measures to detect and fix system performance issues targeted by these resilient actions could facilitate diagnostic safety. PMID:23813210

Microcystic macular oedema in multiple sclerosis is associated with disease severity

PubMed Central

Gelfand, Jeffrey M.; Nolan, Rachel; Schwartz, Daniel M.; Graves, Jennifer

2012-01-01

Macular oedema typically results from blood–retinal barrier disruption. It has recently been reported that patients with multiple sclerosis treated with FTY-720 (fingolimod) may exhibit macular oedema. Multiple sclerosis is not otherwise thought to be associated with macular oedema except in the context of comorbid clinical uveitis. Despite a lack of myelin, the retina is a site of inflammation and microglial activation in multiple sclerosis and demonstrates significant neuronal and axonal loss. We unexpectedly observed microcystic macular oedema using spectral domain optical coherence tomography in patients with multiple sclerosis who did not have another reason for macular oedema. We therefore evaluated spectral domain optical coherence tomography images in consecutive patients with multiple sclerosis for microcystic macular oedema and examined correlations between macular oedema and visual and ambulatory disability in a cross-sectional analysis. Participants were excluded if there was a comorbidity that could account for the presence of macular oedema, such as uveitis, diabetes or other retinal disease. A microcystic pattern of macular oedema was observed on optical coherence tomography in 15 of 318 (4.7%) patients with multiple sclerosis. No macular oedema was identified in 52 healthy controls assessed over the same period. The microcystic oedema predominantly involved the inner nuclear layer of the retina and tended to occur in small, discrete patches. Patients with multiple sclerosis with microcystic macular oedema had significantly worse disability [median Expanded Disability Score Scale 4 (interquartile range 3–6)] than patients without macular oedema [median Expanded Disability Score Scale 2 (interquartile range 1.5–3.5)], P = 0.0002. Patients with multiple sclerosis with microcystic macular oedema also had higher Multiple Sclerosis Severity Scores, a measure of disease progression, than those without oedema [median of 6.47 (interquartile range 4.96–7.98) versus 3.65 (interquartile range 1.92–5.87), P = 0.0009]. Microcystic macular oedema occurred more commonly in eyes with prior optic neuritis than eyes without prior optic neuritis (50 versus 27%) and was associated with lower visual acuity (median logMAR acuity of 0.17 versus −0.1) and a thinner retinal nerve fibre layer. The presence of microcystic macular oedema in multiple sclerosis suggests that there may be breakdown of the blood–retinal barrier and tight junction integrity in a part of the nervous system that lacks myelin. Microcystic macular oedema may also contribute to visual dysfunction beyond that explained by nerve fibre layer loss. Microcystic changes need to be assessed, and potentially adjusted for, in clinical trials that evaluate macular volume as a marker of retinal ganglion cell survival. These findings also have implications for clinical monitoring in patients with multiple sclerosis on sphingosine 1-phosphate receptor modulating agents. PMID:22539259

Pain medication management processes used by oncology outpatients and family caregivers part I: health systems contexts.

PubMed

Schumacher, Karen L; Plano Clark, Vicki L; West, Claudia M; Dodd, Marylin J; Rabow, Michael W; Miaskowski, Christine

2014-11-01

Oncology patients with persistent pain treated in outpatient settings and their family caregivers have significant responsibility for managing pain medications. However, little is known about their practical day-to-day experiences with pain medication management. The aim was to describe day-to-day pain medication management from the perspectives of oncology outpatients and their family caregivers who participated in a randomized clinical trial of a psychoeducational intervention called the Pro-Self(©) Plus Pain Control Program. In this article, we focus on pain medication management by patients and family caregivers in the context of multiple complex health systems. We qualitatively analyzed audio-recorded intervention sessions that included extensive dialogue between patients, family caregivers, and nurses about pain medication management during the 10-week intervention. The health systems context for pain medication management included multiple complex systems for clinical care, reimbursement, and regulation of analgesic prescriptions. Pain medication management processes particularly relevant to this context were getting prescriptions and obtaining medications. Responsibilities that fell primarily to patients and family caregivers included facilitating communication and coordination among multiple clinicians, overcoming barriers to access, and serving as a final safety checkpoint. Significant effort was required of patients and family caregivers to insure safe and effective pain medication management. Health systems issues related to access to needed analgesics, medication safety in outpatient settings, and the effort expended by oncology patients and their family caregivers require more attention in future research and health-care reform initiatives. Copyright © 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

[The blood-brain barrier and drug delivery in the central nervous system].

PubMed

Loch-Neckel, Gecioni; Koepp, Janice

2010-08-01

To provide an updated view of the difficulties due to barriers and strategies used to allow the release of drugs in the central nervous system. The difficulty for the treatment of many diseases of the central nervous system, through the use of intra-venous drugs, is due to the presence of barriers that prevent the release of the same: the blood-brain barrier, blood-cerebro-spinal fluid barrier and the blood-arachnoid barrier. The blood-brain barrier is the main barrier for the transport of drugs in the brain that also acts as a immunologic and metabolic barrier. The endothelial cells of the blood-brain barrier are connected to a junction complex through the interaction of transmembrane proteins that protrude from de inside to the outside, forming a connection between the endothelial cells. The transport of substances to the brain depends on the mechanisms of transport present in the barrier and the diffusion of these compounds also depends on the physicochemical characteristics of the molecule. Some diseases alter the permeability of the blood-brain barrier and thus the passage of drugs. Strategies such as the use of methods for drug delivery in the brain have been investigated. Further details regarding the mechanisms of transport across the blood-brain barrier and the changes in neuropathology would provide important information about the etiology of diseases and lead to better therapeutic strategies.

Adoption Factors of the Electronic Health Record: A Systematic Review

PubMed Central

2016-01-01

Background The Health Information Technology for Economic and Clinical Health (HITECH) was a significant piece of legislation in America that served as a catalyst for the adoption of health information technology. Following implementation of the HITECH Act, Health Information Technology (HIT) experienced broad adoption of Electronic Health Records (EHR), despite skepticism exhibited by many providers for the transition to an electronic system. A thorough review of EHR adoption facilitator and barriers provides ongoing support for the continuation of EHR implementation across various health care structures, possibly leading to a reduction in associated economic expenditures. Objective The purpose of this review is to compile a current and comprehensive list of facilitators and barriers to the adoption of the EHR in the United States. Methods Authors searched Cumulative Index of Nursing and Allied Health Literature (CINAHL) and MEDLINE, 01/01/2012–09/01/2015, core clinical/academic journals, MEDLINE full text, and evaluated only articles germane to our research objective. Team members selected a final list of articles through consensus meetings (n=31). Multiple research team members thoroughly read each article to confirm applicability and study conclusions, thereby increasing validity. Results Group members identified common facilitators and barriers associated with the EHR adoption process. In total, 25 adoption facilitators were identified in the literature occurring 109 times; the majority of which were efficiency, hospital size, quality, access to data, perceived value, and ability to transfer information. A total of 23 barriers to adoption were identified in the literature, appearing 95 times; the majority of which were cost, time consuming, perception of uselessness, transition of data, facility location, and implementation issues. Conclusions The 25 facilitators and 23 barriers to the adoption of the EHR continue to reveal a preoccupation on cost, despite incentives in the HITECH Act. Limited financial backing and outdated technology were also common barriers frequently mentioned during data review. Future public policy should include incentives commensurate with those in the HITECH Act to maintain strong adoption rates. PMID:27251559

Relationships, Being-ness, and Voice: Exploring Multiple Dimensions of Humanizing Work with Black Girls

ERIC Educational Resources Information Center

Edwards, Erica; McArthur, Sherell A.; Russell-Owens, LaToya

2016-01-01

This work argues for an approach to research and education practices that considers the historically deficit-based research practices and views on Black girls and develops humanizing research methods that consider the multiple oppressions that act as barriers for this group. Research must acknowledge the precarious position of Black girls in order…

Epstein Barr Virus and Blood Brain Barrier in Multiple Sclerosis

DTIC Science & Technology

2014-01-01

ABSTRACT Multiple sclerosis (MS) is a chronic, autoimmune neurodegenerative disease . Epstein - Barr virus (EBV) infection is associated with MS...factors such as Epstein - Barr virus (EBV) infections. EBV is a herpesvirus that infects many cell types and associated with other autoimmune diseases . The...AD_________________ Award Number: W81XWH-12-1-0225 TITLE: Epstein Barr virus and

Barriers to sustainable tuberculosis control in the Russian Federation health system.

PubMed Central

Atun, R. A.; Samyshkin, Y. A.; Drobniewski, F.; Skuratova, N. M.; Gusarova, G.; Kuznetsov, S. I.; Fedorin, I. M.; Coker, R. J.

2005-01-01

The Russian Federation has the eleventh highest tuberculosis burden in the world in terms of the total estimated number of new cases that occur each year. In 2003, 26% of the population was covered by the internationally recommended control strategy known as directly observed treatment (DOT) compared to an overall average of 61% among the 22 countries with the highest burden of tuberculosis. The Director-General of WHO has identified two necessary starting points for the scaling-up of interventions to control emerging infectious diseases. These are a comprehensive engagement with the health system and a strengthening of the health system. The success of programmes aimed at controlling infectious diseases is often determined by constraints posed by the health system. We analyse and evaluate the impact of the arrangements for delivering tuberculosis services in the Russian Federation, drawing on detailed analyses of barriers and incentives created by the organizational structures, and financing and provider-payment systems. We demonstrate that the systems offer few incentives to improve the efficiency of services or the effectiveness of tuberculosis control. Instead, the system encourages prolonged supervision through specialized outpatient departments in hospitals (known as dispensaries), multiple admissions to hospital and lengthy hospitalization. The implementation, and expansion and sustainability of WHO-approved methods of tuberculosis control in the Russian Federation are unlikely to be realized under the prevailing system of service delivery. This is because implementation does not take into account the wider context of the health system. In order for the control programme to be sustainable, the health system will need to be changed to enable services to be reconfigured so that incentives are created to reward improvements in efficiency and outcomes. PMID:15798846

An Integrative Review of Factors Associated with Patient Attrition from Community Health Worker Programs that Support Diabetes Self-Care.

PubMed

Merius, Heidy N; Rohan, Annie J

2017-01-01

An integrative review was conducted using PubMed and CINAHL databases to answer: What is known about adult attrition from community health worker (CHW) programs on diabetes self-care? The 14 articles described patients of multiple races who were mainly of lower socioeconomic status. CHW interventions were given in individual meetings and/or group sessions. Incentives to reduce attrition came in different forms. Barriers involved transportation, family obligations, and scheduling conflicts. Attrition from these programs is a multifactorial problem. Alleviating transportation barrier appears to be protective. Program planners should consider these barriers when planning CHW programs.

Design and demonstration of a pumpless 14 compartment microphysiological system.

PubMed

Miller, Paula G; Shuler, Michael L

2016-10-01

We describe a human "Body-on-a-chip" device (or microphysiological system) that could be used to emulate drug distribution, metabolism, and action in the body. It is based upon a physiologically based pharmacokinetic-pharmacodynamic (PBPK-PD) model, where multiple chambers representing different organs are connected with fluidic channels to mimic multi-organ interactions within the body. Here we describe a pumpless 14 chamber (13 organs) microfluidic cell culture device that provides a separation between barrier and nonbarrier types of cell cultures. Our barrier chamber layer (skin, GI tract, and lung) allows for direct access and/or exposures to chemical or biological reagents forcing these reagents to pass through a barrier of cells established on a microfabricated membrane before exposing the nonbarrier tissue chambers (fat, kidney, heart, adrenal glands, liver, spleen, pancreas, bone marrow, brain, muscle) or entering the microfluidic circulation within the device. Our nonbarrier tissue chambers were created as three-dimensional configurations by resuspending cells in hydrogel (PGMatrix). We used cell lines to represent five of these organs (barrier lines-A549 [lung] and Caco2 [GI]) (nonbarrier lines-HepG2 C3A [liver], Meg01 [bone marrow], and HK2 [kidney]). The dimensions of our straight duct-like channels to each organ chamber were designed to provide the appropriate flow of a culture medium. The organ volumes and organ flow rates that have been reported for an average human male were used to estimate the desired fluid retention times in each organ chamber. The flow through the channels was induced by gravity on a custom programmed rocker platform which enabled pumpless operation and minimized bubble entrapment. The purpose of this paper is to describe the design and operation of a 14 chamber multi-organ system representing 13 tissues/organs with both barrier and nonbarrier tissue chambers and to study the interactive responses among the various cell lines. We demonstrate that five different cell lines survived with high viability (above 85%) for 7 days. We compared the individual observed flow rates to the compartments to the desired or estimated flow rates. This work demonstrates the feasibility of constructing, operating and maintaining a simple, gravity-driven, multi-organ microphysiological system with the capability of measuring cellular functions such as CYP1A1 and CYP3A4 activities, albumin release, urea, maintenance of tight junctions, and presence of surfactant for a sustained period. Biotechnol. Bioeng. 2016;113: 2213-2227. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Effect Of N = 40 Shell Closure On Barrier Distributions In 18O+58,60Ni Reactions

NASA Astrophysics Data System (ADS)

Danu, L. S.; Nayak, B. K.; Saxena, A.; Biswas, D. C.; John, B. V.; Thomas, R. G.; Gupta, Y. K.; Choudhury, R. K.

2009-03-01

The quasi-elastic scattering measurements for 18O+58,62Ni systems have been carried out at Θlab = 150° around Coulomb barrier energies to investigate the effect of nuclear shell closure on the barrier distributions. The 18O+58Ni system leads to N = 40 neutron shell closure and 18O+62Ni system is having N = 44 in the compound system. It is observed that target 2+ and 3-, projectile 2+ inelastic and 2n-transfer couplings are required in coupled-channels fusion model (CCFULL) calculations to get good comparison with the experimental barrier distribution of 18O+62Ni system, whereas projectile 2+ inelastic state coupling is not required for 18O+58Ni system. However, the low energy structure observed in the barrier distribution of 18O+58Ni system is not reproduced by coupled-channels calculations. This suggests, a possible additional effect due to N = 40 shell closure in the compound system not accounted for in coupled-channels calculations.

Pentacle gold-copper alloy nanocrystals: a new system for entering male germ cells in vitro and in vivo

NASA Astrophysics Data System (ADS)

Lin, Yu; He, Rong; Sun, Liping; Yang, Yushan; Li, Wenqing; Sun, Fei

2016-12-01

Gold-based nanocrystals have attracted considerable attention for drug delivery and biological applications due to their distinct shapes. However, overcoming biological barriers is a hard and inevitable problem, which restricts medical applications of nanomaterials in vivo. Seeking for an efficient transportation to penetrate biological barriers is a common need. There are three barriers: blood-testis barrier, blood-placenta barrier, and blood-brain barrier. Here, we pay close attention to the blood-testis barrier. We found that the pentacle gold-copper alloy nanocrystals not only could enter GC-2 cells in vitro in a short time, but also could overcome the blood-testis barrier and enter male germ cells in vivo. Furthermore, we demonstrated that the entrance efficiency would become much higher in the development stages. The results also suggested that the pentacle gold-copper alloy nanocrystals could easier enter to germ cells in the pathological condition. This system could be a new method for theranostics in the reproductive system.

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

NASA Astrophysics Data System (ADS)

Herbert, Roger

2010-05-01

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

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

NASA Technical Reports Server (NTRS)

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

1994-01-01

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

Solid-phase based on-chip DNA purification through a valve-free stepwise injection of multiple reagents employing centrifugal force combined with a hydrophobic capillary barrier pressure.

PubMed

Zhang, Hainan; Tran, Hong Hanh; Chung, Bong Hyun; Lee, Nae Yoon

2013-03-21

In this paper, we demonstrate a simple technique for sequentially introducing multiple sample liquids into microchannels driven by centrifugal force combined with a hydrophobic barrier pressure and apply the technique for performing solid-phase based on-chip DNA purification. Three microchannels with varying widths, all equipped with independent sample reservoirs at the inlets, were fabricated on a hydrophobic elastomer, poly(dimethylsiloxane) (PDMS). First, glass beads were packed inside the reaction chamber, and a whole cell containing the DNA extract was introduced into the widest channel by applying centrifugal force for physical adsorption of the DNA onto the glass beads. Next, washing and elution solutions were sequentially introduced into the intermediate and narrowest microchannels, respectively, by gradually increasing the amount of centrifugal force. Through a precise manipulation of the centrifugal force, the DNA adsorbed onto the glass beads was successfully washed and eluted in a continuous manner without the need to introduce each solution manually. A stepwise injection of liquids was successfully demonstrated using multiple ink solutions, the results of which corresponded well with the theoretical analyses. As a practical application, the D1S80 locus of human genomic DNA, which is widely used for forensic purposes, was successfully purified using the microdevice introduced in this study, as demonstrated through successful target amplification. This will pave the way for the construction of a control-free valve system for realizing on-chip DNA purification, which is one of the most labor-intensive and hard-to-miniaturize components, on a greatly simplified and miniaturized platform employing hydrophobic PDMS.

Transition From Clinical to Educator Roles in Nursing: An Integrative Review.

PubMed

Fritz, Elizabeth

This review identified barriers to and facilitators of nurses' transition from clinical positions into nursing professional development and other nurse educator roles. The author conducted literature searches using multiple databases. Twenty-one articles met search criteria, representing a variety of practice settings. The findings, both barriers and facilitators, were remarkably consistent across practice settings. Four practice recommendations were drawn from the literature to promote nurses' successful transition to nursing professional development roles.

How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX.

PubMed

Boulos, Maged N Kamel; Wheeler, Steve; Tavares, Carlos; Jones, Ray

2011-04-05

The latest generation of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development. This paper provides a brief state-of-the-art overview of health and healthcare smartphone apps (applications) on the market today, including emerging trends and market uptake. Platforms available today include Android, Apple iOS, RIM BlackBerry, Symbian, and Windows (Windows Mobile 6.x and the emerging Windows Phone 7 platform). The paper covers apps targeting both laypersons/patients and healthcare professionals in various scenarios, e.g., health, fitness and lifestyle education and management apps; ambient assisted living apps; continuing professional education tools; and apps for public health surveillance. Among the surveyed apps are those assisting in chronic disease management, whether as standalone apps or part of a BAN (Body Area Network) and remote server configuration. We describe in detail the development of a smartphone app within eCAALYX (Enhanced Complete Ambient Assisted Living Experiment, 2009-2012), an EU-funded project for older people with multiple chronic conditions. The eCAALYX Android smartphone app receives input from a BAN (a patient-wearable smart garment with wireless health sensors) and the GPS (Global Positioning System) location sensor in the smartphone, and communicates over the Internet with a remote server accessible by healthcare professionals who are in charge of the remote monitoring and management of the older patient with multiple chronic conditions. Finally, we briefly discuss barriers to adoption of health and healthcare smartphone apps (e.g., cost, network bandwidth and battery power efficiency, usability, privacy issues, etc.), as well as some workarounds to mitigate those barriers.

Health care access and support for disabled women in Canada: falling short of the UN Convention on the Rights of Persons with Disabilities: a qualitative study.

PubMed

Gibson, Barbara E; Mykitiuk, Roxanne

2012-01-01

The United Nations Convention on the Rights of Persons with Disabilities and other international human rights conventions guarantee the fundamental human rights to physical, social, and psychological health. The purpose of this study was to examine whether these rights are being upheld in Canada for disabled women. An interpretive, qualitative, focus group design was employed. Participants were women 18 to 67 years of age with a self-identified physical, sensory, cognitive, and/or psychiatric impairment. Eleven focus groups were conducted with 74 disabled women from urban and rural settings in Northern Ontario, Manitoba, and Nova Scotia. The data were analyzed for themes using a flexible coding system derived from and consistent with the research objectives and the study's human rights framework. Participants described multiple intersecting factors that impeded or facilitated access to health care. Services included both generic health services and impairment-specific services. Participants experienced a number of barriers accessing professionals, support programs, and services. These are described under three broad themes: 1) Labyrinthine health service 'systems,' 2) assumptions, attitudes, and discriminatory practices, and 3) inadequate sexual health or reproductive services and supports. The results suggest that Canada falls significantly short of guaranteeing disabled women's human rights to access health care supports and services. Access barriers resulted from the inefficiencies and complexities of the multiple agencies and programs that disabled women had to navigate, difficulties accessing information on available services, and negative attitudes of some health and social service providers. Copyright © 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX

PubMed Central

2011-01-01

The latest generation of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development. This paper provides a brief state-of-the-art overview of health and healthcare smartphone apps (applications) on the market today, including emerging trends and market uptake. Platforms available today include Android, Apple iOS, RIM BlackBerry, Symbian, and Windows (Windows Mobile 6.x and the emerging Windows Phone 7 platform). The paper covers apps targeting both laypersons/patients and healthcare professionals in various scenarios, e.g., health, fitness and lifestyle education and management apps; ambient assisted living apps; continuing professional education tools; and apps for public health surveillance. Among the surveyed apps are those assisting in chronic disease management, whether as standalone apps or part of a BAN (Body Area Network) and remote server configuration. We describe in detail the development of a smartphone app within eCAALYX (Enhanced Complete Ambient Assisted Living Experiment, 2009-2012), an EU-funded project for older people with multiple chronic conditions. The eCAALYX Android smartphone app receives input from a BAN (a patient-wearable smart garment with wireless health sensors) and the GPS (Global Positioning System) location sensor in the smartphone, and communicates over the Internet with a remote server accessible by healthcare professionals who are in charge of the remote monitoring and management of the older patient with multiple chronic conditions. Finally, we briefly discuss barriers to adoption of health and healthcare smartphone apps (e.g., cost, network bandwidth and battery power efficiency, usability, privacy issues, etc.), as well as some workarounds to mitigate those barriers. PMID:21466669

Performance Evaluation and Modeling of Erosion Resistant Turbine Engine Thermal Barrier Coatings

NASA Technical Reports Server (NTRS)

Miller, Robert A.; Zhu, Dongming; Kuczmarski, Maria

2008-01-01

The erosion resistant turbine thermal barrier coating system is critical to the rotorcraft engine performance and durability. The objective of this work was to determine erosion resistance of advanced thermal barrier coating systems under simulated engine erosion and thermal gradient environments, thus validating a new thermal barrier coating turbine blade technology for future rotorcraft applications. A high velocity burner rig based erosion test approach was established and a new series of rare earth oxide- and TiO2/Ta2O5- alloyed, ZrO2-based low conductivity thermal barrier coatings were designed and processed. The low conductivity thermal barrier coating systems demonstrated significant improvements in the erosion resistance. A comprehensive model based on accumulated strain damage low cycle fatigue is formulated for blade erosion life prediction. The work is currently aiming at the simulated engine erosion testing of advanced thermal barrier coated turbine blades to establish and validate the coating life prediction models.

Photovoltaic driven multiple quantum well optical modulator

NASA Technical Reports Server (NTRS)

Maserjian, Joseph (Inventor)

1990-01-01

Multiple quantum well (MQW) structures (12) are utilized to provide real-time, reliable, high-performance, optically-addressed spatial-light modulators (SLM) (10). The optically-addressed SLM comprises a vertical stack of quantum well layers (12a) within the penetration depth of an optical write signal 18, a plurality of space charge barriers (12b) having predetermined tunneling times by control of doping and thickness. The material comprising the quantum well layers has a lower bandgap than that of the space charge barrier layers. The write signal modulates a read signal (20). The modulation sensitivity of the device is high and no external voltage source is required. In a preferred embodiment, the SLM having interleaved doped semiconductor layers for driving the MQW photovoltaically is characterized by the use of a shift analogous to the Moss-Burnstein shift caused by the filling of two-dimensional states in the multiple quantum wells, thus allowing high modulation sensitivity in very narrow wells. Arrays (30) may be formed with a plurality of the modulators.

Metallic seal for thermal barrier coating systems

NASA Technical Reports Server (NTRS)

Miller, Robert A. (Inventor)

1990-01-01

The invention is particularly concerned with sealing thermal barrier coating systems of the type in use and being contemplated for use in diesel and other internal combustion engines. The invention also would find application in moderately high temperature regions of gas turbine engines and any other application employing a thermal barrier coating at moderate temperatures. Ni-35Cr-6Al-1Y, Ni-35Cr-6Al-1Yb, or other metallic alloy denoted as MCrAlx is applied over a zirconia-based thermal barrier overlayer. The close-out layer is glass-bead preened to densify its surface. This seals and protects the thermal barrier coating system.

Multiple capillary biochemical analyzer with barrier member

DOEpatents

Dovichi, N.J.; Zhang, J.Z.

1996-10-22

A multiple capillary biochemical analyzer is disclosed for sequencing DNA and performing other analyses, in which a set of capillaries extends from wells in a microtiter plate into a cuvette. In the cuvette the capillaries are held on fixed closely spaced centers by passing through a sandwich construction having a pair of metal shims which squeeze between them a rubber gasket, forming a leak proof seal for an interior chamber in which the capillary ends are positioned. Sheath fluid enters the chamber and entrains filament sample streams from the capillaries. The filament sample streams, and sheath fluid, flow through aligned holes in a barrier member spaced close to the capillary ends, into a collection chamber having a lower glass window. The filament streams are illuminated above the barrier member by a laser, causing them to fluoresce. The fluorescence is viewed end-on by a CCD camera chip located below the glass window. The arrangement ensures an equal optical path length from all fluorescing spots to the CCD chip and also blocks scattered fluorescence illumination, providing more uniform results and an improved signal-to-noise ratio. 12 figs.

Multiple capillary biochemical analyzer with barrier member

DOEpatents

Dovichi, Norman J.; Zhang, Jian Z.

1996-01-01

A multiple capillary biochemical analyzer for sequencing DNA and performing other analyses, in which a set of capillaries extends from wells in a microtiter plate into a cuvette. In the cuvette the capillaries are held on fixed closely spaced centers by passing through a sandwich construction having a pair of metal shims which squeeze between them a rubber gasket, forming a leak proof seal for an interior chamber in which the capillary ends are positioned. Sheath fluid enters the chamber and entrains filament sample streams from the capillaries. The filament sample streams, and sheath fluid, flow through aligned holes in a barrier member spaced close to the capillary ends, into a collection chamber having a lower glass window. The filament streams are illuminated above the barrier member by a laser, causing them to fluoresce. The fluorescence is viewed end-on by a CCD camera chip located below the glass window. The arrangement ensures an equal optical path length from all fluorescing spots to the CCD chip and also blocks scattered fluorescence illumination, providing more uniform results and an improved signal to noise ratio.

Reasons People Surrender Unowned and Owned Cats to Australian Animal Shelters and Barriers to Assuming Ownership of Unowned Cats.

PubMed

Zito, Sarah; Morton, John; Vankan, Dianne; Paterson, Mandy; Bennett, Pauleen C; Rand, Jacquie; Phillips, Clive J C

2016-01-01

Most cats surrendered to nonhuman animal shelters are identified as unowned, and the surrender reason for these cats is usually simply recorded as "stray." A cross-sectional study was conducted with people surrendering cats to 4 Australian animal shelters. Surrenderers of unowned cats commonly gave surrender reasons relating to concern for the cat and his/her welfare. Seventeen percent of noncaregivers had considered adopting the cat. Barriers to assuming ownership most commonly related to responsible ownership concerns. Unwanted kittens commonly contributed to the decision to surrender for both caregivers and noncaregivers. Nonowners gave more surrender reasons than owners, although many owners also gave multiple surrender reasons. These findings highlight the multifactorial nature of the decision-making process leading to surrender and demonstrate that recording only one reason for surrender does not capture the complexity of the surrender decision. Collecting information about multiple reasons for surrender, particularly reasons for surrender of unowned cats and barriers to assuming ownership, could help to develop strategies to reduce the number of cats surrendered.

Energy analysis of vehicle-to-cable barrier impacts.

DOT National Transportation Integrated Search

2013-06-01

An accident reconstruction technique was developed for estimating the energy absorbed during an impact with a cable barrier system as well as the initial impact velocity. The kinetic energy absorbed during a cable barrier system impact is comprised o...

Low temperature barriers with heat interceptor wells for in situ processes

DOEpatents

McKinzie, II, Billy John

2008-10-14

A system for reducing heat load applied to a frozen barrier by a heated formation is described. The system includes heat interceptor wells positioned between the heated formation and the frozen barrier. Fluid is positioned in the heat interceptor wells. Heat transfers from the formation to the fluid to reduce the heat load applied to the frozen barrier.

Terrestrial Micro Renewable Energy Applications of Space Technology

NASA Astrophysics Data System (ADS)

Komerath, N. M.; Komerath, P. P.

This paper explores the synergy between technologies intended for extraterrestrial in situ resource utilization and those for terrestrial mass-market micro renewable power generation systems. The case for a micro renewable energy architecture is presented. The obstacles hindering market success are summarized, along with opportunities from recent demonstrations suggesting that the public appetite for sophisticated technology worldwide may be underappreciated by technical researchers. Technical innovations from space research are summarized along with estimates of possible conversion efficiencies. It is argued that the cost-effectiveness of micro power generation must be viewed through the value of the first few watts of available power, rather than the marginal cost per kilowatt-hour of electric power from utility power grids. This leads to the finding that the actual target cost per unit power, and efficiency, are well within reach of space technology products. Hybrid systems integrating power extraction from multiple resources, and adaptable for multiple applications, can break through mass market price barriers. Recent work to develop learning resources and test beds as part of a Micro Renewable Energy Laboratory is summarized.

Advances in the Dynallax solid-state dynamic parallax barrier autostereoscopic visualization display system.

PubMed

Peterka, Tom; Kooima, Robert L; Sandin, Daniel J; Johnson, Andrew; Leigh, Jason; DeFanti, Thomas A

2008-01-01

A solid-state dynamic parallax barrier autostereoscopic display mitigates some of the restrictions present in static barrier systems, such as fixed view-distance range, slow response to head movements, and fixed stereo operating mode. By dynamically varying barrier parameters in real time, viewers may move closer to the display and move faster laterally than with a static barrier system, and the display can switch between 3D and 2D modes by disabling the barrier on a per-pixel basis. Moreover, Dynallax can output four independent eye channels when two viewers are present, and both head-tracked viewers receive an independent pair of left-eye and right-eye perspective views based on their position in 3D space. The display device is constructed by using a dual-stacked LCD monitor where a dynamic barrier is rendered on the front display and a modulated virtual environment composed of two or four channels is rendered on the rear display. Dynallax was recently demonstrated in a small-scale head-tracked prototype system. This paper summarizes the concepts presented earlier, extends the discussion of various topics, and presents recent improvements to the system.

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

PubMed Central

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

2014-01-01

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

``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.

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

PubMed

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

2016-01-01

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

Fusion and direct reactions around the barrier for the systems {sup 7,9}Be,{sup 7}Li+{sup 238}U

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

Raabe, R.; Angulo, C.; Charvet, J. L.

2006-10-15

We present new cross section data for the complete fusion of the weakly bound systems {sup 7,9}Be and {sup 7}Li on {sup 238}U at energies around the Coulomb barrier. In the same measurement, yields for direct processes and incomplete fusion are detected. For all systems, a suppression of the complete fusion cross section around and above the barrier is observed. At energies below the barrier, the fusion of the {sup 7}Be+{sup 238}U system shows no enhancement with respect to simple model predictions.

EFFECTS OF NUCLEAR INDUCED BREAKUP ON THE FUSION OF 6Li+12C AND 6He+12C SYSTEMS AROUND BARRIER ENERGIES

NASA Astrophysics Data System (ADS)

Duhan, Sukhvinder S.; Singh, Manjeet; Kharab, Rajesh

2012-06-01

We have studied the effects of nuclear induced breakup channel coupling on the fusion cross-section for 6Li+12C and 6He+12C systems in the near barrier energy regime using the dynamic polarization potential (DPP) approach. It has been found that there is enhancement in the fusion cross-section with respect to standard one-dimensional barrier penetration model in the below barrier energy regime while at energies above the barrier there is suppression of fusion cross-section with respect to simple barrier penetration model is observed. The agreement between data and predictions for 6Li+12C system improves significantly as a result of the inclusion of nuclear induced DPP.

Advanced Environmental Barrier Coating Development for SiC/SiC Ceramic Matrix Composites: NASA's Perspectives

NASA Technical Reports Server (NTRS)

Zhu, Dongming

2016-01-01

This presentation reviews NASA environmental barrier coating (EBC) system development programs and the coating materials evolutions for protecting the SiC/SiC Ceramic Matrix Composites in order to meet the next generation engine performance requirements. The presentation focuses on several generations of NASA EBC systems, EBC-CMC component system technologies for SiC/SiC ceramic matrix composite combustors and turbine airfoils, highlighting the temperature capability and durability improvements in simulated engine high heat flux, high pressure, high velocity, and with mechanical creep and fatigue loading conditions. The current EBC development emphasis is placed on advanced NASA 2700F candidate environmental barrier coating systems for SiC/SiC CMCs, their performance benefits and design limitations in long-term operation and combustion environments. Major technical barriers in developing environmental barrier coating systems, the coating integrations with next generation CMCs having the improved environmental stability, erosion-impact resistance, and long-term fatigue-environment system durability performance are described. The research and development opportunities for advanced turbine airfoil environmental barrier coating systems by utilizing improved compositions, state-of-the-art processing methods, and simulated environment testing and durability modeling are discussed.

Bridges or Barriers? Conceptualization of the Role of Multiple Identity Gateway Groups in Intergroup Relations.

PubMed

Levy, Aharon; Saguy, Tamar; Halperin, Eran; van Zomeren, Martijn

2017-01-01

The modern era of globalization has been accompanied by a massive growth in interconnections between groups, and has led to the sharing of multiple identities by individuals and groups. Following these developments, research has focused on the issue of multiple identities, and has shed important light on how individuals who hold these complex forms of identity feel and behave, and on the reactions they elicit from members of other groups. However, the potential of groups with such multiple identities (e.g., biracials, immigrants, etc.) to affect the intergroup relations between the groups that represent the respective sources of the different identities (e.g., Blacks and Whites, country of origin and country of residence, etc.) has not been examined to date. Accordingly, in this paper, we first systematically explore the potential of groups in which people identify with multiple social categories, or groups that are perceived as such by others, to play a role in intergroup dynamics. Next, we offer a theoretical framework outlining what functions groups of people with shared multiple identities may serve (as bridges or barriers ) by proposing how their presence may facilitate or deteriorate intergroup relations. Finally, we present recent empirical research examining how groups of people with shared multiple identities can act as gateways and bridge the cleft between two separate groups that represent the respective sources of their different identities, and discuss the theoretical and practical implications for the field of intergroup relations.

Bridges or Barriers? Conceptualization of the Role of Multiple Identity Gateway Groups in Intergroup Relations

PubMed Central

Levy, Aharon; Saguy, Tamar; Halperin, Eran; van Zomeren, Martijn

2017-01-01

The modern era of globalization has been accompanied by a massive growth in interconnections between groups, and has led to the sharing of multiple identities by individuals and groups. Following these developments, research has focused on the issue of multiple identities, and has shed important light on how individuals who hold these complex forms of identity feel and behave, and on the reactions they elicit from members of other groups. However, the potential of groups with such multiple identities (e.g., biracials, immigrants, etc.) to affect the intergroup relations between the groups that represent the respective sources of the different identities (e.g., Blacks and Whites, country of origin and country of residence, etc.) has not been examined to date. Accordingly, in this paper, we first systematically explore the potential of groups in which people identify with multiple social categories, or groups that are perceived as such by others, to play a role in intergroup dynamics. Next, we offer a theoretical framework outlining what functions groups of people with shared multiple identities may serve (as bridges or barriers) by proposing how their presence may facilitate or deteriorate intergroup relations. Finally, we present recent empirical research examining how groups of people with shared multiple identities can act as gateways and bridge the cleft between two separate groups that represent the respective sources of their different identities, and discuss the theoretical and practical implications for the field of intergroup relations. PMID:28706501

Interplay between inflammation, immune system and neuronal pathways: Effect on gastrointestinal motility

PubMed Central

De Winter, Benedicte Y; De Man, Joris G

2010-01-01

Sepsis is a systemic inflammatory response representing the leading cause of death in critically ill patients, mostly due to multiple organ failure. The gastrointestinal tract plays a pivotal role in the pathogenesis of sepsis-induced multiple organ failure through intestinal barrier dysfunction, bacterial translocation and ileus. In this review we address the role of the gastrointestinal tract, the mediators, cell types and transduction pathways involved, based on experimental data obtained from models of inflammation-induced ileus and (preliminary) clinical data. The complex interplay within the gastrointestinal wall between mast cells, residential macrophages and glial cells on the one hand, and neurons and smooth muscle cells on the other hand, involves intracellular signaling pathways, Toll-like receptors and a plethora of neuroactive substances such as nitric oxide, prostaglandins, cytokines, chemokines, growth factors, tryptases and hormones. Multidirectional signaling between the different components in the gastrointestinal wall, the spinal cord and central nervous system impacts inflammation and its consequences. We propose that novel therapeutic strategies should target inflammation on the one hand and gastrointestinal motility, gastrointestinal sensitivity and even pain signaling on the other hand, for instance by impeding afferent neuronal signaling, by activation of the vagal anti-inflammatory pathway or by the use of pharmacological agents such as ghrelin and ghrelin agonists or drugs interfering with the endocannabinoid system. PMID:21105185

Evaluation of the New York low-tension three-cable barrier on curved alignment.

DOT National Transportation Integrated Search

2013-02-01

Three full-scale crash tests were performed on the New York Department of Transportations (NYSDOTs) curved, lowtension, : three-cable barrier systems utilizing the MASH Test Level 3 safety performance criteria. The cable barrier system : for te...

The Malnutrition-Related Increase in Early Visceralization of Leishmania donovani Is Associated with a Reduced Number of Lymph Node Phagocytes and Altered Conduit System Flow

PubMed Central

Ibrahim, Marwa K.; Barnes, Jeffrey L.; Anstead, Gregory M.; Jimenez, Fabio; Travi, Bruno L.; Peniche, Alex G.; Osorio, E. Yaneth; Ahuja, Seema S.; Melby, Peter C.

2013-01-01

In a murine model of moderate childhood malnutrition we found that polynutrient deficiency led to a 4–5-fold increase in early visceralization of L. donovani (3 days post-infection) following cutaneous infection and a 16-fold decrease in lymph node barrier function (p<0.04 for all). To begin to understand the mechanistic basis for this malnutrition-related parasite dissemination we analyzed the cellularity, architecture, and function of the skin-draining lymph node. There was no difference in the localization of multiple cell populations in the lymph node of polynutrient deficient (PND) mice, but there was reduced cellularity with fewer CD11c+dendritic cells (DCs), fibroblastic reticular cells (FRCs), MOMA-2+ macrophages, and CD169+ subcapsular sinus macrophage (p<0.05 for all) compared to the well-nourished (WN) mice. The parasites were equally co-localized with DCs associated with the lymph node conduit network in the WN and PND mice, and were found in the high endothelial venule into which the conduits drain. When a fluorescent low molecular weight (10 kD) dextran was delivered in the skin, there was greater efflux of the marker from the lymph node conduit system to the spleens of PND mice (p<0.04), indicating that flow through the conduit system was altered. There was no evidence of disruption of the conduit or subcapsular sinus architecture, indicating that the movement of parasites into the subcortical conduit region was due to an active process and not from passive movement through a leaking barrier. These results indicate that the impaired capacity of the lymph node to act as a barrier to dissemination of L. donovani infection is associated with a reduced number of lymph node phagocytes, which most likely leads to reduced capture of parasites as they transit through the sinuses and conduit system. PMID:23967356

Primary care physicians, acupuncture and chiropractic clinicians, and chronic pain patients: a qualitative analysis of communication and care coordination patterns.

PubMed

Penney, Lauren S; Ritenbaugh, Cheryl; Elder, Charles; Schneider, Jennifer; Deyo, Richard A; DeBar, Lynn L

2016-01-25

A variety of people, with multiple perspectives, make up the system comprising chronic musculoskeletal pain (CMP) treatment. While there are frequently problems in communication and coordination of care within conventional health systems, more opportunities for communicative disruptions seem possible when providers use different explanatory models and are not within the same health management system. We sought to describe the communication system surrounding the management of chronic pain from the perspectives of allopathic providers, acupuncture and chiropractor (A/C) providers, and CMP patients. We collected qualitative data from CMP patients (n = 90) and primary care physicians (PCPs) (n = 25) in a managed care system, and community acupuncture and chiropractic care providers (n = 14) who received high levels of referrals from the system, in the context of a longitudinal study of CMP patients' experience. Multiple points of divergence and communicative barriers were identified among the main stakeholders in the system. Those that were most frequently mentioned included issues surrounding the referral process (requesting, approving) and lack of consistent information flow back to providers that impairs overall management of patient care. We found that because of these problems, CMP patients were frequently tasked and sometimes overwhelmed with integrating and coordinating their own care, with little help from the system. Patients, PCPs, and A/C providers desire more communication; thus systems need to be created to facilitate more open communication which could positively benefit patient outcomes.

Noncontacting Laser Inspection System for Dimensional Profiling of Space Application Thermal Barriers

NASA Technical Reports Server (NTRS)

Taylor, Shawn C.

2011-01-01

A noncontacting, two-dimensional (2-D) laser inspection system has been designed and implemented to dimensionally profile thermal barriers being developed for space vehicle applications. In a vehicle as-installed state, thermal barriers are commonly compressed between load sensitive thermal protection system (TPS) panels to prevent hot gas ingestion through the panel interface during flight. Loads required to compress the thermal barriers are functions of their construction, as well as their dimensional characteristics relative to the gaps in which they are installed. Excessive loads during a mission could damage surrounding TPS panels and have catastrophic consequences. As such, accurate dimensional profiling of thermal barriers prior to use is important. Due to the compliant nature of the thermal barriers, traditional contact measurement techniques (e.g., calipers and micrometers) are subjective and introduce significant error and variability into collected dimensional data. Implementation of a laser inspection system significantly enhanced the method by which thermal barriers are dimensionally profiled, and improved the accuracy and repeatability of collected data. A statistical design of experiments study comparing laser inspection and manual caliper measurement techniques verified these findings.

77 FR 23303 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing and Immediate Effectiveness of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-18

... the Order Audit Trail System Information Barriers Put Into Place by the ETP Holder in Reliance on... report to the Order Audit Trail System (``OATS'') information barriers put into place by the ETP Holder... uses an effective system of internal controls--such as appropriate information barriers--that operate...

Integration of depression and primary care: barriers to adoption.

PubMed

Grazier, Kyle L; Smith, Judith E; Song, Jean; Smiley, Mary L

2014-01-01

Despite the prevailing consensus as to its value, the adoption of integrated care models is not widespread. Thus, the objective of this article it to examine the barriers to the adoption of depression and primary care models in the United States. A literature search focused on peer-reviewed journal literature in Medline and PsycInfo. The search strategy focused on barriers to integrated mental health care services in primary care, and was based on previously existing searches. The search included: MeSH terms combined with targeted keywords; iterative citation searches in Scopus; searches for grey literature (literature not traditionally indexed by commercial publishers) in Google and organization websites, examination of reference lists, and discussions with researchers. Integration of depression care and primary care faces multiple barriers. Patients and families face numerous barriers, linked inextricably to create challenges not easily remedied by any one party, including the following: vulnerable populations with special needs, patient and family factors, medical and mental health comorbidities, provider supply and culture, financing and costs, and organizational issues. An analysis of barriers impeding integration of depression and primary care presents information for future implementation of services.

Barriers to HIV Medication Adherence as a Function of Regimen Simplification.

PubMed

Chen, Yiyun; Chen, Kun; Kalichman, Seth C

2017-02-01

Barriers to HIV medication adherence may differ by levels of dosing schedules. The current study examined adherence barriers associated with medication regimen complexity and simplification. A total of 755 people living with HIV currently taking anti-retroviral therapy were recruited from community services in Atlanta, Georgia. Participants completed audio-computer-assisted self-interviews that assessed demographic and behavioral characteristics, provided their HIV viral load obtained from their health care provider, and completed unannounced phone-based pill counts to monitor medication adherence over 1 month. Participants taking a single-tablet regimen (STR) were more likely to be adherent than those taking multi-tablets in a single-dose regimen (single-dose MTR) and those taking multi-tablets in a multi-dose regimen (multi-dose MTR), with no difference between the latter two. Regarding barriers to adherence, individuals taking STR were least likely to report scheduling issues and confusion as reasons for missing doses, but they were equally likely to report multiple lifestyle and logistical barriers to adherence. Adherence interventions may need tailoring to address barriers that are specific to dosing regimens.

Transversal analysis of public policies on user fees exemptions in six West African countries.

PubMed

Ridde, Valéry; Queuille, Ludovic; Kafando, Yamba; Robert, Emilie

2012-11-20

While more and more West African countries are implementing public user fees exemption policies, there is still little knowledge available on this topic. The long time required for scientific production, combined with the needs of decision-makers, led to the creation in 2010 of a project to support implementers in aggregating knowledge on their experiences. This article presents a transversal analysis of user fees exemption policies implemented in Benin, Burkina Faso, Mali, Niger, Togo and Senegal. This was a multiple case study with several embedded levels of analysis. The cases were public user fees exemption policies selected by the participants because of their instructive value. The data used in the countries were taken from documentary analysis, interviews and questionnaires. The transversal analysis was based on a framework for studying five implementation components and five actors' attitudes usually encountered in these policies. The analysis of the implementation components revealed: a majority of State financing; maintenance of centrally organized financing; a multiplicity of reimbursement methods; reimbursement delays and/or stock shortages; almost no implementation guides; a lack of support measures; communication plans that were rarely carried out, funded or renewed; health workers who were given general information but not details; poorly informed populations; almost no evaluation systems; ineffective and poorly funded coordination systems; low levels of community involvement; and incomplete referral-evacuation systems. With regard to actors' attitudes, the analysis revealed: objectives that were appreciated by everyone; dissatisfaction with the implementation; specific tensions between healthcare providers and patients; overall satisfaction among patients, but still some problems; the perception that while the financial barrier has been removed, other barriers persist; occasionally a reorganization of practices, service rationing due to lack of reimbursement, and some overcharging or shifting of resources. This transversal analysis confirms the need to assign a great deal of importance to the implementation of user fees exemption policies once these decisions have been taken. It also highlights some practices that suggest avenues of future research.

Understanding Barriers to Colorectal Cancer Screening in Kentucky.

PubMed

Knight, Jennifer Redmond; Kanotra, Sarojini; Siameh, Seth; Jones, Jessica; Thompson, Becki; Thomas-Cox, Sue

2015-06-18

Colorectal cancer screening rates have increased significantly in Kentucky, from 35% in 1999 to 66% in 2012. A continued improvement in screening requires identification of existing barriers and implementation of interventions to address barriers. The state of Kentucky added a question to the 2012 Kentucky Behavioral Risk Factor Surveillance System survey for respondents aged 50 years or older who answered no to ever having been screened for colorectal cancer by colonoscopy or sigmoidoscopy to assess the reasons why respondents had not been screened. Combined responses constituted 4 categories: attitudes and beliefs, health care provider and health care systems barriers, cost, and other. Prevalence estimates for barriers were calculated by using raking weights and were stratified by race/ethnicity, sex, education, income, and health insurance coverage. Logistic regression estimated odds ratios for barriers to screening. The most common barriers in all areas were related to attitudes and beliefs, followed by health care provider and systems, and cost. Non-Hispanic whites and respondents with more than a high school education were more likely to choose attitudes and beliefs as a barrier than were non-Hispanic blacks and those with less than a high school education. Respondents with low incomes and with no insurance were significantly more likely to select cost as a barrier. No significant associations were observed between demographic variables and the selection of a health care provider and a health care system. Barriers related to education, race/ethnicity, income, and insurance coverage should be considered when designing interventions. Expansion of Medicaid and implementation of the Affordable Care Act in Kentucky could have an impact on reducing these barriers.

A Peptide Targeting Inflammatory CNS Lesions in the EAE Rat Model of Multiple Sclerosis.

PubMed

Boiziau, Claudine; Nikolski, Macha; Mordelet, Elodie; Aussudre, Justine; Vargas-Sanchez, Karina; Petry, Klaus G

2018-06-01

Multiple sclerosis is characterized by inflammatory lesions dispersed throughout the central nervous system (CNS) leading to severe neurological handicap. Demyelination, axonal damage, and blood brain barrier alterations are hallmarks of this pathology, whose precise processes are not fully understood. In the experimental autoimmune encephalomyelitis (EAE) rat model that mimics many features of human multiple sclerosis, the phage display strategy was applied to select peptide ligands targeting inflammatory sites in CNS. Due to the large diversity of sequences after phage display selection, a bioinformatics procedure called "PepTeam" designed to identify peptides mimicking naturally occurring proteins was used, with the goal to predict peptides that were not background noise. We identified a circular peptide CLSTASNSC called "Ph48" as an efficient binder of inflammatory regions of EAE CNS sections including small inflammatory lesions of both white and gray matter. Tested on human brain endothelial cells hCMEC/D3, Ph48 was able to bind efficiently when these cells were activated with IL1β to mimic inflammatory conditions. The peptide is therefore a candidate for further analyses of the molecular alterations in inflammatory lesions.

Optimizing Barrier Removal to Restore Connectivity in Utah's Weber Basin

NASA Astrophysics Data System (ADS)

Kraft, M.; Null, S. E.

2016-12-01

Instream barriers, such as dams, culverts and diversions are economically important for water supply, but negatively affect river ecosystems and disrupt hydrologic processes. Removal of uneconomical and aging in-stream barriers to improve habitat connectivity is increasingly used to restore river connectivity. Most past barrier removal projects focused on individual barriers using a score-and-rank technique, ignoring cumulative change from multiple, spatially-connected barrier removals. Similarly, most water supply models optimize either human water use or aquatic connectivity, failing to holistically represent human and environmental benefits. In this study, a dual objective optimization model identified in-stream barriers that impede aquatic habitat connectivity for trout, using streamflow, temperature, and channel gradient as indicators of aquatic habitat suitability. Water scarcity costs are minimized using agricultural and urban economic penalty functions to incorporate water supply benefits and a budget monetizes costs of removing small barriers like culverts and road crossings. The optimization model developed is applied to a case study in Utah's Weber basin to prioritize removal of the most environmentally harmful barriers, while maintaining human water uses. The dual objective solution basis was developed to quantify and graphically visualize tradeoffs between connected quality-weighted habitat for Bonneville cutthroat trout and economic water uses. Modeled results include a spectrum of barrier removal alternatives based on budget and quality-weighted reconnected habitat that can be communicated with local stakeholders. This research will help prioritize barrier removals and future restoration decisions. The modeling approach expands current barrier removal optimization methods by explicitly including economic and environmental water uses.

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.

Racial Barrier Socialization and the Well-being of African American Adolescents: The Moderating Role of Mother-Adolescent Relationship Quality

PubMed Central

Cooper, Shauna M.; McLoyd, Vonnie C.

2012-01-01

Racial socialization has been suggested as an important factor in helping African American adolescents cope effectively with racism and discrimination. Although multiple studies have reported a positive link between racial pride socialization and psychological adjustment among African American youth, assessments of the association between adolescent adjustment and another dimension of racial socialization—racial barrier socialization—have yielded inconsistent findings. Using a sample of 190 African American adolescents, the present study focuses attention on the quality of mother-adolescent relations as an indicator of affective context, and examines its moderating influence on the association between racial barrier socialization and adolescent adjustment. Regression analyses indicated that the link between racial barrier socialization and adolescent adjustment is moderated by mother-adolescent relationship quality. However, these associations varied by gender. PMID:23152648

Adoption of electronic health records and barriers

PubMed Central

Palabindala, Venkataraman; Pamarthy, Amaleswari; Jonnalagadda, Nageshwar Reddy

2016-01-01

Electronic health records (EHR) are not a new idea in the U.S. medical system, but surprisingly there has been very slow adoption of fully integrated EHR systems in practice in both primary care settings and within hospitals. For those who have invested in EHR, physicians report high levels of satisfaction and confidence in the reliability of their system. There is also consensus that EHR can improve patient care, promote safe practice, and enhance communication between patients and multiple providers, reducing the risk of error. As EHR implementation continues in hospitals, administrative and physician leadership must actively investigate all of the potential risks for medical error, system failure, and legal responsibility before moving forward. Ensuring that physicians are aware of their responsibilities in relation to their charting practices and the depth of information available within an EHR system is crucial for minimizing the risk of malpractice and lawsuit. Hospitals must commit to regular system upgrading and corresponding training for all users to reduce the risk of error and adverse events. PMID:27802857

[Comprehensive system integration and networking in operating rooms].

PubMed

Feußner, H; Ostler, D; Kohn, N; Vogel, T; Wilhelm, D; Koller, S; Kranzfelder, M

2016-12-01

A comprehensive surveillance and control system integrating all devices and functions is a precondition for realization of the operating room of the future. Multiple proprietary integrated operation room systems are currently available with a central user interface; however, they only cover a relatively small part of all functionalities. Internationally, there are at least three different initiatives to promote a comprehensive systems integration and networking in the operating room: the Japanese smart cyber operating theater (SCOT), the American medical device plug-and-play interoperability program (MDPnP) and the German secure and dynamic networking in operating room and hospital (OR.NET) project supported by the Federal Ministry of Education and Research. Within the framework of the internationally advanced OR.NET project, prototype solution approaches were realized, which make short-term and mid-term comprehensive data retrieval systems probable. An active and even autonomous control of the medical devices by the surveillance and control system (closed loop) is expected only in the long run due to strict regulatory barriers.

Equity in Reform: Case Studies of Five Middle Schools Involved in Systemic Reform

NASA Astrophysics Data System (ADS)

Kahle, Jane Butler; Kelly, Mary Kay

Science and mathematics education reform documents of the last decade have called for improved teaching and learning for all children. To overcome inequalities, a systemic approach to reform has been adopted. The case studies synthesized in this analysis arc part of a larger effort to reform science and mathematics education systemically and assess the progress of systemic reform. The purpose of this study was to assess the progress toward achieving equitable systemic reform in five middle schools. A multiple-case study design was used, and qualitative data were collected. Kahle's Equity Metric was used to analyze the schools' progress toward achieving equitable systemic reform of mathematics and science. Two results occurred: Various equity issues were identified in the five case studies, and the metric proved efficacious in identifying barriers to or facilitators of equitable reform in the schools. Overall, the study illustrates how schools might assess their commitments to providing high-quality science and mathematics education to all students.

Evaluating Continuing Nursing Education: A Qualitative Study of Intention to Change Practice and Perceived Barriers to Knowledge Translation.

PubMed

Wellings, Cynthea A; Gendek, Marilyn A; Gallagher, Silvia E

Evaluating the effectiveness of continuing nursing education does not always include behavioral change and patient health outcomes. A qualitative analysis of open-ended evaluation questions from continuing nursing education activities was conducted. The aim was to evaluate learners' intentions to change their practice resulting from their learning and their perceived barriers to implementing practice changes. Results revealed the multiple, interconnected challenges involved in translating new learning into practice.

Photocurrent Cancellation Due to Barrier Asymmetry in GaAs/AlGaAs Heterostructure Infrared Detectors

DTIC Science & Technology

2014-05-01

with previous work published on QWIP current mechanisms. The Barrier Workfunction and Collection Efficiency give the relevant values obtained by using...infrared photodetectors ( QWIPs ,) multiple quantum well (MQW,) and superlattice structures. 15 2.5.1 Heterojunction Interfacial Workfunction Internal...for aluminum fractions of x = 0.28, 0.37, and 0.57, respectively. Similar results were found previously14 by Tsai et. al. in GaAs/AlGaAs QWIPs

Measuring Perceived Barriers to Physical Activity in Adolescents.

PubMed

Gunnell, Katie E; Brunet, Jennifer; Wing, Erin K; Bélanger, Mathieu

2015-05-01

Perceived barriers to moderate-to-vigorous physical activity (PA) may contribute to the low rates of moderate-to-vigorous PA in adolescents. We examined the psychometric properties of scores from the perceived barriers to moderate-to-vigorous PA scale (PB-MVPA) by examining composite reliability and validity evidence based on the internal structure of the PB-MVPA and relations with other variables. This study was a cross-sectional analysis of data collected in 2013 from adolescents (N = 507; Mage = 12.40, SD = .62) via self-report scales. Using exploratory and confirmatory factor analyses, we found that perceived barriers were best represented as two factors representing internal (e.g., "I am not interested in physical activity") and external (e.g., "I need equipment I don't have") dimensions. Composite reliability was over .80. Using multiple regression to examine the relationship between perceived barriers and moderate-to-vigorous PA, we found that perceived internal barriers were inversely related to moderate-to-vigorous PA (β = -.32, p < .05). Based on results of the analysis of variances, there were no known-group sex differences for perceived internal and external barriers (p > .26). The PB-MVPA scale demonstrated evidence of score reliability and validity. To improve the understanding of the impact of perceived barriers on moderate-to- vigorous PA in adolescents, researchers should examine internal and external barriers separately.