Culture: what is its effect on stress in the military?

PubMed

Langston, Victoria; Gould, Matthew; Greenberg, Neil

2007-09-01

Culture provides the unwritten rules that inform and shape expected behaviors. To date, little research has been conducted into the attitudes or opinions that service personnel hold toward mental health issues. This article examines current literature and research into the recognition of mental health problems in the military and potential organizational barriers to care including stigma and the specific characteristics of a military culture such as the significant reliance on buddy support. We conclude that the barriers to care which operate in both military and civilian populations are not insignificant. Western militaries in fact currently face an uphill struggle to combat the substantial barriers to care that exist.

Facilitators and barriers to doing workplace mental health research: Case study of acute psychological trauma in a public transit system.

PubMed

Links, Paul S; Bender, Ash; Eynan, Rahel; O'Grady, John; Shah, Ravi

2016-03-10

The Acute Psychological Trauma (APT) Study was a collaboration between an acute care hospital, a specialized multidisciplinary program designed to meet the mental health needs of injured workers, and a large urban public transit system. The overall purpose was to evaluate a Best Practices Intervention (BPI) for employees affected by acute psychological trauma compared to a Treatment as Usual (TAU) group. The specific purpose is to discuss facilitators and barriers that were recognized in implementing and carrying out mental health research in a workplace setting. Over the course of the APT study, a joint implementation committee was responsible for day-to-day study operations and made regular observations on the facilitators and barriers that arose throughout the study. The facilitators to this study included the longstanding relationships among the partners, increased recognition for the need of mental health research in the workplace, and the existence of a community advisory committee. The significant barriers to doing this study of mental health research in the workplace included differences in organizational culture, inconsistent union support, co-interventions, and stigma. Researchers and funding agencies need to be flexible and provide additional resources in order to overcome the barriers that can exist doing workplace mental health research.

Motivational readiness for active commuting by university students: incentives and barriers.

PubMed

Cole, Rachel; Leslie, Eva; Donald, Maria; Cerin, Ester; Neller, Anne; Owen, Neville

2008-12-01

Walking for transport can contribute significantly to health-enhancing physical activity. We examined the associations of stages of motivational readiness for active transport with perceived barriers and incentives to walking to and from university among students. Mail-back surveys were completed by 781 students in a regional university in south-east Queensland. They identified one of eight options on motivational readiness for active commuting, which were then classified as: pre-contemplation; contemplation-preparation; or, action-maintenance. Open-ended questions were used to identify relevant barriers and incentives. Logistic regressions were used to examine the barriers and incentives that distinguished between those at different stages of motivational readiness. Barriers most frequently reported were long travel distances, inconvenience and time constraints. Incentives most frequently reported were shorter travel distance, having more time, supportive infrastructure and better security. Those not considering active commuting (pre-contemplation) were significantly more likely to report shorter travel distance as an incentive compared to those in contemplation-preparation. Those in contemplation-preparation were significantly more likely to report lack of motivation, inadequate infrastructure, shorter travel distance and inconvenience as barriers; and, having more time, supportive infrastructure, social support and incentive programs as encouragement. Different barriers and incentives to walking to or from university exist for students in the different stages of motivational readiness for active commuting. Interventions targeted specifically to stage of motivational readiness may be potentially helpful in increasing activity levels, through active transport.

Membrane fouling in a submerged membrane bioreactor: effect of pH and its implications.

PubMed

Zhang, Ye; Zhang, Meijia; Wang, Fangyuan; Hong, Huachang; Wang, Aijun; Wang, Juan; Weng, Xuexiang; Lin, Hongjun

2014-01-01

The effect of pH on membrane fouling in a submerged membrane bioreactor (MBR) was investigated in this study. It was found that, pH increase slightly increased the resistance of virgin membrane and fouled membrane. Pore clogging resistance was quite low, which was not apparently affected by the pH variation. Lower pH resulted in higher adherence of sludge flocs on membrane surface. Thermodynamic analysis showed that a repulsive energy barrier existed in the process of the foulants approaching to membrane surface. This energy barrier would decrease with pH decreased, suggesting the existence of a critical pH below which the repulsive energy barrier would disappear, which would facilitate attachment of the foulants. The resistance of the formed cake layer would significantly increase with the feed pH. This result could be explained by the osmotic pressure mechanism. The obtained findings also provided important implications for membrane fouling mitigation in MBRs. Copyright © 2013 Elsevier Ltd. All rights reserved.

Perceived and real barriers for men entering nursing: implications for gender diversity.

PubMed

Roth, Jay E; Coleman, Christopher Lance

2008-01-01

The objective of this literature review is to describe the perceived or real barriers to men seeking a career in nursing, and to suggest strategies for ameliorating barriers. A literature search exploring barriers existing for men pursuing nursing was conducted. Although the literature underscored the structure of nursing has changed substantially over the last fifty years, these changes have not always provoked a change in the public's perception of nursing. Barriers for men entering nursing still exist. Implications for gender diversity in nursing are discussed. Strategies for decreasing barriers experienced by males entering nursing are warranted.

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

PubMed

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

2013-11-01

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

In situ clay formation : evaluation of a proposed new technology for stable containment barriers.

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

Nagy, Kathryn L.; DiGiovanni, Anthony Albert; Fredrich, Joanne T.

2004-03-01

Containment of chemical wastes in near-surface and repository environments is accomplished by designing engineered barriers to fluid flow. Containment barrier technologies such as clay liners, soil/bentonite slurry walls, soil/plastic walls, artificially grouted sediments and soils, and colloidal gelling materials are intended to stop fluid transport and prevent plume migration. However, despite their effectiveness in the short-term, all of these barriers exhibit geochemical or geomechanical instability over the long-term resulting in degradation of the barrier and its ability to contain waste. No technologically practical or economically affordable technologies or methods exist at present for accomplishing total remediation, contaminant removal, or destruction-degradationmore » in situ. A new type of containment barrier with a potentially broad range of environmental stability and longevity could result in significant cost-savings. This report documents a research program designed to establish the viability of a proposed new type of containment barrier derived from in situ precipitation of clays in the pore space of contaminated soils or sediments. The concept builds upon technologies that exist for colloidal or gel stabilization. Clays have the advantages of being geologically compatible with the near-surface environment and naturally sorptive for a range of contaminants, and further, the precipitation of clays could result in reduced permeability and hydraulic conductivity, and increased mechanical stability through cementation of soil particles. While limited success was achieved under certain controlled laboratory conditions, the results did not warrant continuation to the field stage for multiple reasons, and the research program was thus concluded with Phase 2.« less

Telehealth as gatekeeper: policy implications for geography and scope of services.

PubMed

Kraetschmer, Nancy M; Deber, Raisa B; Dick, Paul; Jennett, Penny

2009-09-01

Why, despite enthusiasm, is telehealth still a relatively minor part of healthcare delivery in many health systems? We examined two less-considered policy issues: (1) the scope of services being offered by telehealth and how this matches existing arrangements for insured services; and (2) how the ability of telehealth services to minimize barriers associated with geography is dealt with in a system organized and financed on geographical boundaries. Fifty-three semistructured interviews with key stakeholders involved in the management of 43 Canadian telehealth programs were conducted. In addition, quantitative activity data were analyzed from 33 telehealth programs. Two telehealth approaches emerged: telephone-based (N = 3), and video-conferencing-based (N = 40). Most programs reflected, rather than superceded, existing geographical boundaries; with the technology being used, the videoconferencing models imposed significant barriers to unfettered access by outlying communities because they required sites to acquire expensive technology, be affiliated with an existing telehealth network, and schedule visits in advance. In consequence, much activity was administrative and educational, rather than clinical, and often extended beyond the set of mandatory insured services. Despite high hopes that telehealth would improve access to care for rural/remote areas, gatekeeping inherent in certain telehealth systems imposes barriers to unfettered use by rural/remote areas, although it does facilitate other valued activities. Policy approaches are needed to promote a closer match between the expectations for telehealth and the realities reflected by many existing models.

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

PubMed

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

2011-04-01

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

Toward an Integrated Research Agenda for Critical Illness in Aging

PubMed Central

Milbrandt, Eric B.; Eldadah, Basil; Nayfield, Susan; Hadley, Evan; Angus, Derek C.

2010-01-01

Aging brings an increased predisposition to critical illness. Patients older than 65 years of age account for approximately half of all intensive care unit (ICU) admissions in the United States, a proportion that is expected to increase considerably with the aging of the population. Emerging research suggests that elderly survivors of intensive care suffer significant long-term sequelae, including accelerated age-related functional decline. Existing evidence-based interventions are frequently underused and their efficacy untested in older subjects. Improving ICU outcomes in the elderly will require not only better methods for translating sound science into improved ICU practice but also an enhanced understanding of the underlying molecular, physiological, and pathophysiological interactions of critical illness with the aging process itself. Yet, significant barriers to research for critical illness in aging exist. We review the state of knowledge and identify gaps in knowledge, research opportunities, and barriers to research, with the goal of promoting an integrated research agenda for critical illness in aging. PMID:20558632

Recruiting and retaining men in nursing: a review of the literature.

PubMed

Villeneuve, M J

1994-01-01

A review of literature published primarily since 1980 was conducted to identify (1) historical events that have influenced the sex imbalance in the nursing workforce, (2) the existence and types of barriers affecting the recruitment of male nurses, and (3) feasible strategies that might form the basis of intervention studies in the future. Nursing continues to be undervalued as an end-point career by some, and most potential candidates lack exposure to male nurses and nursing in general. Family resistance and salary remain concerns, but they may be as important a deterrent for some women as for men. Significant barriers to men exist in nursing education and practice, and the language and history of nursing have sexualized nursing practice itself by labeling it as women's work. The latter pattern has influenced legal decisions affecting the clinical practice of male nurses and has contributed to perhaps the most significant barrier to the recruitment of male candidates: the job title and its associated images. Proactive recruitment from selected target groups, the use of role models, and the exploitation of appropriate media sources are but three feasible strategies identified from the literature review that might be considered if nurses really would value changing the sex imbalance in the nursing workforce.

Resonant tunneling of spin-wave packets via quantized states in potential wells.

PubMed

Hansen, Ulf-Hendrik; Gatzen, Marius; Demidov, Vladislav E; Demokritov, Sergej O

2007-09-21

We have studied the tunneling of spin-wave pulses through a system of two closely situated potential barriers. The barriers represent two areas of inhomogeneity of the static magnetic field, where the existence of spin waves is forbidden. We show that for certain values of the spin-wave frequency corresponding to the quantized spin-wave states existing in the well formed between the barriers, the tunneling has a resonant character. As a result, transmission of spin-wave packets through the double-barrier structure is much more efficient than the sequent tunneling through two single barriers.

Telerobotics in rehabilitation: Barriers to a virtual existence

NASA Technical Reports Server (NTRS)

Leifer, Larry; Vanderloos, Machiel; Michalowski, Stefan

1991-01-01

The topics covered include the following: the need for telerobotics in rehabilitation; barriers to telerobotics technology in rehabilitation and health care; institutional barriers; technical barriers; and a partial view of the future.

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.

College Preparation Program for High School Youth Who Are Blind: The Summer Academy

ERIC Educational Resources Information Center

Coduti, Wendy A.; Herbert, James T.; Chiu, Herbert; Döke, Deniz Aydemir

2017-01-01

Students with disabilities have significantly lower graduation rates in four-year postsecondary institutions than students without disabilities. Although there are many barriers associated with persistence and graduation, for students with vision loss, additional accessibility challenges exist. This paper describes a pilot study that examined the…

Impact of treated wastewater for irrigation on soil microbial communities

USDA-ARS?s Scientific Manuscript database

The use of treated wastewater (TWW) for irrigation has been suggested as an alternative to use of fresh water because of the increasing scarcity of fresh water in arid and semiarid regions of the world. However, significant barriers exist to widespread adoption due to some potential contaminants tha...

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.

Defect Clustering and Nano-phase Structure Characterization of Multicomponent Rare Earth-Oxide-Doped Zirconia-Yttria Thermal Barrier Coatings

NASA Technical Reports Server (NTRS)

Zhu, Dongming; Chen, Yuan L.; Miller, Robert A.

2004-01-01

Advanced thermal barrier coatings (TBCs) have been developed by incorporating multicomponent rare earth oxide dopants into zirconia-based thermal barrier coatings to promote the creation of the thermodynamically stable, immobile oxide defect clusters and/or nanophases within the coating systems. In this paper, the defect clusters, induced by Nd, Gd, and Yb rare earth dopants in the zirconia-yttria thermal barrier coatings, were characterized by high-resolution transmission electron microscopy (TEM). The TEM lattice imaging, selected area diffraction (SAD), and electron energy-loss spectroscopy (EELS) analyses demonstrated that the extensive nanoscale rare earth dopant segregation exists in the plasma-sprayed and electron-physical-vapor-deposited (EB PVD) thermal barrier coatings. The nanoscale concentration heterogeneity and the resulting large lattice distortion promoted the formation of parallel and rotational defective lattice clusters in the coating systems. The presence of the 5-to 100-nm-sized defect clusters and nanophases is believed to be responsible for the significant reduction of thermal conductivity, improved sintering resistance, and long-term high temperature stability of the advanced thermal barrier coating systems.

In Situ Formation Of Reactive Barriers For Pollution Control

DOEpatents

Gilmore, Tyler J.; Riley, Robert G.

2004-04-27

A method of treating soil contamination by forming one or more zones of oxidized material in the path of percolating groundwater is disclosed. The zone or barrier region is formed by delivering an oxidizing agent into the ground for reaction with an existing soil component. The oxidizing agent modifies the existing soil component creating the oxidized zone. Subsequently when soil contaminates migrate into the zone, the oxidized material is available to react with the contaminates and degrade them into benign products. The existing soil component can be an oxidizable mineral such as manganese, and the oxidizing agent can be ozone gas or hydrogen peroxide. Soil contaminates can be volatile organic compounds. Oxidized barriers can be used single or in combination with other barriers.

Comparison of skin barrier function and sensory nerve electric current perception threshold between IgE-high extrinsic and IgE-normal intrinsic types of atopic dermatitis.

PubMed

Mori, T; Ishida, K; Mukumoto, S; Yamada, Y; Imokawa, G; Kabashima, K; Kobayashi, M; Bito, T; Nakamura, M; Ogasawara, K; Tokura, Y

2010-01-01

Background Two types of atopic dermatitis (AD) have been proposed, with different pathophysiological mechanisms underlying this seemingly heterogeneous disorder. The extrinsic type shows high IgE levels presumably as a consequence of skin barrier damage and feasible allergen permeation, whereas the intrinsic type exhibits normal IgE levels and is not mediated by allergen-specific IgE. Objectives To investigate the relationship between pruritus perception threshold and skin barrier function of patients with AD in a comparison between the extrinsic and intrinsic types. Methods Enrolled in this study were 32 patients with extrinsic AD, 17 with intrinsic AD and 24 healthy individuals. The barrier function of the stratum corneum was assessed by skin surface hydration and transepidermal water loss (TEWL), and pruritus perception was evaluated by the electric current perception threshold (CPT) of sensory nerves upon neuroselective transcutaneous electric stimulation. Results Skin surface hydration was significantly lower and TEWL was significantly higher in extrinsic AD than intrinsic AD or normal controls. Although there was no statistically significant difference in CPT among extrinsic AD, intrinsic AD and normal controls, CPT was significantly correlated with skin surface hydration and inversely with TEWL in intrinsic AD and normal controls, but not extrinsic AD. Finally, CPT was correlated with the visual analogue scale of itch in the nonlesional skin of patients with extrinsic but not intrinsic AD. Conclusions Patients with extrinsic AD have an impaired barrier, which increases the pre-existing pruritus but rather decreases sensitivity to external stimuli. In contrast, patients with intrinsic AD retain a normal barrier function and sensory reactivity to external pruritic stimuli.

Overcoming Barriers to Integrating Behavioral Health and Primary Care Services

PubMed Central

Grazier, Kyle L.; Smiley, Mary L.; Bondalapati, Kirsten S.

2016-01-01

Objective: Despite barriers, organizations with varying characteristics have achieved full integration of primary care services with providers and services that identify, treat, and manage those with mental health and substance use disorders. What are the key factors and common themes in stories of this success? Methods: A systematic literature review and snowball sampling technique was used to identify organizations. Site visits and key informant interviews were conducted with 6 organizations that had over time integrated behavioral health and primary care services. Case studies of each organization were independently coded to identify traits common to multiple organizations. Results: Common characteristics include prioritized vulnerable populations, extensive community collaboration, team approaches that included the patient and family, diversified funding streams, and data-driven approaches and practices. Conclusions: While significant barriers to integrating behavioral health and primary care services exist, case studies of organizations that have successfully overcome these barriers share certain common factors. PMID:27380923

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

PubMed

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

2014-12-01

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

Barriers to implementing protocols for kidney paired donation and desensitization: survey of U.S. transplant programs.

PubMed

Clark, Emma; Hanto, Ruthanne; Rodrigue, James R

2010-12-01

Special types of kidney transplant exist for patients who have willing but incompatible donors. Two types of transplants that circumvent donor-recipient incompatibility are "kidney paired donation" and "desensitization." Lack of access to these protocols limits living donations and shortens the life span of patients with willing but incompatible donors. To understand potential barriers to implementing kidney paired donation and desensitization, as well as attitudes toward nondirected donation and compatible type O donation, which would maximize the number of kidney paired donation transplants performed via chains. We created a 56-question Web-based survey to elicit information from US transplant program directors about 24 potential barriers to implementing these protocols. Of 166 programs contacted, 96 responded, including 88 complete and 8 partial responses. After pediatric-only programs and multiple responses from the same program were removed, 84 total (78 complete) remained. Respondents were asked to designate each barrier as "major," "minor," or "not a barrier". Availability of dedicated nurse coordinators and the United Network for Organ Sharing's variance request process (although kidney paired donation does not actually require a variance) were significant barriers to kidney paired donation. Most respondents (54%, 42/78) would prefer to participate in a regional rather than a national protocol for kidney paired donation. Risk of complications was the most significant barrier to desensitization. University affiliation, region, and training (nephrologist vs surgeon) had little effect on perception of barriers. Most (92%, 71/78) would evaluate nondirected donations; 53% (41/78) would encourage compatible type O donors to enter kidney paired donation.

Overview of thermal barrier coatings in diesel engines

NASA Technical Reports Server (NTRS)

Yonushonis, Thomas M.

1995-01-01

An understanding of delamination mechanisms in thermal barrier coatings has been developed for diesel engine applications through rig tests, structural analysis modeling, nondestructive evaluation, and engine evaluation of various thermal barrier coatings. This knowledge has resulted in improved thermal barrier coatings which survive abusive cyclic fatigue tests in high output diesel engines. Although much conflicting literature now exists regarding the impact of thermal barrier coatings on engine performance and fuel consumption, the changes in fuel consumption appear to be less than a few percent and can be negative for state-of-the-art diesel engines. The ability of the thermal barrier coating to improve fuel economy tends to be dependent on a number of factors including the fuel injection system, combustion chamber design, and the initial engine fuel economy. Limited investigations on state-of-the-art diesel engines have indicated that the surface connected porosity and coating surface roughness may influence engine fuel economy. Current research efforts on thermal barrier coatings are primarily directed at reducing in-cylinder heat rejection, thermal fatigue protection of underlying metal surfaces and a possible reduction in diesel engine emissions. Significant efforts are still required to improve the plasma spray processing capability and the economics for complex geometry diesel engine components.

Effect of vilon and epithalon on activity of enzymes in epithelial and subepithelial layers in small intestine of old rats.

PubMed

Khavinson, V Kh; Timofeeva, N M; Malinin, V V; Gordova, L A; Nikitina, A A

2002-12-01

Per os administration of Vilon (Lys-Glu) or Epithalon (Ala-Glu-Asp-Gly) to aged Wistar rats for 1 month significantly increased activity of membrane enzymes maltase and alkaline phosphatase in epithelial layer of the small intestine. In addition, Vilon significantly increased activity of cytosolic glycyl-L-leucine dipeptidase in the stromal and seromuscular layers of the small intestine in comparison with the control rats not treated with this agent. These findings suggest improvement of trophic and barrier functions of the small intestine and corroborate the hypothesis on the existence of not only epithelial, but also subepithelial enzymatic barrier supporting the enzyme system in the small intestine, especially in aged animals.

Latina and Non-Latina Mothers' Perceived Health Barriers and Benefits and Their Relationship to Children's Health Behaviors.

PubMed

Highland, Krista B; Lundahl, Alyssa; Kidwell, Katherine M; Hankey, Maren; Caballos, Miguel; McChargue, Dennis

2016-06-01

Objectives Disparities exist in rates of overweight/obesity between Latino and non-Latino populations. Attention should be given to risk factors that may be modifiable through interventions involving both the parent and child. The current study sought to identify ethnic differences in parental health beliefs and their relation to children's health behaviors. Methods Latina and non-Latina mothers (N = 203) at rural and urban clinics and health departments completed self-report questionnaires. Key information included beliefs about barriers and benefits to health practices and children's health behaviors. Results Children of Latina mothers consumed significantly more soda and fried foods and exercised less than children of non-Latina mothers. Latina mothers were significantly more likely to perceive barriers to healthy eating and significantly less likely to perceive benefits to healthy eating and physical activity than non-Latina mothers. Ethnicity mediated the relationship between maternal views of health benefits and soda consumption. Conclusions Policy changes are needed to promote health education and increase the accessibility of healthy foods and safe places to exercise for Latino families.

Identifying barriers to medication discharge counselling by pharmacists.

PubMed

Walker, Sandra A N; Lo, Jennifer K; Compani, Sara; Ko, Emily; Le, Minh-Hien; Marchesano, Romina; Natanson, Rimona; Pradhan, Rahim; Rzyczniak, Grace; Teo, Vincent; Vyas, Anju

2014-05-01

Medication errors may occur more frequently at discharge, making discharge counselling a vital facet of medication reconciliation. Discharge counselling is a recognized patient safety initiative for which pharmacists have appropriate expertise, but data are lacking about the barriers to provision of this service to adult inpatients by pharmacists. To determine the proportion of eligible patients who received discharge counselling, to quantify perceived barriers preventing pharmacists from performing discharge counselling, and to determine the relative frequency of barriers and associated time expenditures. In this prospective study, 8 pharmacists working in general medicine, medical oncology, or nephrology wards of an acute care hospital completed a survey for each of the first 50 patients eligible for discharge counselling on their respective wards from June 2010 to February 2011. Patients discharged to another facility (rehabilitation, palliative care, or long-term care), those with hospital stay less than 48 h before discharge, and those whose medications were unchanged from hospital admission were ineligible. Discharge counselling was performed for 116 (29%) of the 403 eligible patients and involved a median preparation time of 25 min and median counselling time of 15 min per patient. At least one documented barrier to discharge counselling existed for 295 (73%) of the patients. Several barriers to discharge counselling occurred significantly more frequently on the general medicine and oncology wards than on the nephrology ward (p < 0.05). The most common barrier was failure to notify the pharmacist about impending patient discharge (130/313 [41%]). Time constraints existed for 130 (32%) of the patients, the most common related to clarification of prescriptions (96 [24%]), creation of a medication list (69 [17%]), and faxing of prescriptions (64 [16%]). This study generated objective data about the barriers to and time constraints associated with medication discharge counselling by pharmacists. These findings should raise awareness of the challenges faced by pharmacists in busy hospital positions and may support avenues of change for their hospital discharge counselling programs.

Impenetrable barriers for positrons in neighbourhood of superheavy nuclei with Z>118

NASA Astrophysics Data System (ADS)

Neznamov, V. P.

2017-12-01

Analysis of quantum mechanical motion of charged half-spin particles in the repulsive Coulomb field results in that an impenetrable potential barrier not explored earlier was found. For a particle at rest with a reduced mass m, the barrier radius is equal to half classical radius: the barrier radius decreases with increase in the particle energy. For the stable and quasi-stable nuclei with Z > 118, presence of an impenetrable barrier as β +-decay leads to the existence of “traps” for positrons in the neighbourhood of nuclei and as Zcr ≃ 170 (with emission of electron-positron pairs by vacuum) leads to the existence of a quasi-constant source of annihilation quanta.

Exercise barriers self-efficacy: development and validation of a subcale for individuals with cancer-related lymphedema.

PubMed

Buchan, Jena; Janda, Monika; Box, Robyn; Rogers, Laura; Hayes, Sandi

2015-03-18

No tool exists to measure self-efficacy for overcoming lymphedema-related exercise barriers in individuals with cancer-related lymphedema. However, an existing scale measures confidence to overcome general exercise barriers in cancer survivors. Therefore, the purpose of this study was to develop, validate and assess the reliability of a subscale, to be used in conjunction with the general barriers scale, for determining exercise barriers self-efficacy in individuals facing lymphedema-related exercise barriers. A lymphedema-specific exercise barriers self-efficacy subscale was developed and validated using a cohort of 106 cancer survivors with cancer-related lymphedema, from Brisbane, Australia. An initial ten-item lymphedema-specific barrier subscale was developed and tested, with participant feedback and principal components analysis results used to guide development of the final version. Validity and test-retest reliability analyses were conducted on the final subscale. The final lymphedema-specific subscale contained five items. Principal components analysis revealed these items loaded highly (>0.75) on a separate factor when tested with a well-established nine-item general barriers scale. The final five-item subscale demonstrated good construct and criterion validity, high internal consistency (Cronbach's alpha = 0.93) and test-retest reliability (ICC = 0.67, p < 0.01). A valid and reliable lymphedema-specific subscale has been developed to assess exercise barriers self-efficacy in individuals with cancer-related lymphedema. This scale can be used in conjunction with an existing general exercise barriers scale to enhance exercise adherence in this understudied patient group.

Improving Rural Cancer Patients' Outcomes: A Group-Randomized Trial

ERIC Educational Resources Information Center

Elliott, Thomas E.; Elliott, Barbara A.; Regal, Ronald R.; Renier, Colleen M.; Haller, Irina V.; Crouse, Byron J.; Witrak, Martha T.; Jensen, Patricia B.

2004-01-01

Significant barriers exist in the delivery of state-of-the-art cancer care to rural populations. Rural providers' knowledge and practices, their rural health care delivery systems, and linkages to cancer specialists are not optimal; therefore, rural cancer patient outcomes are less than achievable. Purpose: To test the effects of a strategy…

Implementing Pedagogical Change in Introductory Biology Courses through the Use of Faculty Learning Communities

ERIC Educational Resources Information Center

Addis, Elizabeth A.; Quardokus, Kathleen M.; Bassham, Diane C.; Becraft, Philip W.; Boury, Nancy; Coffman, Clark R.; Colbert, James T.; Powell-Coffman, Jo Anne

2013-01-01

Recent national reports have indicated a need for significant changes in science higher education, with the inclusion of more student centered learning. However, substantial barriers to change exist. These include a lack of faculty awareness and understanding of appropriate pedagogical approaches, large class sizes, the time commitment needed to…

Challenges to Evaluating Physical Activity Programs in American Indian/Alaska Native Communities

ERIC Educational Resources Information Center

Roberts, Erica Blue; Butler, James; Green, Kerry M.

2018-01-01

Despite the importance of evaluation to successful programming, a lack of physical activity program (PAP) evaluation for American Indian/Alaska Native (AI/AN) programs exists, which is significant given the high rates of obesity and diabetes in this population. While evaluation barriers have been identified broadly among AI/AN programs, challenges…

The New Politics of US Health Care Prices: Institutional Reconfiguration and the Emergence of All-Payer Claims Databases.

PubMed

Rocco, Philip; Kelly, Andrew S; Béland, Daniel; Kinane, Michael

2017-02-01

Prices are a significant driver of health care cost in the United States. Existing research on the politics of health system reform has emphasized the limited nature of policy entrepreneurs' efforts at solving the problem of rising prices through direct regulation at the state level. Yet this literature fails to account for how change agents in the states gradually reconfigured the politics of prices, forging new, transparency-based policy instruments called all-payer claims databases (APCDs), which are designed to empower consumers, purchasers, and states to make informed market and policy choices. Drawing on pragmatist institutional theory, this article shows how APCDs emerged as the dominant model for reforming health care prices. While APCD advocates faced significant institutional barriers to policy change, we show how they reconfigured existing ideas, tactical repertoires, and legal-technical infrastructures to develop a politically and technologically robust reform. Our analysis has important implications for theories of how change agents overcome structural barriers to health reform. Copyright © 2017 by Duke University Press.

App-guided exposure and response prevention for obsessive compulsive disorder: an open pilot trial.

PubMed

Boisseau, Christina L; Schwartzman, Carly M; Lawton, Jessica; Mancebo, Maria C

2017-11-01

Although effective treatments for obsessive-compulsive disorder (OCD) exist, there are significant barriers to receiving evidence-based care. Mobile health applications (Apps) offer a promising way of overcoming these barriers by increasing access to treatment. The current study investigated the feasibility, acceptability, and preliminary efficacy of LiveOCDFree, an App designed to help OCD patients conduct exposure and response prevention (ERP). Twenty-one participants with mild to moderate symptoms of OCD were enrolled in a 12-week open trial of App-guided self-help ERP. Self-report assessments of OCD, depression, anxiety, and quality of life were completed at baseline, mid-treatment, and post-treatment. App-guided ERP was a feasible and acceptable self-help intervention for individuals with OCD, with high rates of retention and satisfaction. Participants reported significant improvement in OCD and anxiety symptoms pre- to post-treatment. Findings suggest that LiveOCDFree is a feasible and acceptable self-help intervention for OCD. Preliminary efficacy results are encouraging and point to the potential utility of mobile Apps in expanding the reach of existing empirically supported treatments.

Barriers for Hispanic women in receiving the human papillomavirus vaccine: a nursing challenge.

PubMed

Wagner, Janelle

2009-12-01

Cervical cancer affects more Hispanic women than non-Hispanic women in the United States. A vaccination exists to aid in the prevention of cervical cancer; an estimated 70% of cases could be avoided with the human papillomavirus (HPV) vaccine. However, women of Hispanic descent have many access barriers. By identifying and addressing such barriers, nurses can play a significant role in educating Hispanic women about the benefits of vaccination before HPV exposure occurs. Theoretical integration with Leininger's Culture Care Theory of Diversity and Universality provides a framework to address cultural differences and awareness when educating Hispanic women about this health issue. Additional nursing research into effective communication and educational programs to help reach the Hispanic population continues to be a priority in this vulnerable community.

36 CFR 1154.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... TRANSPORTATION BARRIERS COMPLIANCE BOARD ENFORCEMENT OF NONDISCRIMINATION ON THE BASIS OF HANDICAP IN PROGRAMS OR ACTIVITIES CONDUCTED BY THE ARCHITECTURAL AND TRANSPORTATION BARRIERS COMPLIANCE BOARD § 1154.150 Program accessibility: Existing facilities. (a) General. The agency shall operate each program or activity so that the...

Structural violence: a barrier to achieving the millennium development goals for women.

PubMed

Mukherjee, Joia S; Barry, Donna J; Satti, Hind; Raymonville, Maxi; Marsh, Sarah; Smith-Fawzi, Mary Kay

2011-04-01

In 2000, all 191 United Nations member states agreed to work toward the achievement of a set of health and development goals by 2015. The achievement of these eight goals, the Millennium Development goals (MDGs) is highly dependent on improving the status of women, who play a key role in health and education in families and communities around the world. Yet structural violence, defined as the systematic exclusion of a group from the resources needed to develop their full human potential, remains a significant barrier against women's development and threatens the achievement of the MDGs. Although sound evidence has long existed for improving women's survival, the will to address women's health concretely and holistically is only recently gaining the advocacy needed to change policy. Concrete examples of the integration of approaches to mitigate structural violence within the delivery of health services do exist and should be incorporated into global advocacy for women's health.

Emergency nurses' knowledge of pain management principles.

PubMed

Tanabe, P; Buschmann, M

2000-08-01

The purpose of this study was to determine areas of emergency nurses' knowledge deficit regarding pain management, and to identify barriers to pain management as perceived by emergency nurses. Data were collected anonymously in a mail survey using a 52-item knowledge questionnaire addressing pain management principles and asking emergency nurses (Illinois Emergency Nurses Association members) to rate various barriers as to how often they affect their practice. Questionnaires were mailed to all Illinois ENA members (n = 1000). Three hundred five emergency nurses' questionnaires were returned. A significant deficit existed on 2 domains of knowledge: understanding of the terms "addiction," "tolerance," and "dependence"; and knowledge of various pharmacologic analgesic principles. Nurses with a master's degree or higher, or those who attended a 1-day seminar on pain management, achieved statistically significantly higher scores. The 2 barriers identified by emergency nurses as the most common were the inability to administer medication until a diagnosis is made (53%), and inadequate assessment of pain and pain relief (48%) (the percentage indicates how often the emergency nurses believed the barrier was present in their practice). The data indicate that emergency nurses may not have a good understanding of the management of pain with drugs, or of such issues as risk of addiction.

Incident reporting in dentistry: Clinical supervisor's awareness, practice and perceived barriers.

PubMed

AlBlaihed, R M; AlSaeed, M I; Abuabat, A A; Ahsan, S H

2017-12-21

The significance of patient safety and risk management in dentistry has surfaced as dental settings bear delicate procedures carried out by teams utilising numerous devices and tools in complex environments. Our aim is to assess awareness, practice, attitude and perceived barriers of reporting incidents amongst dental clinical supervisors working at dental colleges in Riyadh, Saudi Arabia. The objectives are as follows: (i) Determine if correlations exist between socio-demographic data and supervisors' awareness, practice, attitude and perceived barriers. (ii) Identify most common perceived barriers. An online questionnaire was sent to the 450 clinical supervisors working at five dental colleges of Riyadh. The collected data included items assessing the awareness, practice and attitude of reporting students' incidents along with the perceived barriers. A response rate of (60.1% n = 264 of 450) was established. The majority of the respondents (62.9% n = 166) were aware of the incident reporting policy. Yet, only (35.4% n = 93) of them had completed an incident reporting form before. Most of the participants (90.5% n = 239) agreed on the necessity of reporting student's incidents, but only (67.0% n = 177) agreed on the necessity of reporting well-handled incidents. The possible negative relationship with students was the most agreed on barrier to reporting. This study shows that certain demographics of supervisors had significant relationship with their awareness, attitude, perceived barriers and practice. Awareness of the policy and form was linked to the increase in supervisors' practice, although they tend to report verbally rather than in writing. The possible negative relationship with students was the most common perceived barrier. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

75 FR 24584 - Request for Nominations for the Industry Trade Advisory Committees (ITACs)

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-05

... and the USTR regarding trade barriers, negotiation of trade agreements, and implementation of existing... trade negotiation objectives adequately reflect U.S. commercial and economic interests. Section 135(a)(1... regarding trade barriers, negotiation of trade agreements, and implementation of existing trade agreements...

Using Appropriate Digital Tools to Overcome Barriers to Collaborative Learning in Classrooms

ERIC Educational Resources Information Center

Wardlow, Liane; Harm, Eian

2015-01-01

Collaborative learning provides students with vital opportunities to create and build knowledge. Existing technologies can facilitate collaborative learning. However, barriers exist to enacting collaborative practices related to the coverage of material for assessments and classroom management concerns, among others. Teachers can overcome these…

Health care barriers, racism, and intersectionality in Australia.

PubMed

Bastos, João L; Harnois, Catherine E; Paradies, Yin C

2018-02-01

While racism has been shown to negatively affect health care quality, little is known about the extent to which racial discrimination works with and through gender, class, and sexuality to predict barriers to health care (e.g., perceived difficulty accessing health services). Additionally, most existing studies focus on racial disparities in the U.S. context, with few examining marginalized groups in other countries. To address these knowledge gaps, we analyze data from the 2014 Australian General Social Survey, a nationally representative survey of individuals aged 15 and older living in 12,932 private dwellings. Following an intersectional perspective, we estimate a series of multivariable logit regression models to assess three hypotheses: racial discrimination will be positively associated with perceived barriers to health care (H1); the effect of perceived racial discrimination will be particularly severe for women, sexual minorities, and low socio-economic status individuals (H2); and, in addition to racial discrimination, other forms of perceived discrimination will negatively impact perceived barriers to health care (H3). Findings show that perceptions of racial discrimination are significantly associated with perceived barriers to health care, though this relationship is not significantly stronger for low status groups. In addition, our analyses reveal that perceived racism and other forms of discrimination combine to predict perceived barriers to health care. Taken together, these results speak to the benefits of an intersectional approach for examining racial inequalities in perceived access to health care. Copyright © 2017 Elsevier Ltd. All rights reserved.

Environmental barriers and subjective health among people with chronic spinal cord injury: A cohort study

PubMed Central

Cao, Yue; Walker, Elizabeth A.; Krause, James S.

2015-01-01

Objective Although previous studies have found environmental barriers to be associated with social participation and life satisfaction after spinal cord injury (SCI), few studies exist reporting their effects on subjective health after SCI. Our purpose was to identify the prevalence of perceived environmental barriers and their effects on subjective health in persons with chronic SCI who completed two repeated measurements during a 5-year longitudinal study. Design This is a prospective cohort study. Environmental barriers were measured at baseline by the Craig Hospital Inventory of Environmental Factors-Short Form. Subjective health was measured at baseline and 5-year follow-up by days of physical and mental health not good. Other control variables included sex, race, age at injury, years since injury, and injury severity at baseline. Setting Data were collected at a specialty hospital and analyzed at a medical university in the Southeastern USA. Participants A total of 1635 participants completed both baseline and follow-up surveys. Results Twenty per cent of participants reported at least one policy barrier, 46% at least one physical and structural barrier, 22% at least one attitudinal and support barrier, 26% at least one barrier to services and assistance, and 13% at least one barrier at work or school. After controlling for sex, race, age at injury, years since injury, and injury severity, the physical and structural barriers, and services and assistance barriers measured at baseline significantly predicted subjective physical and mental health measured at follow-up. Conclusion Environmental barriers are prevalent among people with chronic SCI. They are important predictors for future subjective health. PMID:25329423

Dwell time, Hartman effect and transport properties in a ferromagnetic phosphorene monolayer

NASA Astrophysics Data System (ADS)

Hedayati Kh, Hamed; Faizabadi, Edris

2018-02-01

In this paper, spin-dependent dwell time, spin Hartman effect and spin-dependent conductance were theoretically investigated through a rectangular barrier in the presence of an exchange field by depositing a ferromagnetic insulator on the phosphorene layer in the barrier region. The existence of the spin Hartman effect was shown for all energies (energies lower than barrier height) and all incident angles in phosphorene. We also compared our results of the dwell time in the phosphorene structure with similar research performed on graphene. We reported a significant difference between the tunneling time values of incident quasiparticles with spin-up and spin-down. We found that the barrier was almost transparent for incident quasiparticles with a wide range of incident angles and energies higher than the barrier height in phosphorene. We also found that the maximum spin-dependent transmission probability for energies higher than barrier height does not necessarily occur in the zero incident angle. In addition, we showed that the spin conductance for energies higher (lower) than barrier height fluctuates (decays) in terms of barrier thickness. We discovered that, in contrast to graphene, the Klein paradox does not occur in the normal incident in the phosphorene structure. Furthermore, the results demonstrated the achievement of good total conductance at certain thicknesses of the barrier for energies higher than the barrier height. This study could serve as a basis for investigations of the basic physics of tunneling mechanisms and also for using phosphorene as a spin polarizer in designing nanoelectronic devices.

Dwell time, Hartman effect and transport properties in a ferromagnetic phosphorene monolayer.

PubMed

Hedayati Kh, Hamed; Faizabadi, Edris

2018-02-28

In this paper, spin-dependent dwell time, spin Hartman effect and spin-dependent conductance were theoretically investigated through a rectangular barrier in the presence of an exchange field by depositing a ferromagnetic insulator on the phosphorene layer in the barrier region. The existence of the spin Hartman effect was shown for all energies (energies lower than barrier height) and all incident angles in phosphorene. We also compared our results of the dwell time in the phosphorene structure with similar research performed on graphene. We reported a significant difference between the tunneling time values of incident quasiparticles with spin-up and spin-down. We found that the barrier was almost transparent for incident quasiparticles with a wide range of incident angles and energies higher than the barrier height in phosphorene. We also found that the maximum spin-dependent transmission probability for energies higher than barrier height does not necessarily occur in the zero incident angle. In addition, we showed that the spin conductance for energies higher (lower) than barrier height fluctuates (decays) in terms of barrier thickness. We discovered that, in contrast to graphene, the Klein paradox does not occur in the normal incident in the phosphorene structure. Furthermore, the results demonstrated the achievement of good total conductance at certain thicknesses of the barrier for energies higher than the barrier height. This study could serve as a basis for investigations of the basic physics of tunneling mechanisms and also for using phosphorene as a spin polarizer in designing nanoelectronic devices.

Efficient option valuation of single and double barrier options

NASA Astrophysics Data System (ADS)

Kabaivanov, Stanimir; Milev, Mariyan; Koleva-Petkova, Dessislava; Vladev, Veselin

2017-12-01

In this paper we present an implementation of pricing algorithm for single and double barrier options using Mellin transformation with Maximum Entropy Inversion and its suitability for real-world applications. A detailed analysis of the applied algorithm is accompanied by implementation in C++ that is then compared to existing solutions in terms of efficiency and computational power. We then compare the applied method with existing closed-form solutions and well known methods of pricing barrier options that are based on finite differences.

Attacking the Achievement Gap in a Diverse Urban-Suburban Community: A Curricular Case Study

ERIC Educational Resources Information Center

Alson, Allan

2006-01-01

The persistent and significant achievement gap between black and Latino students and their white and Asian counterparts at Evanston (Illinois) Township High School (ETHS) has existed for as long as anyone can remember. Stories real and apocryphal abound about the institutional barriers that have denied fairness and opportunity for minority…

""Moby-Dick" Is My Favorite:" Evaluating a Cognitively Accessible Portable Reading System for Audiobooks for Individuals with Intellectual Disability

ERIC Educational Resources Information Center

Davies, Daniel K.; Stock, Steven E.; King, Larry R.; Wehmeyer, Michael L.

2008-01-01

Significant barriers exist for individuals with intellectual disability to independently access print-based content. It is regrettable that, while the amount of content now available electronically increases, tools to access these materials have not been developed with individuals with intellectual disability in mind. This article reports the…

A Predictive Study of Learner Attitudes toward Open Learning in a Robotics Class

ERIC Educational Resources Information Center

Avsec, Stanislav; Rihtarsic, David; Kocijancic, Slavko

2014-01-01

Open learning (OL) strives to transform teaching and learning by applying learning science and emerging technologies to increase student success, improve learning productivity, and lower barriers to access. OL of robotics has a significant growth rate in secondary and/or high schools, but failures exist. Little is known about why many users stop…

Supporting the Implementation of Evidence-Based Practices for Adults with Co-Occurring Mental and Substance Use Disorders

ERIC Educational Resources Information Center

Biegel, David E.; Kola, Lenore A.; Ronis, Robert R.

2007-01-01

Significant barriers exist to the implementation of evidence-based practices into routine mental health and substance abuse settings. This paper discusses the role and function of technical assistance centers to help support the implementation process using, as a guide, the experience of the Ohio Substance Abuse and Mental Illness Coordinating…

Telehealth Delivery of Cognitive-Behavioral Intervention to Youth with Autism Spectrum Disorder and Anxiety: A Pilot Study

ERIC Educational Resources Information Center

Hepburn, Susan L.; Blakeley-Smith, Audrey; Wolff, Brian; Reaven, Judy A.

2016-01-01

Youth with autism spectrum disorders frequently experience significant symptoms of anxiety. Empirically supported psychosocial interventions exist, yet access is limited, especially for families in rural areas. Telehealth (i.e. videoconferencing) has potential to reduce barriers to access to care; however, little is known about the feasibility or…

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

ERIC Educational Resources Information Center

Johnson, Cooper; Long, Jamye; Faught, Sam

2014-01-01

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

Correlation between nicotine dependence and barriers to cessation between exclusive cigarette smokers and dual (water pipe) smokers among Arab Americans

PubMed Central

El-Shahawy, Omar; Haddad, Linda

2015-01-01

Background Evidence suggests that dual cigarette and water pipe use is growing among minority groups, particularly among Arab Americans. Differences in nicotine dependence and barriers to smoking cessation among such dual smokers have not been previously examined in this population. We examined potential differences that might exist between exclusive cigarette smokers and dual smokers (cigarette and water pipe) pertaining to nicotine dependence and barriers to cessation among Arab Americans. Methods We conducted a cross-sectional study using a convenience sample of self-identified Arab immigrant smokers (n=131) living in the Richmond, VA metropolitan area. Data were collected using four questionnaires: Demographic and Cultural Information questionnaire, Tobacco Use questionnaire, Fagerström Test for Nicotine Dependence (FTND) questionnaire, and Barriers to Cessation questionnaire. We examined differences in nicotine dependence and barriers to cessation between exclusive cigarette smokers and dual smokers of cigarettes and water pipe. Furthermore, we explored the correlations of these measures with select variables. Results There was a significant difference in the FTND scores between the exclusive cigarette smokers (mean M=2.55, standard deviation [SD] =2.10) and dual smokers (M=3.71, SD =2.42); t(129) = (2.51), P=0.0066. There was also a significant difference in the Barriers to Cessation scores between exclusive cigarette smokers (M=38.47, SD =13.07) and dual smokers (M=45.21, SD =9.27); t(129) = (2.56), P=0.0058. Furthermore, there was a highly significant correlation among FTND scores, Barriers to Cessation scores, and past quit attempts among dual smokers. Conclusion Water pipe tobacco smoking seems to be both adding to the dependence potential of cigarette smoking and enhancing barriers to cessation in our study sample. However, the high correlation between quit attempts, FTND, and barriers to cessation needs further investigation to ascertain the possible reasons behind it. This preliminary study utilized a cross-sectional survey among participants of a rather small convenience sample, especially in the dual smokers group. Thus, there is a need to examine these differences via a longitudinal design in a larger sample. PMID:25674035

Low-cost grass restoration using erosion barriers in a degraded African rangeland

USGS Publications Warehouse

Kimiti, David W; Riginos, Corinna; Belnap, Jayne

2017-01-01

Rangeland degradation, typified by extensive bare ground and soil erosion, is a serious problem around the world. In sub-Saharan Africa, rangeland degradation threatens the food security of millions of people who depend on livestock and the region's large mammalian wildlife diversity. We tested the ability of five simple, low-cost erosion barriers to promote grass and forb establishment in a bare ground-dominated rangeland in Kenya. These treatments were: (1) trenches with small berms; (2) bundles of branches; and bundles of branches with (3) elephant dung balls, (4) burlap sacking, or (5) nylon mesh sacking inside them. We also tested whether barrier performance depended on (1) supplemental seeding with the grass Cenchrus ciliaris and (2) whether a barrier was located next to existing vegetation patches versus in the open. Within months, the trench and nylon mesh barriers had accumulated 20–50% more sediment than other treatments and had greater grass and forb seedling establishment. Seeding with Cenchrusresulted in higher herbaceous cover but was not necessary for other grasses to establish. After 3 years, the trench and nylon mesh barriers had created patches of new vegetation averaging 18–63% larger than patches created by the other treatments. Barriers that were initially adjacent to existing vegetation had created new vegetation patches averaging 65% larger than those created by solitary barriers. Results suggest that all barrier types increase grass cover but that trenches—especially if placed next to existing vegetation patches—are a particularly cost-effective way to reduce bare ground and erosion in degraded rangelands.

A palliative care needs assessment of rural hospitals.

PubMed

Fink, Regina M; Oman, Kathleen S; Youngwerth, Jeanie; Bryant, Lucinda L

2013-06-01

Palliative care services are lacking in rural hospitals. Implementing palliative care services in rural and remote areas requires knowledge of available resources, specific barriers, and a commitment from the hospital and community. The purpose of the study was to determine awareness, knowledge, barriers, and resources regarding palliative care services in rural hospitals. A descriptive survey design used an investigator-developed needs assessment to survey 374 (40% response rate) health care providers (chief executive officers, chiefs of medical staff, chief nursing officers, and social worker directors) at 236 rural hospitals (<100 beds) in seven Rocky Mountain states. Significant barriers to integrating palliative care exist: lack of administrative support, mentorship, and access to palliative care resources; inadequate basic knowledge about palliative care strategies; and limited training/skills in palliative care. Having contractual relationships with local hospices is a key facilitator. Respondents (56%) want to learn more about palliative care, specifically focusing on pain management, communication techniques, and end-of-life care issues. Webinar and online courses were suggested as strategies to promote long distance learning. It is imperative for quality of care that rural hospitals have practitioners who are up to date on current evidence and practice within a palliative care framework. Unique challenges exist to implementing palliative care services in rural hospitals. Opportunities for informing rural areas focus around utilizing existing hospice resources and relationships, and favoring Web-based classes and online courses. The development of a multifaceted intervention to facilitate education about palliative care and cultivate palliative care services in rural settings is indicated.

Application of the modified transient plane source technique for early detection of liquid explosives

NASA Astrophysics Data System (ADS)

Bateman, Robert; Harris, Adam; Lee, Linda; Howle, Christopher R.; Ackermann, Sarah L. G.

2016-05-01

The paper will review the feasibility of adapting the Modified Transient Plane Source (MTPS) method as a screening tool for early-detection of explosives and hazardous materials. Materials can be distinguished from others based on their inherent thermal properties (e.g. thermal effusivity) in testing through different types of barrier materials. A complimentary advantage to this technique relative to other traditional detection technologies is that it can penetrate reflective barrier materials, such as aluminum, easily. A strong proof-of-principle is presented on application of the MTPS transient thermal property measuring in the early-screening of liquid explosives. The work demonstrates a significant sensitivity to distinguishing a wide range of fluids based on their thermal properties through a barrier material. The work covers various complicating factors to the longer-term adoption of such a method including the impact of carbonization and viscosity. While some technical challenges remain, the technique offers significant advantages in complimenting existing detection methods in being able to penetrate reflective metal containers (e.g. aluminum soft drinkscans) with ease.

78 FR 63270 - Request for Public Comments To Compile the Report on Sanitary and Phytosanitary Measures

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-23

... focus on the most significant SPS barriers to trade, USTR will be guided by the existence of active... protect the life or health of humans, animals, and plants from risks arising from additives, contaminants....regulations.gov Web site provides the option of making submissions by filling in a comments field, or by...

A Game-Theoretic Model of Curriculum Integration and School Leadership. Publication Series No. 4

ERIC Educational Resources Information Center

Stull, William J.

2004-01-01

Curriculum integration (CI) is an educational strategy aimed primarily at students who take significant numbers of both academic and vocational courses either as part of a formal program or on their own. Its goal is to enhance the learning of these students by breaking down the traditional barrier that exists in most schools between the two…

Right at Your Fingertips: Important Web-Based Resources for Understanding Evidence-Based Practices

ERIC Educational Resources Information Center

Purper, Cammy J.

2016-01-01

The era of educational accountability has drawn attention to a need for the use of evidence-based practices (EBPs) in today's classrooms. The existence of a research-to-practice gap is well established in the field of early childhood education (ECE), and significant barriers to the use of EBPs by practitioners have been documented through…

Primary Health Care

PubMed Central

Leslie, Laurel K.; Mehus, Christopher J.; Hawkins, J. David; Boat, Thomas; McCabe, Mary Ann; Barkin, Shari; Perrin, Ellen C.; Metzler, Carol W.; Prado, Guillermo; Tait, V. Fan; Brown, Randall; Beardslee, William

2017-01-01

Family-focused prevention programs have been shown to effectively reduce a range of negative behavioral health outcomes but have had limited reach. Three key barriers must be overcome to expand the reach of family-focused prevention programs and thereby achieve a significant public health impact. These barriers are: (1) current social norms and perceptions of parenting programs; (2) concerns about the expertise and legitimacy of sponsoring organizations to offer parenting advice; and (3) a paucity of stable, sustainable funding mechanisms. Primary healthcare settings are well positioned to overcome these barriers. Recent changes within health care make primary care settings an increasingly favorable home for family-focused prevention and suggest possibilities for sustainable funding of family-focused prevention programs. This paper discusses the existing advantages of primary care settings and lays out a plan to move toward realizing the potential public health impact of family-focused prevention through widespread implementation in primary healthcare settings. PMID:27498167

Intrinsic rotation, hysteresis and back transition in reversed shear internal transport barriers

NASA Astrophysics Data System (ADS)

Kim, S. S.; Jhang, Hogun; Diamond, P. H.; Terzolo, L.; Yi, S.; Hahm, T. S.

2011-07-01

A study of intrinsic rotation and hysteresis in ion thermal internal transport barrier (ITB) is presented. Global flux-driven gyrofluid simulations are performed. It is found that significant co-current intrinsic rotation (0.1 <~ Mth <~ 0.2, where Mth is the thermal Mach number) can be produced in ITB plasmas. Exploration of the relationship between the intrinsic rotation and the ITB temperature gradient leads to a novel scaling of intrinsic rotation in ITB plasmas. Long time power ramp simulations with self-consistently evolving profiles clearly demonstrate the existence of hysteresis in reversed shear ITBs. It is shown that intrinsic rotation plays an important role in ITB dynamics and is responsible for determining unique properties of ITB hysteresis. A negative feedback mechanism based on destruction of E × B shear prevails in barrier back transition, triggered by an outward momentum transport event during the power ramp down.

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

PubMed Central

2014-01-01

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

Controlled growth of aligned carbon nanotube using pulsed glow barrier discharge

NASA Astrophysics Data System (ADS)

Nozaki, Tomohiro; Kimura, Yoshihito; Okazaki, Ken

2002-10-01

We first achieved a catalytic growth of aligned carbon nanotube (CNT) using atmospheric pressure pulsed glow barrier discharge combined with DC bias (1000 V). Aligned CNT can grow with the directional electric field, and this is a big challenge in barrier discharges since dielectric barrier does not allow DC bias and forces to use AC voltage to maintain stable plasma conditions. To overcome this, we developed a power source generating Gaussian-shape pulses at 20 kpps with 4% duty, and DC bias was applied to the GND electrode where Ni-, Fe-coated substrate existed. With positive pulse, i.e. substrate was the cathode, random growth of CNT was observed at about 10^9 cm-2. Growth rate significantly reduced when applied negative pulse; Negative glow formation near substrate is essential for sufficient supply of radical species to the catalyst. If -DC was biased, aligned CNT with 20 nm was synthesized because negative bias enhanced negative glow formation. Interestingly, 2 to 3 CNTs stuck each other with +DC bias, resulting in 50-70 nm and non-aligned CNT. Atmospheric pressure glow barrier discharges can be highly controlled and be a potential alternative to vacuum plasmas for CVD, micro-scale, nano-scale fabrication.

Targeting Hispanic populations: future research and prevention strategies.

PubMed Central

Ramirez, A G; McAlister, A; Gallion, K J; Villarreal, R

1995-01-01

Minority populations face a wide variety of economic, institutional, and cultural barriers to health care. These barriers and low levels of education and income pose significant challenges for health professionals in developing cancer research and prevention-control strategies. It is suggested that specific segments of Hispanic populations fit the model of an underdeveloped country in the intermediate stage of epidemiological transition. Since noncommunicable diseases have not yet fully emerged in some of these Hispanic population segments, the opportunity exists to apply primordial prevention strategies. Such campaigns would focus on dissuading members of these populations from adopting negative health behaviors while promoting positive lifestyle choices. Optimal programs would increase cancer screening participation and discourage risk behaviors through community-oriented, population-based interventions. Future directions in prevention and control efforts for minority populations should include expanded health insurance coverage, improved access to health care, greater emphasis on minority recruitment in health care fields, focused epidemiologic and clinical research, and identification and replication of effective components within existing prevention-control programs. PMID:8741800

Making an APPropriate Care Program for Indigenous Cardiac Disease: Customization of an Existing Cardiac Rehabilitation Program.

PubMed

Bradford, DanaKai; Hansen, David; Karunanithi, Mohan

2015-01-01

Cardiovascular disease is a major health problem for all Australians and is the leading cause of death in Aboriginal and Torres Strait Islanders. In 2010, more then 50% of all heart attack deaths were due to repeated events. Cardiac rehabilitation programs have been proven to be effective in preventing the recurrence of cardiac events and readmission to hospitals. There are however, many barriers to the use of these programs. To address these barriers, CSIRO developed an IT enabled cardiac rehabilitation program delivered by mobile phone through a smartphone app and succesfully trialed it in an urban general population. If these results can be replicated in Indigenous populations, the program has the potential to significantly improve life expectancy and help close the gap in health outcomes. The challenge described in this paper is customizing the existing cardiac health program to make it culturally relevant and suitable for Indigenous Australians living in urban and remote communities.

Enhanced communication and coordination in the public health surveillance component of the Cincinnati Drinking Water Contamination Warning System.

PubMed

Dangel, Chrissy; Allgeier, Steven C; Gibbons, Darcy; Haas, Adam; Simon, Katie

2012-03-01

Effective communication and coordination are critical when investigating a possible drinking water contamination incident. A contamination warning system is designed to detect water contamination by initiating a coordinated, effective response to mitigate significant public health and economic consequences. This article describes historical communication barriers during water contamination incidents and discusses how these barriers were overcome through the public health surveillance component of the Cincinnati Drinking Water Contamination Warning System, referred to as the "Cincinnati Pilot." By enhancing partnerships in the public health surveillance component of the Cincinnati Pilot, information silos that existed in each organization were replaced with interagency information depots that facilitated effective decision making.

Free energy profiles of cocaine esterase-cocaine binding process by molecular dynamics and potential of mean force simulations.

PubMed

Zhang, Yuxin; Huang, Xiaoqin; Han, Keli; Zheng, Fang; Zhan, Chang-Guo

2016-11-25

The combined molecular dynamics (MD) and potential of mean force (PMF) simulations have been performed to determine the free energy profile of the CocE)-(+)-cocaine binding process in comparison with that of the corresponding CocE-(-)-cocaine binding process. According to the MD simulations, the equilibrium CocE-(+)-cocaine binding mode is similar to the CocE-(-)-cocaine binding mode. However, based on the simulated free energy profiles, a significant free energy barrier (∼5 kcal/mol) exists in the CocE-(+)-cocaine binding process whereas no obvious free energy barrier exists in the CocE-(-)-cocaine binding process, although the free energy barrier of ∼5 kcal/mol is not high enough to really slow down the CocE-(+)-cocaine binding process. In addition, the obtained free energy profiles also demonstrate that (+)-cocaine and (-)-cocaine have very close binding free energies with CocE, with a negligible difference (∼0.2 kcal/mol), which is qualitatively consistent with the nearly same experimental K M values of the CocE enzyme for (+)-cocaine and (-)-cocaine. The consistency between the computational results and available experimental data suggests that the mechanistic insights obtained from this study are reasonable. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Nobody's Really Ever Asked Me Why: Anxiety as a Barrier to School Success

ERIC Educational Resources Information Center

Kratt, Diane M.

2016-01-01

Children's mental health can be a barrier to school success. School-based mental health services exist and research has shown positive results with the implementation of them. However, students spend the majority of their school time with a teacher and very little research exists on the role of a teacher in regards to students with mental health…

Evidence-based surgery: barriers, solutions, and the role of evidence synthesis.

PubMed

Garas, George; Ibrahim, Amel; Ashrafian, Hutan; Ahmed, Kamran; Patel, Vanash; Okabayashi, Koji; Skapinakis, Petros; Darzi, Ara; Athanasiou, Thanos

2012-08-01

Surgery is a rapidly evolving field, making the rigorous testing of emerging innovations vital. However, most surgical research fails to employ randomized controlled trials (RCTs) and has particularly been based on low-quality study designs. Subsequently, the analysis of data through meta-analysis and evidence synthesis is particularly difficult. Through a systematic review of the literature, this article explores the barriers to achieving a strong evidence base in surgery and offers potential solutions to overcome the barriers. Many barriers exist to evidence-based surgical research. They include enabling factors, such as funding, time, infrastructure, patient preference, ethical issues, and additionally barriers associated with specific attributes related to researchers, methodologies, or interventions. Novel evidence synthesis techniques in surgery are discussed, including graphics synthesis, treatment networks, and network meta-analyses that help overcome many of the limitations associated with existing techniques. They offer the opportunity to assess gaps and quantitatively present inconsistencies within the existing evidence of RCTs. Poorly or inadequately performed RCTs and meta-analyses can give rise to incorrect results and thus fail to inform clinical practice or revise policy. The above barriers can be overcome by providing academic leadership and good organizational support to ensure that adequate personnel, resources, and funding are allocated to the researcher. Training in research methodology and data interpretation can ensure that trials are conducted correctly and evidence is adequately synthesized and disseminated. The ultimate goal of overcoming the barriers to evidence-based surgery includes the improved quality of patient care in addition to enhanced patient outcomes.

Attitudes and barriers to evidence-based practice in optometry educators.

PubMed

Suttle, Catherine M; Challinor, Kirsten L; Thompson, Rachel E; Pesudovs, Konrad; Togher, Leanne; Chiavaroli, Neville; Lee, Adrian; Junghans, Barbara; Stapleton, Fiona; Watt, Kathleen; Jalbert, Isabelle

2015-04-01

Evidence-based practice (EBP) is an essential component of good quality, patient-centered health care. This requires practitioners to acquire EBP skills and knowledge during undergraduate and continuing education. Evidence-based practice education exists in a range of health care disciplines, including optometry. Evidence-based practice education, however, depends on relevant skills and knowledge in educators. Courses and workshops exist for the development of EBP teaching skills in some areas of health care but not in optometry. Here, we describe a pilot workshop designed to enhance the teaching of EBP and to investigate the perspectives of optometric educators on EBP including their attitudes and perceived barriers to EBP and its teaching. Twenty-seven optometric educators including 8 facilitators participated. Of these, 14 were academics (including the 8 facilitators) and 13 were practitioners. Evidence-based practice attitudes were assessed using the Evidence-Based Practice Attitude Scale-50 with appropriate modifications for optometry. Workshop design incorporated strategies to trigger discussion among participants. A nominal group technique was used to identify, prioritize, and reach consensus on barriers to EBP. Although some participants expressed reservations about EBP, a common understanding of the contemporary definition of EBP emerged in educators. Thirty-five barriers to EBP were identified; "time" was selected in the top five barriers by most participants and attracted the highest total score, well above any other barrier (negative attitude to EBP, volume of evidence, integration with clinical practice, and lack of lifelong learning mind-set). Attitudes toward EBP were generally positive and negatively correlated with age and time since graduation, respectively. A group of optometrists and academics new to implementing education in EBP displayed positive attitudes to EBP but considered that its application and teaching could be significantly hindered by a lack of time to access and appraise the large volume of available research evidence in the field of eye care.

Barriers and Enablers to Evidence-Based Practices

ERIC Educational Resources Information Center

Foster, Robyn

2014-01-01

The importance of educational practices based on evidence is well-supported in the literature, however barriers to their implementation in classrooms still exist. This paper examines the phenomenon of evidence-based practice in education highlighting enablers and barriers to their implementation with particular reference to RTLB practice.

Barriers to the long-term recovery of individuals with disabilities following a disaster.

PubMed

Stough, Laura M; Sharp, Amy N; Resch, J Aaron; Decker, Curt; Wilker, Nachama

2016-07-01

This study examines how pre-existing disabling conditions influenced the recovery process of survivors of Hurricane Katrina. It focuses specifically on the barriers that hindered the recovery process in these individuals. Focus groups were convened in four Gulf Coast states with 31 individuals with disabilities who lived in or around New Orleans, Louisiana, prior to Hurricane Katrina in August 2005. Qualitative data were analysed using grounded theory methodology. Five themes emerged as the most significant barriers to recovery: housing; transportation; employment; physical and mental health; and accessing recovery services. While these barriers to recovery were probably common to most survivors of the disaster, the research results suggest that disability status enhanced the challenges that participants experienced in negotiating the recovery process and in acquiring resources that accommodated their disabilities. The findings indicate that, when disaster recovery services and resources did not accommodate the needs of individuals with disabilities, recovery was hindered. Recovery efforts should include building accessible infrastructure and services that will allow for participation by all. © 2016 The Author(s). Disasters © Overseas Development Institute, 2016.

49 CFR 213.347 - Automotive or railroad crossings at grade.

Code of Federal Regulations, 2010 CFR

2010-10-01

... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION TRACK SAFETY STANDARDS Train Operations at Track Classes 6 and.../barrier system to address the protection of highway traffic and high speed trains. Trains shall not...-approved warning/barrier system exists on that track segment; and (2) All elements of that warning/barrier...

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...

"My Award Is for My Students"

ERIC Educational Resources Information Center

Adults Learning, 2009

2009-01-01

This article features ESOL (English for Speakers of Other Languages) co-ordinator Lynn Evans, recipient of the Learning and Skills Improvement Service STAR Award. Lynn's teaching is all about breaking down barriers, whether that means the personal barriers that prevent learners from achieving their potential or the barriers that exist among…

Homoclinic orbits and critical points of barrier functions

NASA Astrophysics Data System (ADS)

Cannarsa, Piermarco; Cheng, Wei

2015-06-01

We interpret the close link between the critical points of Mather's barrier functions and minimal homoclinic orbits with respect to the Aubry sets on {{T}}n . We also prove a critical point theorem for barrier functions and the existence of such homoclinic orbits on {{T}}2 as an application.

Prediction of barrier island restoration response and its interactions with the natural environment

NASA Astrophysics Data System (ADS)

Plant, N. G.; Stockdon, H. F.; Flocks, J.; Sallenger, A. H.; Long, J. W.; Cormier, J. M.; Guy, K.; Thompson, D. M.

2012-12-01

A 2-meter high sand berm was constructed along Chandeleur Island, Louisiana, in an attempt to provide protection against the Deepwater Horizon oil spill. Berm construction started in June 2010 and ended in April 2011. Variations in both island morphology and construction of the 15-km long berm resulted in the development of four different morphologies: a berm built on a submerged island platform to the north of the existing island, a berm built seaward of the existing island, a berm built along the island shoreline, and portions of the island where no berm was constructed. These different morphologies provide a natural laboratory for testing the understanding of berm and barrier island response to storms. In particular, the ability to predict berm evolution using statistical modeling of the interactions between the island, berm, and oceanographic processes was tested. This particular test was part of a broader USGS research effort to understand processes that bridge the gap between short-term storm response and longer-term geologic and climate interactions that shape barrier-island systems. Berm construction and subsequent berm and island evolution were monitored using satellite and aerial remote sensing and topographic and bathymetric surveys. To date, significant berm evolution occurred in both the north (including terminal erosion, overwash, and a large breach), center (overwash and numerous breaches), and south (overwash). The response of the central portion of the berm to winter and tropical storms was significant such that none of the residual berm remained within its construction footprint. The evolution of the central portion of the berm was well predicted using a statistical modeling approach that used predicted and modeled wave conditions to identify the likelihood of overwash events. Comparison of different modeled evolution scenarios to the one that was observed showed that berm response was sensitive to the frequency and severity of winter and tropical storms. These findings demonstrate an observation and modeling approach that can be applied to understanding and managing other natural and restored barrier islands.

Magnetic resonance imaging of blood-brain barrier permeability in ischemic stroke using diffusion-weighted arterial spin labeling in rats.

PubMed

Tiwari, Yash V; Lu, Jianfei; Shen, Qiang; Cerqueira, Bianca; Duong, Timothy Q

2017-08-01

Diffusion-weighted arterial spin labeling magnetic resonance imaging has recently been proposed to quantify the rate of water exchange (K w ) across the blood-brain barrier in humans. This study aimed to evaluate the blood-brain barrier disruption in transient (60 min) ischemic stroke using K w magnetic resonance imaging with cross-validation by dynamic contrast-enhanced magnetic resonance imaging and Evans blue histology in the same rats. The major findings were: (i) at 90 min after stroke (30 min after reperfusion), group K w magnetic resonance imaging data showed no significant blood-brain barrier permeability changes, although a few animals showed slightly abnormal K w . Dynamic contrast-enhanced magnetic resonance imaging confirmed this finding in the same animals. (ii) At two days after stroke, K w magnetic resonance imaging revealed significant blood-brain barrier disruption. Regions with abnormal K w showed substantial overlap with regions of hyperintense T 2 (vasogenic edema) and hyperperfusion. Dynamic contrast-enhanced magnetic resonance imaging and Evans blue histology confirmed these findings in the same animals. The K w values in the normal contralesional hemisphere and the ipsilesional ischemic core two days after stroke were: 363 ± 17 and 261 ± 18 min -1 , respectively (P < 0.05, n = 9). K w magnetic resonance imaging is sensitive to blood-brain barrier permeability changes in stroke, consistent with dynamic contrast-enhanced magnetic resonance imaging and Evans blue extravasation. K w magnetic resonance imaging offers advantages over existing techniques because contrast agent is not needed and repeated measurements can be made for longitudinal monitoring or averaging.

Perceived barriers to accessing adequate nutrition among food insecure households within a food desert.

PubMed

Tolzman, Casey; Rooney, Brenda; Duquette, R Daniel; Rees, Keely

2014-08-01

The US Department of Agriculture has identified an area in La Crosse, Wisconsin as a food desert-a low-income area with a low level of access to a grocery store or healthy, affordable food outlet. The purpose of this study was to determine the prevalence and potential predictors of severe food insecurity in this area. Questionnaires assessing food insecurity and perceived barriers to accessing adequate nutrition were sent out to 2,068 households located within the food desert in La Crosse. Data was analyzed to examine correlations between severe food insecurity and demographics, certain health behaviors, and perceived barriers to nutrition. Overall food insecurity existed in 33.9% of households: severe food insecurity with hunger in 14.6%, and without hunger in 19.3%. Significant correlations to severe food insecurity included health insurance status (Medicaid vs private insurance, OR 3.5), renting a home (OR 5.23), identifying the cost of healthy foods as a significant barrier (OR 2.97), having no transportation to a store (OR 3.09), not having enough money (OR 22.88), and currently smoking (OR 3.60). Severe food insecurity was much higher in this population than expected. Clinicians should consider the patient's ability to access and afford healthy food as part of the patient's health history, as well as considering individual and population solutions.

Approaches to formalization of the informal waste sector into municipal solid waste management systems in low- and middle-income countries: Review of barriers and success factors.

PubMed

Aparcana, Sandra

2017-03-01

The Municipal Solid Waste Management (MSWM) sector represents a major challenge for low-and middle-income countries due to significant environmental and socioeconomic issues involving rapid urbanization, their MSWM systems, and the existence of the informal waste sector. Recognizing its role, several countries have implemented various formalization measures, aiming to address the social problems linked to this sector. However, regardless of these initiatives, not all attempts at formalization have proved successful due to the existence of barriers preventing their implementation in the long term. Along with this, there is a frequent lack of knowledge or understanding regarding these barriers and the kind of measures that may enable formalization, thereby attaining a win-win situation for all the stakeholders involved. In this context, policy- and decision-makers in the public and private sectors are frequently confronted with the dilemma of finding workable approaches to formalization, adjusted to their particular MSWM contexts. Building on the review of frequently implemented approaches to formalization, including an analysis of the barriers to and enabling measures for formalization, this paper aims to address this gap by explaining to policy- and decision-makers, and to waste managers in the private sector, certain dynamics that can be observed and that should be taken into account when designing formalization strategies that are adapted to their particular socioeconomic and political-institutional context. This includes possible links between formalization approaches and barriers, the kinds of barriers that need to be removed, and enabling measures leading to successful formalization in the long term. This paper involved a literature review of common approaches to formalization, which were classified into three categories: (1) informal waste workers organized in associations or cooperatives; (2) organized in CBOs or MSEs; and (3) contracted as individual workers by the formal waste sector. This was followed by the identification and subsequent classification of measures for removing common barriers to formalization into five categories: policy/legal, institutional/organizational, technical, social, and economic/financial. The approaches to formalization, as well as the barrier categories, were validated through the assessment of twenty case studies of formalization. Building on the assessment, the paper discussed possible links between formalization approaches and barriers, the 'persistent' challenges that represent barriers to formalization, as well as key enabling factors improving the likelihood of successful formalization. Regardless of the type of approach adopted to formalization, the review identifies measures to remove barriers in all five categories, with a stronger link between the approaches 1 and 2 and the existence of measures in the policy, institutional, and financial categories. Regarding persistent barriers, the review identified ones arising from the absence of measures to address a particular issue before formalization or due to specific country- or sector-related conditions, and their interaction with the MSWM context. 75% of the case studies had persistent barriers in respect of policy/legal issues, 50% of institutional/organizational, 45% of financial/economic, and 40%, and 35% of social and technical issues respectively. This paper concludes that independently of the formalization approach, the lack of interventions or measures in any of the five categories of barriers may lead formalization initiatives to fail, as unaddressed barriers become 'persistent' after formalization is implemented. Furthermore, 'persistent barriers' may also appear due to unfavorable country-specific conditions. The success of a formalization initiative does not depend on a specific approach, but most likely on the inclusion of country-appropriate measures at the policy, economic and institutional levels. The empowerment of informal waste-workers is again confirmed as a further key success factor for their formalization. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

PubMed Central

Rhee, Daniel S.; Heckman, Jennifer E.

2014-01-01

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

Education, implementation, and policy barriers to greater integration of palliative care: A literature review.

PubMed

Aldridge, Melissa D; Hasselaar, Jeroen; Garralda, Eduardo; van der Eerden, Marlieke; Stevenson, David; McKendrick, Karen; Centeno, Carlos; Meier, Diane E

2016-03-01

Early integration of palliative care into the management of patients with serious disease has the potential to both improve quality of life of patients and families and reduce healthcare costs. Despite these benefits, significant barriers exist in the United States to the early integration of palliative care in the disease trajectory of individuals with serious illness. To provide an overview of the barriers to more widespread palliative care integration in the United States. A literature review using PubMed from 2005 to March 2015 augmented by primary data collected from 405 hospitals included in the Center to Advance Palliative Care's National Palliative Care Registry for years 2012 and 2013. We use the World Health Organization's Public Health Strategy for Palliative Care as a framework for analyzing barriers to palliative care integration. We identified key barriers to palliative care integration across three World Health Organization domains: (1) education domain: lack of adequate education/training and perception of palliative care as end-of-life care; (2) implementation domain: inadequate size of palliative medicine-trained workforce, challenge of identifying patients appropriate for palliative care referral, and need for culture change across settings; (3) policy domain: fragmented healthcare system, need for greater funding for research, lack of adequate reimbursement for palliative care, and regulatory barriers. We describe the key policy and educational opportunities in the United States to address and potentially overcome the barriers to greater integration of palliative care into the healthcare of Americans with serious illness. © The Author(s) 2015.

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.

Identifying Food Safety Concerns when Communication Barriers Exist

ERIC Educational Resources Information Center

Neal, Jack A.; Dawson, Mary; Madera, Juan M.

2011-01-01

Abstract: Students must be prepared to lead a diverse workforce. The objective of this study was to establish a teaching method that helps students identify barriers to food safety while working in a simulated environment with communication barriers. This study employed a perspective taking exercise based upon the principles of social learning…

Is There a Foreign Language Barrier in Engineering Research?

ERIC Educational Resources Information Center

Hawks, Carla; And Others

Perception and effects of foreign language publications in engineering research are examined. Through the use of both survey and archival sources, including coverage in major scientific and technical databases as vended by DIALOG, various aspects of the foreign language barrier were measured. A foreign language barrier is said to exist when…

Possibilities of the fish pass restoration

NASA Astrophysics Data System (ADS)

Čubanová, Lea

2018-03-01

According to the new elaborated methodology of the Ministry of Environment of the Slovak Republic: Identification of the appropriate fish pass types according to water body typology (2015) each barrier on the river must be passable. On the barriers or structures without fish passes new ones should be design and built and on some water structures with existed but nonfunctional fish passes must be realized reconstruction or restoration of such objects. Assessment should be done in terms of the existing migratory fish fauna and hydraulic conditions. Fish fauna requirements resulting from the ichthyological research of the river section with barrier. Hydraulic conditions must than fulfil these requirements inside the fish pass body.

Barriers to meditation by gender and age among cancer family caregivers.

PubMed

Williams, Anna-Leila; Ness, Peter Van; Dixon, Jane; McCorkle, Ruth

2012-01-01

Despite solid basic science research supporting meditation's physiologic benefits, meditation remains a marginalized practice for many Westerners; observational and descriptive studies indicate a spectrum of barriers to meditation practice. The aim of this study was to determine differences in barriers to meditation by gender and age. A cross-sectional survey study of 150 family caregivers to adults with cancer visiting an outpatient chemotherapy center in Connecticut was conducted. The primary outcome was the Determinants of Meditation Practice Inventory. Explanatory variables included demographic characteristics, Center for Epidemiologic Studies-Depression Scale, Big Five Inventory, and Caregiver Reaction Assessment. Participants included 98 women and 52 men. Age range was 18-84 years (M = 52.3 years). The highest frequency of barriers for both genders related to misconceptions about meditation. The total number of barriers to meditation did not significantly vary by gender (p = .10) nor age (p = .27). After adjusting for personality trait, reactions to caregiving, and emotional distress, gender (adjusted β = 0.81, SE = 1.70, p = .63) and age (adjusted β = 0.02, SE = 0.05, p = .67) still did not predict the number of barriers to meditation. Backward elimination in model building showed that personality trait and reactions to caregiving account for 32% of the variability in barriers. The total number of barriers to meditation was examined, and a difference was not found by age or gender. It is possible that differences by age and gender exist at the item level of evaluation but were not evident when evaluating total scores. Further study is needed with samples large enough to have statistical power for item-level analysis.

Perceived benefits and barriers to exercise among persons with physical disabilities or chronic health conditions within action or maintenance stages of exercise.

PubMed

Malone, Laurie A; Barfield, J P; Brasher, Joel D

2012-10-01

Information regarding factors that affect the initial step to exercise behavior change among persons with physical disabilities or chronic health conditions is available in the literature but much less is known regarding perceived benefits and barriers to exercise among those who are regularly active. The purpose of this study was to examine the perceived benefits and barriers to exercise among persons with physical disabilities or chronic health conditions within action or maintenance stages of exercise. Participants (n = 152) completed the Exercise Benefits and Barriers Scale (EBBS). For data analyses, disabilities and health conditions were grouped as neuromuscular, orthopedic, cardiovascular/pulmonary, or multiple conditions. Multivariate analysis of variance (MANOVA) was conducted to determine if mean differences on EBBS benefits and barriers scores existed among disability types, between sexes, among age groups, and between physical activity levels. Sum scores were computed to determine the strongest benefit and barrier responses. No significant mean differences in EBBS scores were found between disability types, sexes, age groups, or physical activity levels (p > 0.05). Strongest benefit responses varied by group. Strongest barrier responses were the same for all demographic groups: "Exercise tires me," "Exercise is hard work for me," and "I am fatigued by exercise." EBBS scores were similar across disability/health condition, sex, age, and physical activity level. Primary benefits reported were in the areas of improved physical performance and psychological outlook whereas the primary barriers were in the area of physical exertion. Copyright © 2012 Elsevier Inc. All rights reserved.

Geographic distance affects dispersal of the patchy distributed greater long-tailed hamster (Tscherskia triton).

PubMed

Xue, Huiliang; Zhong, Min; Xu, Jinhui; Xu, Laixiang

2014-01-01

Dispersal is a fundamental process in ecology influencing the genetic structure and the viability of populations. Understanding how variable factors influence the dispersal of the population is becoming an important question in animal ecology. To date, geographic distance and geographic barriers are often considered as main factors impacting dispersal, but their effects are variable depending on different conditions. In general, geographic barriers affect more significantly than geographic distance on dispersal. In rapidly expanding populations, however, geographic barriers have less effect on dispersal than geographic distance. The effects of both geographic distance and geographic barriers in low-density populations with patchy distributions are poorly understood. By using a panel of 10 microsatellite loci we investigated the genetic structure of three patchy-distributed populations of the Greater long-tailed hamster (Tscherskia triton) from Raoyang, Guan and Shunyi counties of the North China Plain. The results showed that (i) high genetic diversity and differentiation exist in three geographic populations with patchy distributions; (ii) gene flow occurs among these three populations with physical barriers of Beijing city and Hutuo River, which potentially restricted the dispersal of the animal; (iii) the gene flow is negatively correlated with the geographic distance, while the genetic distance shows the positive correlation. Our results suggest that the effect of the physical barriers is conditional-dependent, including barrier capacity or individual potentially dispersal ability. Geographic distance also acts as an important factor affecting dispersal for the patchy distributed geographic populations. So, gene flow is effective, even at relatively long distances, in balancing the effect of geographic barrier in this study.

The construction of power grid operation index system considering the risk of maintenance

NASA Astrophysics Data System (ADS)

Tang, Jihong; Wang, Canlin; Jiang, Xinfan; Ye, Jianhui; Pan, Feilai

2018-02-01

In recent years, large-scale blackout occurred at home and abroad caused widespread concern about the operation of the grid in the world, and the maintenance risk is an important indicator of grid safety. The barrier operation of the circuit breaker exists in the process of overhaul of the power grid. The operation of the different barrier is of great significance to the change of the power flow, thus affecting the safe operation of the system. Most of the grid operating status evaluation index system did not consider the risk of maintenance, to this end, this paper from the security, economy, quality and cleanliness of the four angles, build the power grid operation index system considering the risk of maintenance.

Barriers to the Identification and Management of Psychosocial Problems: Changes from 2004 to 2013

PubMed Central

Horwitz, Sarah McCue; Storfer-Isser, Amy; Kerker, Bonnie D.; Szilagyi, Moira; Garner, Andrew; O’Connor, Karen G.; Hoagwood, Kimberly E.; Stein, Ruth E.K.

2015-01-01

Objective Pediatricians report many barriers to caring for children with mental health (MH) problems. The American Academy of Pediatrics (AAP) has focused attention on MH problems but the impact on perceived barriers is unknown. We examined whether perceived barriers and their correlates changed from 2004 to 2013. Methods In 2004, 832/1600 (52%) and in 2013, 594/1617 (36.7%) of randomly selected AAP members surveyed responded to Periodic Surveys, answering questions about socio-demographics, practice characteristics, and 7 barriers to identifying, treating/managing and referring child/adolescent MH problems. To reduce non-response bias, weighted descriptive and logistic regression analyses were conducted. Results Lack of training in treatment of child MH problems (~65%) and lack of confidence treating children with counseling (~60%) did not differ across surveys. Five barriers (lack of training in identifying MH problems, lack of confidence diagnosing, lack of confidence treating with medications, inadequate reimbursement and lack of time) were less frequently endorsed in 2013 (all p<.01), although lack of time was still endorsed by 70% in 2013. In 2004, 34% of pediatricians endorsed 6 or 7 barriers compared to 26% in 2013 (p<.005). Practicing general pediatrics exclusively was associated with endorsing 6 or 7 barriers in both years (p <.001). Conclusion Although fewer barriers were endorsed in 2013, most pediatricians believe that they have inadequate training in treating child MH problems, a lack of confidence to counsel children, and limited time for these problems. These findings suggest significant barriers still exist, highlighting the need for improved developmental and behavioral pediatrics training. What’s New This study compares reported barriers from the 2004 and 2013 Periodic Surveys. Although pediatricians report fewer barriers in 2013, 66% continue to report lack of training in counseling or medication of children with MH problems, suggesting deficits in developmental and behavioral pediatrics training. PMID:26409303

Physiological and pathophysiological factors affecting the expression and activity of the drug transporter MRP2 in intestine. Impact on its function as membrane barrier.

PubMed

Arana, Maite R; Tocchetti, Guillermo N; Rigalli, Juan P; Mottino, Aldo D; Villanueva, Silvina S M

2016-07-01

The gastrointestinal epithelium functions as a selective barrier to absorb nutrients, electrolytes and water, but at the same time restricts the passage into the systemic circulation of intraluminal potentially toxic compounds. This epithelium maintains its selective barrier function through the presence of very selective and complex intercellular junctions and the ability of the absorptive cells to reject those compounds. Accordingly, the enterocytes metabolize orally incorporated xenobiotics and secrete the hydrophilic metabolites back into the intestinal lumen through specific transporters localized apically. In the recent decades, there has been increasing recognition of the existence of the intestinal cellular barrier. In the present review we focus on the role of the multidrug resistance-associated protein 2 (MRP2, ABCC2) in the apical membrane of the enterocytes, as an important component of this intestinal barrier, as well as on its regulation. We provide a detailed compilation of significant contributions demonstrating that MRP2 expression and function vary under relevant physiological and pathophysiological conditions. Because MRP2 activity modulates the availability and pharmacokinetics of many therapeutic drugs administered orally, their therapeutic efficacy and safety may vary as well. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

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

Stephens, T.

2013-03-01

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

Barriers and facilitators to parents seeking and accessing professional support for anxiety disorders in children: qualitative interview study.

PubMed

Reardon, Tessa; Harvey, Kate; Young, Bridget; O'Brien, Doireann; Creswell, Cathy

2018-01-25

Anxiety disorders are among the most common mental health disorders experienced by children, but only a minority of these children access professional help. Understanding the difficulties parents face seeking support for child anxiety disorders could inform targeted interventions to improve treatment access. The aims of the study were to identify barriers and facilitators to seeking and accessing professional support for child anxiety disorders, and ways to minimise these barriers. A qualitative interview study was conducted with parents of 16 children (aged 7-11 years) with anxiety disorders identified through screening in schools. Barriers and facilitators were identified in relation to four distinct stages in the help-seeking process: parents recognising the anxiety difficulty, parents recognising the need for professional support, parents contacting professionals, and families receiving professional support. Barriers and facilitators at each stage related to the child's difficulties, the role of the parent, and parent perceptions of professionals and services. Findings illustrate the need (1) for readily available tools to help parents and professionals identify clinically significant anxiety in children, (2) to ensure that families and professionals can easily access guidance on the help-seeking process and available support, and (3) to ensure existing services offer sufficient provision for less severe difficulties that incorporates direct support for parents.

Perceptions of reporting practices and barriers to reporting incidents among registered nurses and physicians in accredited and nonaccredited Jordanian hospitals.

PubMed

AbuAlRub, Raeda F; Al-Akour, Nemeh A; Alatari, Nour H

2015-10-01

To explore the awareness of the incident reporting system, incident reporting practices and barriers to reporting incidents among Jordanian staff nurses and physicians in accredited and nonaccredited hospitals. Reporting medical incidents is an important element of patient safety enhancement and quality of care improvement and it should be an integral part of the organisational culture. A descriptive exploratory survey was used for the present study. A modified version of the Incident Reporting Questionnaire was used to collect data from 307 nurses and 144 physicians at seven hospitals (four accredited and three not accredited) in Jordan. The response rate was 28·8% for nurses and 58·8% for physicians. Nurses were more aware of the incident reporting system than physicians. Physicians were less likely to report any incident on 50% or more of occasions. The major three barriers to reporting incidents were believing that there was no point in reporting near misses, lack of feedback and fear of disciplinary actions. The study showed significant differences between nurses in accredited and nonaccredited hospitals regarding barriers to reporting incidents and reporting practices. Nurse administrators should modify existing systems for reporting incidents to overcome the barriers as shown in the present study. © 2015 John Wiley & Sons Ltd.

Barriers to surgical care in Nepal.

PubMed

van Loenhout, Joris Adriaan Frank; Delbiso, Tefera Darge; Gupta, Shailvi; Amatya, Kapendra; Kushner, Adam L; Gil Cuesta, Julita; Guha-Sapir, Debarati

2017-01-23

Various barriers exist that preclude individuals from undergoing surgical care in low-income countries. Our study assessed the main barriers in Nepal, and identified individuals most at risk for not receiving required surgical care. A countrywide survey, using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool, was carried out in 2014, surveying 2,695 individuals with a response rate of 97%. Our study used data from a subset, namely individuals who required surgical care in the last twelve months. Data were collected on individual characteristics, transport characteristics, and reasons why individuals did not undergo surgical care. Of the 2,695 individuals surveyed, 207 individuals needed surgical care at least once in the previous 12 months. The main reasons for not undergoing surgery were affordability (n = 42), accessibility (n = 42) and fear/no trust (n = 34). A factor significantly associated with affordability was having a low education (OR = 5.77 of having no education vs. having secondary education). Living in a rural area (OR = 2.59) and a long travel time to a secondary and tertiary health facility (OR = 1.17 and 1.09, respectively) were some of the factors significantly associated with accessibility. Being a woman was significantly associated with fear/no trust (OR = 3.54). More than half of the individuals who needed surgical care did not undergo surgery due to affordability, accessibility, or fear/no trust. Providing subsidised transport, introducing mobile surgical clinics or organising awareness raising campaigns are measures that could be implemented to overcome these barriers to surgical care.

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.

Dismissive and deceptive car dealerships create barriers to electric vehicle adoption at the point of sale

NASA Astrophysics Data System (ADS)

Zarazua de Rubens, Gerardo; Noel, Lance; Sovacool, Benjamin K.

2018-06-01

As most consumers do not have pre-existing knowledge of electric vehicles (EVs), and current market conditions favour petrol and diesel vehicles, car dealership experiences may strongly influence EV purchasing decisions. Here, we show that car dealerships pose a significant barrier at the point of sale due to a perceived lack of business case viability in relation to petrol and diesel vehicles. In 126 shopping experiences at 82 car dealerships across Denmark, Finland, Iceland, Norway and Sweden, we find that dealers were dismissive of EVs, misinformed shoppers on vehicle specifications, omitted EVs from the sales conversation and strongly oriented customers towards petrol and diesel vehicle options. Dealers' technological orientation, willingness to sell and displayed knowledge of EVs were the main contributors to likely purchase intentions. These findings combined with expert interviews suggest that government and industry signalling affect sales strategies and purchasing trends. Policy and business strategies that address barriers at the point of sale are needed to accelerate EV adoption.

Barriers affecting successful technology enablement of supply chain: An Indian perspective

NASA Astrophysics Data System (ADS)

Arora, R.; Haleem, A.; Farooquie, J. A.

2018-03-01

In order to compete, organizations need to focus on improving supply chain and technology acts as a major enabler. Technology enablement of supply chain has not always been successful and has been examined by many researchers. The purpose of this paper is to do a systematic literature review of technology enabled supply chain from a strategic viewpoint. The literature is examined from two perspectives. Firstly, it studies the growing interest in technology-enabled supply chain in India. Secondly, it studies barriers affecting technology enablement of supply chain. The literature review identifies that technology enabled supply chain helps in improving performance via effective decision making, monitoring entire supply chain, faster reaction to customer service problems, etc. The research has emphasized the importance of 12 barriers affecting technology enablement. This research will help as a guide for practitioners in order to successfully implement technology and fills the gap in existing literature by highlighting and consolidating the significant research work done in past.

Barriers to employability among substance dependent and nonsubstance-affected women on federal welfare: implications for program design.

PubMed

Morgenstern, Jon; McCrady, Barbara S; Blanchard, Kimberly A; McVeigh, Katharine H; Riordan, Annette; Irwin, Thomas W

2003-03-01

This study examined barriers to employability among women meeting criteria for a substance dependence disorder who were identified by routine screening conducted in welfare offices. The characteristics of these women were compared to other women on welfare who did not have a substance use disorder. A sample of 214 substance dependent women on federal welfare were recruited to participate in a substance use disorders welfare demonstration project. An additional 69 nonsubstance-affected women on welfare served as a comparison sample. All participants were assessed in welfare settings through a standardized battery of measures. Substance dependent women reported moderate to severe substance use problems. They also reported significantly higher rates than the women with no substance use disorder of other barriers such as domestic violence, mental health problems, legal problems, child welfare investigations and fewer job skills. Findings raise questions about the likely effectiveness of existing welfare reform services in addressing the needs of substance dependent women.

Low-impact, high toughness transportation barriers.

DOT National Transportation Integrated Search

2012-10-01

Alternatives to existing transportation truck escape ramps and crash barriers are examined using arrays of : wood, bamboo, and fiberglass structural elements that act as energy absorbers as they deform. The : behaviors of each material type are analy...

Connecting Hispanic Women in Baltimore to the Mercy Medical Center Sexual Assault Forensic Examiners/Forensic Nurse Examiners Program: A Preliminary Assessment of Service Utilization and Community Awareness.

PubMed

Adams, Margaret; Fitzgerald, Sheila; Holbrook, Debra

2016-01-01

Sexual violence and gender-based violence represent a major public health problem causing significant negative mental, physical, and social outcomes for victims. The rapidly growing population of Hispanic women in Baltimore are both more vulnerable to sexual assault and less able to access postassault services. In an effort to assess service utilization and community awareness of the Mercy Medical Center Sexual Assault Forensic Examiners/Forensic Nurse Examiners Program, we conducted a retrospective chart review of 2,322 women who were seen by the program between 2010 and 2013 and found that only 2.5% of the women were identified as Hispanic, about half of what Baltimore City demographic data would predict. This exploratory pilot project, augmented by key informant interviews, reveals that Hispanic women are underutilizing sexual assault services. Multiple barriers exist for Hispanic women in obtaining victim services, including lack of awareness within the community that the services exist, cultural factors, language barriers, lack of awareness of legal rights, and a fear of deportation.

On the Existence of Our Metals-Based Civilization: I. Phase Space Analysis

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

D.D. Macdonald

2005-06-22

The stability of the barrier layers of bilayer passive films that form on metal and alloy surfaces, when in contact with oxidizing aqueous environments, is explored within the framework of the Point Defect Model (PDM) using phase-space analysis (PSA), in which the rate of growth of the barrier layer into the metal, (dL{sup +}/dt), and the barrier layer dissolution rate, (dL{sup -}/dt), are plotted simultaneously against the barrier layer thickness. A point of intersection of dL{sup -}/dt with dL{sup +}/dt indicates the existence of a metastable barrier layer with a steady state thickness greater than zero. If dL{sup -}/dt >more » (dL{sup +}/dt){sub L=0}, where the latter quantity is the barrier layer growth rate at zero barrier layer thickness, the barrier layer cannot exist, even as a metastable phase, as the resulting thickness would be negative. Under these conditions, the surface is depassivated and the metal may corrode at a rapid rate. Depassivation may result from a change in the oxidation state of the cation upon dissolution of the barrier layer, such that the dissolution rate becomes highly potential dependent (as in the case of transpassive dissolution of chromium-containing alloys, for example, in which the reaction Cr{sub 2}O{sub 3} + 5H{sub 2}O {yields} 2CrO{sub 4}{sup 2-} + 10H {sup +} + 6e{sup -} results in the destruction of the film), or by the action of some solution-phase species (e.g., H{sup +}, Cl{sup -}) that enhances the dissolution rate to the extent that dL{sup -}/dt > (dL{sup +}/dt){sub L=0}. The boundaries for depassivation may be plotted in potential-pH space to develop Kinetic Stability Diagrams (KSDs) as alternatives to the classical Pourbaix diagrams for describing the conditions under which metals or alloys exist in contact with an aqueous environment. The advantage of KSDs is that they provide kinetic descriptions of the state of a metal or alloy that is in much closer concert with the kinetic phenomenon of passivity and depassivation than are equilibrium thermodynamic diagrams. Thus, KSDs more accurately account for the limits of passivity in highly acidic systems, where acid depassivation occurs, and at high potentials, where transition to the transpassive state may occur in some systems. In any event, phase space analysis of the PDM permits specification of the conditions over which reactive metals will remain passive in contact with aqueous systems and hence of the conditions that must be met for the existence of our metals-based civilization.« less

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

PubMed Central

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

2009-01-01

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

An Examination of Barriers to Physical Education for Christian and Muslim Girls Attending Comprehensive Secondary Schools in the UK

ERIC Educational Resources Information Center

Elliott, Dave; Hoyle, Kathryn

2014-01-01

This study examined barriers to Physical Education (PE) in a sample of Christian and Muslim schoolgirls attending UK comprehensive secondary schools. Also assessed was whether religion and school year (age) had any impact upon barrier strength and if school year × religion interactions existed. A questionnaire was developed and exploratory factor…

Efficient free energy calculations by combining two complementary tempering sampling methods.

PubMed

Xie, Liangxu; Shen, Lin; Chen, Zhe-Ning; Yang, Mingjun

2017-01-14

Although energy barriers can be efficiently crossed in the reaction coordinate (RC) guided sampling, this type of method suffers from identification of the correct RCs or requirements of high dimensionality of the defined RCs for a given system. If only the approximate RCs with significant barriers are used in the simulations, hidden energy barriers with small to medium height would exist in other degrees of freedom (DOFs) relevant to the target process and consequently cause the problem of insufficient sampling. To address the sampling in this so-called hidden barrier situation, here we propose an effective approach to combine temperature accelerated molecular dynamics (TAMD), an efficient RC-guided sampling method, with the integrated tempering sampling (ITS), a generalized ensemble sampling method. In this combined ITS-TAMD method, the sampling along the major RCs with high energy barriers is guided by TAMD and the sampling of the rest of the DOFs with lower but not negligible barriers is enhanced by ITS. The performance of ITS-TAMD to three systems in the processes with hidden barriers has been examined. In comparison to the standalone TAMD or ITS approach, the present hybrid method shows three main improvements. (1) Sampling efficiency can be improved at least five times even if in the presence of hidden energy barriers. (2) The canonical distribution can be more accurately recovered, from which the thermodynamic properties along other collective variables can be computed correctly. (3) The robustness of the selection of major RCs suggests that the dimensionality of necessary RCs can be reduced. Our work shows more potential applications of the ITS-TAMD method as the efficient and powerful tool for the investigation of a broad range of interesting cases.

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

PubMed

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

2014-08-01

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

Efficient free energy calculations by combining two complementary tempering sampling methods

NASA Astrophysics Data System (ADS)

Xie, Liangxu; Shen, Lin; Chen, Zhe-Ning; Yang, Mingjun

2017-01-01

Although energy barriers can be efficiently crossed in the reaction coordinate (RC) guided sampling, this type of method suffers from identification of the correct RCs or requirements of high dimensionality of the defined RCs for a given system. If only the approximate RCs with significant barriers are used in the simulations, hidden energy barriers with small to medium height would exist in other degrees of freedom (DOFs) relevant to the target process and consequently cause the problem of insufficient sampling. To address the sampling in this so-called hidden barrier situation, here we propose an effective approach to combine temperature accelerated molecular dynamics (TAMD), an efficient RC-guided sampling method, with the integrated tempering sampling (ITS), a generalized ensemble sampling method. In this combined ITS-TAMD method, the sampling along the major RCs with high energy barriers is guided by TAMD and the sampling of the rest of the DOFs with lower but not negligible barriers is enhanced by ITS. The performance of ITS-TAMD to three systems in the processes with hidden barriers has been examined. In comparison to the standalone TAMD or ITS approach, the present hybrid method shows three main improvements. (1) Sampling efficiency can be improved at least five times even if in the presence of hidden energy barriers. (2) The canonical distribution can be more accurately recovered, from which the thermodynamic properties along other collective variables can be computed correctly. (3) The robustness of the selection of major RCs suggests that the dimensionality of necessary RCs can be reduced. Our work shows more potential applications of the ITS-TAMD method as the efficient and powerful tool for the investigation of a broad range of interesting cases.

Maximum dose angle for oblique incidence on primary beam protective barriers in the design of medical radiation therapy facilities.

PubMed

Fondevila, Damián; Arbiser, Silvio; Sansogne, Rosana; Brunetto, Mónica; Dosoretz, Bernardo

2008-05-01

Primary barrier determinations for the shielding of medical radiation therapy facilities are generally made assuming normal beam incidence on the barrier, since this is geometrically the most unfavorable condition for that shielding barrier whenever the occupation line is allowed to run along the barrier. However, when the occupation line (for example, the wall of an adjacent building) runs perpendicular to the barrier (especially roof barrier), then two opposing factors come in to play: increasing obliquity angle with respect to the barrier increases the attenuation, while the distance to the calculation point decreases, hence, increasing the dose. As a result, there exists an angle (alpha(max)) for which the equivalent dose results in a maximum, constituting the most unfavorable geometric condition for that shielding barrier. Based on the usual NCRP Report No. 151 model, this article presents a simple formula for obtaining alpha(max), which is a function of the thickness of the barrier (t(E)) and the equilibrium tenth-value layer (TVL(e)) of the shielding material for the nominal energy of the beam. It can be seen that alpha(max) increases for increasing TVL(e) (hence, beam energy) and decreases for increasing t(E), with a range of variation that goes from 13 to 40 deg for concrete barriers thicknesses in the range of 50-300 cm and most commercially available teletherapy machines. This parameter has not been calculated in the existing literature for radiotherapy facilities design and has practical applications, as in calculating the required unoccupied roof shielding for the protection of a nearby building located in the plane of the primary beam rotation.

A cross sectional observational study of research activity of allied health teams: is there a link with self-reported success, motivators and barriers to undertaking research?

PubMed

Wenke, Rachel J; Mickan, Sharon; Bisset, Leanne

2017-02-06

Team-based approaches to research capacity building (RCB) may be an efficient means to promote allied health research participation and activity. In order to tailor such interventions, a clearer understanding of current patterns of research participation within allied health teams is needed. Different self-report measures exist which evaluate a team's research capacity and participation, as well as associated barriers and motivators. However, it remains unclear how such measures are associated with a team's actual research activity (e.g., journal publications, funding received). In response, this observational study aimed to identify the research activity, self-reported success, and motivations and barriers to undertaking research of eight allied health professional (AHP) teams and to explore whether any relationships exist between the self-reported measures and actual research activity within each team. A total of 95 AHPs from eight teams completed the research capacity and culture survey to evaluate team success, barriers and motivators to undertaking research, and an audit of research activity from January 2013 to August 2014 was undertaken within each team. Kendell's correlation coefficients were used to determine the association between research activity (i.e., number of journal publications, ethically approved projects and funding received) and the self-reported measures. Seven out of eight teams rated their teams as having average success in research and demonstrated some form of research activity including at least two ethically approved projects. Research activity varied between teams, with funding received ranging from $0 to over $100,000, and half the teams not producing any journal publications. Team motivators demonstrated a stronger association with research activity compared to barriers, with the motivator "enhancing team credibility" being significantly associated with funding received. No significant association between self-reported research success and actual research activity was identified. Preliminary findings suggest that self-report measures of research success may not always correspond to actual research activity, and a combination of both these measures may be useful when planning RCB interventions. Variation in activity between teams and organisations should also be considered when tailoring RCB interventions. Reinforcing intrinsically motivating rewards of research may also be useful in promoting research participation for some teams.

Category mistakes: A barrier to effective environmental management.

PubMed

Wallace, Ken J; Jago, Mark

2017-09-01

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

Analysis of projected replacement and costs for potential aquatic barriers maintained by MaineDOT.

DOT National Transportation Integrated Search

2014-02-01

Recent discussions around State and federal stream crossing regulations have focused on resolving existing barriers : to fish movement created by pipe culverts associated with transportation infrastructure. Approximately 30% of : Maine has been surve...

Potential Strategies to Address the Major Clinical Barriers Facing Stem Cell Regenerative Therapy for Cardiovascular Disease: A Review.

PubMed

Nguyen, Patricia K; Neofytou, Evgenios; Rhee, June-Wha; Wu, Joseph C

2016-11-01

Although progress continues to be made in the field of stem cell regenerative medicine for the treatment of cardiovascular disease, significant barriers to clinical implementation still exist. To summarize the current barriers to the clinical implementation of stem cell therapy in patients with cardiovascular disease and to discuss potential strategies to overcome them. Information for this review was obtained through a search of PubMed and the Cochrane database for English-language studies published between January 1, 2000, and July 25, 2016. Ten randomized clinical trials and 8 systematic reviews were included. One of the major clinical barriers facing the routine implementation of stem cell therapy in patients with cardiovascular disease is the limited and inconsistent benefit observed thus far. Reasons for this finding are unclear but may be owing to poor cell retention and survival, as suggested by numerous preclinical studies and a small number of human studies incorporating imaging to determine cell fate. Additional studies in humans using imaging to determine cell fate are needed to understand how these factors contribute to the limited efficacy of stem cell therapy. Treatment strategies to address poor cell retention and survival are under investigation and include the following: coadministration of immunosuppressive and prosurvival agents, delivery of cardioprotective factors packaged in exosomes rather than the cells themselves, and use of tissue-engineering strategies to provide structural support for cells. If larger grafts are achieved using these strategies, it will be imperative to carefully monitor for the potential risks of tumorigenicity, immunogenicity, and arrhythmogenicity. Despite important achievements to date, stem cell therapy is not yet ready for routine clinical implementation. Significant research is still needed to address the clinical barriers outlined herein before the next wave of large clinical trials is under way.

Barriers to and Correlates of Retention in Behavioral Health Treatment among Latinos in Two Different Host Countries: U.S. and Spain

PubMed Central

Falgas, I.; Ramos, Z.; Herrera, L.; Qureshi, A.; Chavez, L.; Bonal, C.; McPeck, S.; Wang, Y.; Cook, B.; Alegría, M.

2015-01-01

Context Latino immigrants constitute a large portion of the Spanish and U.S. immigrant populations, yet a dearth of research exists regarding barriers to retention in behavioral health care. Objectives To identify and compare perceived barriers related to behavioral health care among first and second generation Latinos in Boston, Madrid, and Barcelona, and evaluate whether the frequency of behavioral health care use in the last year was related to these barriers. Design, Setting and Participants Data come from the International Latino Research Partnership project. First or second generation self-identified Latino immigrants ages 18+ who resided more than one year in the host country were recruited from community agencies and primary care, mental health, substance abuse, and HIV clinics. Main Outcome Measures Eleven barriers were assessed and compared across sites. The relationship between barriers and behavioral services visits within the last year was evaluated, adjusting for socio-demographics, clinical measures, degree of health literacy, cultural and social factors. Results Wanting to handle the problem on one's own, thinking that treatment would not work, and being unsure of where to go or who to see were the most frequently reported barriers for Latino immigrants. Previous treatment failure, difficulties in transportation or scheduling, and linguistic barriers were more likely to be reported in Boston; trying to deal with mental health problems on one's own was more commonly reported in Barcelona and Madrid. Two barriers associated with number of visits were concerns about the cost of services and uncertainty about where to go or who to see. Conclusions After adjusting for socio-demographics, clinical measures, degree of health literacy, cultural and social factors, barriers still differed significantly across sites. Efforts to improve behavioral health services must be tailored to immigrants' context, with attention to changing attitudes of self-reliance and outreach to improve access to and retention in care. PMID:26910867

Vision-based calibration of parallax barrier displays

NASA Astrophysics Data System (ADS)

Ranieri, Nicola; Gross, Markus

2014-03-01

Static and dynamic parallax barrier displays became very popular over the past years. Especially for single viewer applications like tablets, phones and other hand-held devices, parallax barriers provide a convenient solution to render stereoscopic content. In our work we present a computer vision based calibration approach to relate image layer and barrier layer of parallax barrier displays with unknown display geometry for static or dynamic viewer positions using homographies. We provide the math and methods to compose the required homographies on the fly and present a way to compute the barrier without the need of any iteration. Our GPU implementation is stable and general and can be used to reduce latency and increase refresh rate of existing and upcoming barrier methods.

Opting out or denying discrimination? How the framework of free choice in American society influences perceptions of gender inequality.

PubMed

Stephens, Nicole M; Levine, Cynthia S

2011-10-01

American women still confront workplace barriers (e.g., bias against mothers, inflexible policies) that hinder their advancement at the upper levels of organizations. However, most Americans fail to recognize that such gender barriers still exist. Focusing on mothers who have left the workforce, we propose that the prevalent American assumption that actions are a product of choice conceals workplace barriers by communicating that opportunities are equal and that behavior is free from contextual influence. Study 1 reveals that stay-at-home mothers who view their own workplace departure as an individual choice experience greater well-being but less often recognize workplace barriers and discrimination as a source of inequality than do mothers who do not view their workplace departure as an individual choice. Study 2 shows that merely exposing participants to a message that frames actions in terms of individual choice increases participants' belief that society provides equal opportunities and that gender discrimination no longer exists. By concealing the barriers that women still face in the workplace, this choice framework may hinder women's long-term advancement in society.

Learning from Recruitment Challenges: Barriers to Diagnosis, Treatment, and Research Participation for Latinos with Symptoms of Alzheimer's Disease

PubMed Central

Gelman, Caroline Rosenthal

2014-01-01

This paper discusses barriers to diagnosis and treatment of Alzheimer's disease (AD) and concomitantly to participation in AD research as elicited from 29 potential Latino participants who ultimately did not enroll in a study evaluating a caregiver intervention. Nearly half of all individuals contacting the researcher about the intervention study failed to meet criteria stipulating an existing AD diagnosis. Barriers to obtaining a diagnosis include lack of knowledge about AD, perceptions of memory loss as normal aging, and structural barriers to accessing care. A quarter of caregivers contacting the researcher felt too overwhelmed to participate. Many of these barriers have been previously identified as challenges to treatment, suggesting this is not just a methodological research problem but inextricably tied to larger issues of AD knowledge and service accessibility. Engaging Latino communities equitably in the assessment of needs and the process of addressing them, thus ensuring the validity and applicability of the research and findings, is important both for increasing this group's participation in relevant studies and for addressing existing health disparities. PMID:20029704

A Survey of Homework Use, Experience of Barriers to Homework, and Attitudes about the Barriers to Homework among Couples and Family Therapists

ERIC Educational Resources Information Center

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

2011-01-01

Homework is a therapeutic process that has strong theoretical and empirical basis, but existing research has focused on "compliance" rather than considering the broader and more clinically meaningful construct of "engagement." Absent in the literature is empirical study of the barriers to engagement or study of homework use among couple and family…

Retrofit of existing statewide Louisiana safety walk bridge barrier railing systems : research project capsule.

DOT National Transportation Integrated Search

2016-07-01

Currently, the Louisiana Department of Transportation and Development (DOTD) : maintains approximately 200 miles of concrete safety walk barrier railing systems on : its bridges. Some of these vintage systems do not meet the current crash performance...

Stacked silicide/silicon mid- to long-wavelength infrared detector

NASA Technical Reports Server (NTRS)

Maserjian, Joseph (Inventor)

1990-01-01

The use of stacked Schottky barriers (16) with epitaxially grown thin silicides (10) combined with selective doping (22) of the barriers provides high quantum efficiency infrared detectors (30) at longer wavelengths that is compatible with existing silicon VLSI technology.

Stacked silicide/silicon mid- to long-wavelength infrared detector

DOEpatents

Maserjian, Joseph

1990-03-13

The use of stacked Schottky barriers (16) with epitaxially grown thin silicides (10) combined with selective doping (22) of the barriers provides high quantum efficiency infrared detectors (30) at longer wavelengths that is compatible with existing silicon VLSI technology.

Breastfeeding: What are the Barriers? Why Women Struggle to Achieve Their Goals.

PubMed

Sriraman, Natasha K; Kellams, Ann

2016-07-01

Despite recognized health benefits for both mothers and infants, significant disparities still exist in the rates of breastfeeding in the United States. Major organizations representing the health of women and children (including the Centers for Disease Control and Prevention [CDC], American Academy of Pediatrics [AAP], American Congress of Obstetrics and Gynecology [ACOG], American Academy of Family Physicians [AAFP], United Nations International Children's Emergency Fund (UNICEF), the World Health Organization [WHO], and the United States Public Health Service [PHS]) recommend exclusive breastfeeding, but statistics show that although many women initiate breastfeeding, few meet the recommended goals for duration and exclusivity. This article reviews the evidence related to barriers (prenatal, medical, societal, hospital, and sociocultural) that many mothers face, and explore the known barriers and the impact they have on a woman's ability to breastfeed her infant. Strategies will be discussed to address (and potentially overcome) some of the most common barriers women face along with a list of resources that can be useful in this effort. Gaps in care and areas that need further research will be noted. This article is targeted toward physicians and other healthcare providers who work with women and who can assist with and advocate for the removal of barriers and thereby improve the health of women and children by increasing the rates of breastfeeding initiation, duration, and exclusivity in the United States.

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

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

Stephens, Thomas

2013-03-01

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

Barriers to Employment among Unemployed Drug Users: Age Predicts Severity

PubMed Central

Sigurdsson, Sigurdur Oli; Ring, Brandon M.; O’Reilly, Kristen; Silverman, Kenneth

2014-01-01

Background Drug users in treatment or exiting treatment face many barriers to employment when entering the job market, such as low levels of education and technical skills, and low levels of interpersonal skills. As a result of these and other barriers, employment rates in these groups are generally low. Objective This article examines the existence and possible predictors of specific barriers to employment related to interpersonal and technical skills in a sample of participants enrolled in a therapeutic workplace intervention for substance abuse. Methods In Study I (N = 77), we characterized and examined predictors of participant scores on a staff-rated scale of interpersonal skills (Work Behavior Inventory). In Study II (N = 29), we examined whether participants had lower levels of computer knowledge than job seekers in the general population, and investigated possible predictors of computer knowledge in the sample. Results In general, participants in Study I displayed low levels of interpersonal skills, and participants in Study II scored lower on the computer knowledge test than job seekers in the general population. Older participants tended to have lower levels of interpersonal skills and lower levels of computer knowledge. Conclusions and Scientific Significance These results suggest that providers of workforce development services for drug users in treatment or exiting treatment should attend to these specific barriers to employment, which may also be more pronounced among older clients. PMID:22242680

A knowledge translation intervention to enhance clinical application of a virtual reality system in stroke rehabilitation.

PubMed

Levac, Danielle; Glegg, Stephanie M N; Sveistrup, Heidi; Colquhoun, Heather; Miller, Patricia A; Finestone, Hillel; DePaul, Vincent; Harris, Jocelyn E; Velikonja, Diana

2016-10-06

Despite increasing evidence for the effectiveness of virtual reality (VR)-based therapy in stroke rehabilitation, few knowledge translation (KT) resources exist to support clinical integration. KT interventions addressing known barriers and facilitators to VR use are required. When environmental barriers to VR integration are less amenable to change, KT interventions can target modifiable barriers related to therapist knowledge and skills. A multi-faceted KT intervention was designed and implemented to support physical and occupational therapists in two stroke rehabilitation units in acquiring proficiency with use of the Interactive Exercise Rehabilitation System (IREX; GestureTek). The KT intervention consisted of interactive e-learning modules, hands-on workshops and experiential practice. Evaluation included the Assessing Determinants of Prospective Take Up of Virtual Reality (ADOPT-VR) Instrument and self-report confidence ratings of knowledge and skills pre- and post-study. Usability of the IREX was measured with the System Usability Scale (SUS). A focus group gathered therapist experiences. Frequency of IREX use was recorded for 6 months post-study. Eleven therapists delivered a total of 107 sessions of VR-based therapy to 34 clients with stroke. On the ADOPT-VR, significant pre-post improvements in therapist perceived behavioral control (p = 0.003), self-efficacy (p = 0.005) and facilitating conditions (p =0.019) related to VR use were observed. Therapist intention to use VR did not change. Knowledge and skills improved significantly following e-learning completion (p = 0.001) and was sustained 6 months post-study. Below average perceived usability of the IREX (19 th percentile) was reported. Lack of time was the most frequently reported barrier to VR use. A decrease in frequency of perceived barriers to VR use was not significant (p = 0.159). Two therapists used the IREX sparingly in the 6 months following the study. Therapists reported that client motivation to engage with VR facilitated IREX use in practice but that environmental and IREX-specific barriers limited use. Despite increased knowledge and skills in VR use, the KT intervention did not alter the number of perceived barriers to VR use, intention to use or actual use of VR. Poor perceived system usability had an impact on integration of this particular VR system into clinical practice.

Danish research-active clinical nurses overcome barriers in research utilization.

PubMed

Adamsen, Lis; Larsen, Kristian; Bjerregaard, Lene; Madsen, Jan K

2003-03-01

The aim of this study was to examine whether there was a difference between clinical nurses who were research-active, and clinical nurses who were nonresearch-active in utilization of research. A further aim was to identify the most significant barriers faced by a group of Danish clinical nurses in their use of research. Discrepancy between the improved quality of research results and the lack of implementing them was the starting point for a series of studies which showed the types of barriers clinical nurses found especially cumbersome when applying the research results of other researchers. This study investigates whether the clinical nurses' own engagement in research had any impact on their perception of research utilization. The study had an exploratory and descriptive design. Seventy-nine Danish clinical nurses participated and semi-structured interviewing was used as the research method. There was a statistically significant difference between the research-active and nonresearch-active nurses on various variables. The study showed that, to a larger extent, research-active nurses used evidence-based knowledge and were generally more internationally orientated. Furthermore, two important barriers for research utilization were identified by all 79 clinical nurses included in the study, i.e. 90% of the nurses explained that the quantity of research results was overwhelming, and 75% of them found that they were unable to evaluate the quality of the research. Clinical nurses, who were research-active themselves, experienced more success in overcoming some of the barriers, which existed in applying research to practice. The research potential found amongst clinical nurses in Denmark needed to be further supported through training and guidance in research methodology, establishing introductory stipends and part-time research positions. By doing so, some of the barriers affecting research utilization and the so-called theory-practice gap might be reduced. Further empirical studies, based on Giddens theory of sociological reflectivity, might see clinical nurses in a more serious light and simultaneously perceive them as producers of knowledge.

Transport of the moving barrier driven by chiral active particles

NASA Astrophysics Data System (ADS)

Liao, Jing-jing; Huang, Xiao-qun; Ai, Bao-quan

2018-03-01

Transport of a moving V-shaped barrier exposed to a bath of chiral active particles is investigated in a two-dimensional channel. Due to the chirality of active particles and the transversal asymmetry of the barrier position, active particles can power and steer the directed transport of the barrier in the longitudinal direction. The transport of the barrier is determined by the chirality of active particles. The moving barrier and active particles move in the opposite directions. The average velocity of the barrier is much larger than that of active particles. There exist optimal parameters (the chirality, the self-propulsion speed, the packing fraction, and the channel width) at which the average velocity of the barrier takes its maximal value. In particular, tailoring the geometry of the barrier and the active concentration provides novel strategies to control the transport properties of micro-objects or cargoes in an active medium.

The antimicrobial stewardship program in Gulf Cooperation Council (GCC) states: insights from a regional survey.

PubMed

Enani, Mushira A

2016-01-01

The purpose of the current study is to describe the prevalence and characteristics of antimicrobial stewardship programs (ASP) in Gulf Cooperation Council (GCC) states to explore opportunities and overcome barriers to effective ASP implementation. A cross-sectional questionnaire survey was used to evaluate the current status of ASP: major stewardship components, barriers of implementation and program impact in acute care hospitals of GCC states. Forty-seven healthcare professionals responded from four GCC states, the majority from Saudi Arabia (81%). Twenty-nine (62%) participating hospitals had ASP in place. Of these established programs, 35 (75%) reported lack of funding and personnel as major barriers to program implementation. The top three objectives cited for the hospital ASP were to reduce resistance (72.3%), improve clinical outcomes (70.2%) and reduce costs (44.7%). The reported impact of existing ASP was reduction of inappropriate prescribing (68%), reduction of broad spectrum antibiotic use (63.8%), reduction of healthcare-associated infections (61.7%), reduction of length of stay or mortality metrics (59.6%), reduction in direct antibiotic cost (57.4%) and reduction of reported antibiotic resistance (55.3%). Survey participants from GCC states who have implemented ASP report significant impacts in the reduction of broad spectrum antibiotic use, hospital-acquired infection, inappropriate prescribing and antimicrobial resistance. These findings suggest a promising opportunity to enhance existing ASP through sharing of best practices and support the development of regional guidelines across GCC states.

The antimicrobial stewardship program in Gulf Cooperation Council (GCC) states: insights from a regional survey

PubMed Central

2015-01-01

Objectives: The purpose of the current study is to describe the prevalence and characteristics of antimicrobial stewardship programs (ASP) in Gulf Cooperation Council (GCC) states to explore opportunities and overcome barriers to effective ASP implementation. Methods: A cross-sectional questionnaire survey was used to evaluate the current status of ASP: major stewardship components, barriers of implementation and program impact in acute care hospitals of GCC states. Results: Forty-seven healthcare professionals responded from four GCC states, the majority from Saudi Arabia (81%). Twenty-nine (62%) participating hospitals had ASP in place. Of these established programs, 35 (75%) reported lack of funding and personnel as major barriers to program implementation. The top three objectives cited for the hospital ASP were to reduce resistance (72.3%), improve clinical outcomes (70.2%) and reduce costs (44.7%). The reported impact of existing ASP was reduction of inappropriate prescribing (68%), reduction of broad spectrum antibiotic use (63.8%), reduction of healthcare-associated infections (61.7%), reduction of length of stay or mortality metrics (59.6%), reduction in direct antibiotic cost (57.4%) and reduction of reported antibiotic resistance (55.3%). Conclusion: Survey participants from GCC states who have implemented ASP report significant impacts in the reduction of broad spectrum antibiotic use, hospital-acquired infection, inappropriate prescribing and antimicrobial resistance. These findings suggest a promising opportunity to enhance existing ASP through sharing of best practices and support the development of regional guidelines across GCC states. PMID:28989448

Barriers to Office-Based Mental Health Care and Interest in E-Communication With Providers: A Survey Study.

PubMed

Rai, Minnie; Vigod, Simone N; Hensel, Jennifer M

2016-08-01

With rising availability and use of Internet and mobile technology in society, the demand and need for its integration into health care is growing. Despite great potential within mental health care and growing uptake, there is still little evidence to guide how these tools should be integrated into traditional care, and for whom. To examine factors that might inform how e-communication should be implemented in our local outpatient mental health program, including barriers to traditional office-based care, patient preferences, and patient concerns. We conducted a survey in the waiting room of our outpatient mental health program located in an urban, academic ambulatory hospital. The survey assessed (1) age, mobile phone ownership, and general e-communication usage, (2) barriers to attending office-based appointments, (3) preferences for, and interest in, e-communication for mental health care, and (4) concerns about e-communication use for mental health care. We analyzed the data descriptively and examined associations between the presence of barriers, identifying as a social media user, and interest level in e-communication. Respondents (N=68) were predominantly in the age range of 25-54 years. The rate of mobile phone ownership was 91% (62/68), and 59% (40/68) of respondents identified as social media users. There was very low existing use of e-communication between providers and patients, with high levels of interest endorsed by survey respondents. Respondents expressed an interest in using e-communication with their provider to share updates and get feedback, coordinate care, and get general information. In regression analysis, both a barrier to care and identifying as a social media user were significantly associated with e-communication interest (P=.03 and P=.003, respectively). E-communication interest was highest among people who both had a barrier to office-based care and were a social media user. Despite high interest, there were also many concerns including privacy and loss of in-person contact. A high burden of barriers to attending office-based care paired with a high interest in e-communication supports the integration of e-communication within our outpatient services. There may be early adopters to target: those with identified barriers to office-based care and who are active on social media. There is also a need for caution and preservation of existing services for those who choose not to, or cannot, access e-services.

Legally protecting and compelling veterinarians in issues of animal abuse and domestic violence.

PubMed

Robertson, I A

2010-06-01

The majority of veterinarians recognise their important role and responsibility to society and animal welfare in the detection and reporting of suspected abuse of animals and humans. In spite of the existing moral, ethical, and legal duties applied to veterinarians, they face substantial barriers that prohibit them from fulfilling their professional role in handling cases of suspected abuse. With increasing public and legal attention on issues of animal welfare, the non-fulfillment of these duties places the profession and its members at considerable risk of public criticism and adverse legal accountability. The issue is raised here that the veterinary profession in New Zealand needs to provide a clear policy statement and take pro-active measures that provide practical enforceable solutions to these existing barriers and legal risks. Such an initiative will assist in ensuring that all registered members consistently fulfil their obligations, and are legally protected while doing so. Veterinary counterparts overseas already provide a legislative immunity for their veterinarians who report suspected abuse as part of a mandated duty to report. Implementation of such a duty has significant benefits for all veterinarians, including the requirement for education and effective support systems. In the absence of such a mandatory duty, intermediary measures can be introduced, demonstrating social responsibility and commitment by the profession to their existing duty of care.

Development of the Tensoral Computer Language

NASA Technical Reports Server (NTRS)

Ferziger, Joel; Dresselhaus, Eliot

1996-01-01

The research scientist or engineer wishing to perform large scale simulations or to extract useful information from existing databases is required to have expertise in the details of the particular database, the numerical methods and the computer architecture to be used. This poses a significant practical barrier to the use of simulation data. The goal of this research was to develop a high-level computer language called Tensoral, designed to remove this barrier. The Tensoral language provides a framework in which efficient generic data manipulations can be easily coded and implemented. First of all, Tensoral is general. The fundamental objects in Tensoral represent tensor fields and the operators that act on them. The numerical implementation of these tensors and operators is completely and flexibly programmable. New mathematical constructs and operators can be easily added to the Tensoral system. Tensoral is compatible with existing languages. Tensoral tensor operations co-exist in a natural way with a host language, which may be any sufficiently powerful computer language such as Fortran, C, or Vectoral. Tensoral is very-high-level. Tensor operations in Tensoral typically act on entire databases (i.e., arrays) at one time and may, therefore, correspond to many lines of code in a conventional language. Tensoral is efficient. Tensoral is a compiled language. Database manipulations are simplified optimized and scheduled by the compiler eventually resulting in efficient machine code to implement them.

An assessment of the barriers to accessing the Basic Package of Health Services (BPHS) in Afghanistan: was the BPHS a success?

PubMed

Frost, Alexandra; Wilkinson, Matthew; Boyle, Peter; Patel, Preeti; Sullivan, Richard

2016-11-15

Afghanistan is one of the most fragile and conflict-affected countries in the world. It has experienced almost uninterrupted conflict for the last thirty years, with the present conflict now lasting over a decade. With no history of a functioning healthcare system, the creation of the Basic Package of Health Services (BPHS) in 2003 was a response to Afghanistan's dire health needs following decades of war. Its objective was to provide a bare minimum of essential health services, which could be scaled up rapidly through contracting mechanisms with Non-Governmental Organisations (NGOs). The central thesis of this article is that, despite the good intentions of the BPHS, not enough has been done to overcome the barriers to accessing its services. This analysis, enabled through a review of the existing literature, identifies and categorises these barriers into the three access dimensions of: acceptability, affordability and availability. As each of these is explored individually, analysis will show the extent to which these barriers to access are a critical issue, consider the underlying reasons for their existence and evaluate the efforts to overcome these barriers. Understanding these barriers and the policies that have been implemented to address them is critical to the future of health system strengthening in Afghanistan.

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

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

Waters, Richard Thomas

2015-12-01

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

Barriers to dental care for children with autism spectrum disorder.

PubMed

Barry, S; O'Sullivan, E A; Toumba, K J

2014-04-01

This study examined the problems encountered by children with autism spectrum disorder (ASD), when accessing dental care. This was a cross-sectional, case-control questionnaire study. A piloted questionnaire was developed to identify the main barriers to dental care experienced by patients with ASD in Hull and East Riding. The study group was comprised of parents/carers of children with ASD, and the control group was comprised of parents/carers of age matched healthy, neurotypical children. Results were analysed using Chi-square and Fisher's exact tests where appropriate. Significance was deemed at p < 0.05. Ordinal data was presented using medians and 25th and 75th centiles and compared using Mann-Whitney U test. A piloted questionnaire was developed to identify the main barriers to dental care experienced by patients with ASD in Hull and East Riding. The study group was comprised of parents/carers of children with ASD, and the control group was comprised of parents/carers of age matched healthy, neurotypical children. 112 subjects completed the questionnaire. There was no significant difference in accessing dental care between study and control groups (p = 0.051), although access was perceived as more difficult in the ASD group (p < 0.001). There was a significantly greater perceived difficulty in travelling to the dental surgery in the ASD group. Predicted negative behaviours were more frequent in the ASD group. All suggested interventions were predicted to be helpful in a significantly greater proportion of the ASD group. Difficulties exist for children with ASD in accessing dental care in the Hull and East Riding area.

Human gene therapy: novel approaches to improve the current gene delivery systems.

PubMed

Cucchiarini, Magali

2016-06-01

Even though gene therapy made its way through the clinics to treat a number of human pathologies since the early years of experimental research and despite the recent approval of the first gene-based product (Glybera) in Europe, the safe and effective use of gene transfer vectors remains a challenge in human gene therapy due to the existence of barriers in the host organism. While work is under active investigation to improve the gene transfer systems themselves, the use of controlled release approaches may offer alternative, convenient tools of vector delivery to achieve a performant gene transfer in vivo while overcoming the various physiological barriers that preclude its wide use in patients. This article provides an overview of the most significant contributions showing how the principles of controlled release strategies may be adapted for human gene therapy.

Inner Ear Drug Delivery for Auditory Applications

PubMed Central

Swan, Erin E. Leary; Mescher, Mark J.; Sewell, William F.; Tao, Sarah L.; Borenstein, Jeffrey T.

2008-01-01

Many inner ear disorders cannot be adequately treated by systemic drug delivery. A blood-cochlear barrier exists, similar physiologically to the blood-brain barrier, which limits the concentration and size of molecules able to leave the circulation and gain access to the cells of the inner ear. However, research in novel therapeutics and delivery systems has led to significant progress in the development of local methods of drug delivery to the inner ear. Intratympanic approaches, which deliver therapeutics to the middle ear, rely on permeation through tissue for access to the structures of the inner ear, whereas intracochlear methods are able to directly insert drugs into the inner ear. Innovative drug delivery systems to treat various inner ear ailments such as ototoxicity, sudden sensorineural hearing loss, autoimmune inner ear disease, and for preserving neurons and regenerating sensory cells are being explored. PMID:18848590

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

PubMed

Litherland, Rachel

2012-08-01

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

Persistent barriers and strategic practices: why (asking about) the everyday matters in diabetes care.

PubMed

Rendle, Katharine A S; May, Suepattra G; Uy, Visith; Tietbohl, Caroline K; Mangione, Carol M; Frosch, Dominick L

2013-01-01

The purpose of this study was to explore the everyday barriers to and practices of low-income patients managing their diabetes. The study team conducted semistructured qualitative interviews with 20 patients with type 2 diabetes who were receiving care at safety-net clinics in Southern California. Transcripts were analyzed using grounded theory to identify emergent themes across participants. Participants described managing diabetes with limited financial resources as often a game of balance and negotiation, whereby purchasing healthy foods is abandoned because of a more pressing concern in their life. Although participants described strategic attempts at incorporating healthy dietary practices for diabetes management into their daily decisions, these efforts were significantly impeded by the existence of persistent and seemingly insurmountable barriers. Although the challenges that low-income patients face in managing their diabetes may seem insurmountable at times, there are several ways that health care providers can help reduce the burden of these challenges, including tailoring their recommendations to incorporate the everyday socioeconomic environment of patients and engaging in clear, open communication with patients.

Through seniors' eyes: an exploratory qualitative study to identify environmental barriers to and facilitators of walking.

PubMed

Lockett, Donna; Willis, Alette; Edwards, Nancy

2005-09-01

This qualitative exploratory study examined environmental factors influencing the walking choices of elderly people using the photovoice approach. A total of 13 seniors in Ottawa, Canada, took photographs of barriers to and facilitators of walking in their neighbourhoods. These photos were displayed during 3 focus-group sessions and served as touchstones for discussion. A total of 22 seniors, including 8 of the 13 photographers, participated in the focus-group sessions. The findings show that environmental hazards related to traffic and falls risks can be significant barriers to walking for seniors, and that connectivity can truly exist for the elderly only if convenience, hazard-free routes are available. They also indicate that simple amenities such as benches and washrooms might facilitate walking for seniors. A neighbourhood that is activity-friendly for seniors will also be a good place for everyone else to live, work, and play. The use of photovoice as a method was well received by the participants and provided rich information that may not have been captured through other means.

Tunneling magnetoresistance tuned by a vertical electric field in an AA-stacked graphene bilayer with double magnetic barriers

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

Wang, Dali, E-mail: wangdali@mail.ahnu.edu.cn; National Laboratory of Solid State Microstructures and Department of Physics, Nanjing University, Nanjing 210093; Jin, Guojun, E-mail: gjin@nju.edu.cn

2013-12-21

We investigate the effect of a vertical electric field on the electron tunneling and magnetoresistance in an AA-stacked graphene bilayer modulated by the double magnetic barriers with parallel or antiparallel configuration. The results show that the electronic transmission properties in the system are sensitive to the magnetic-barrier configuration and the bias voltage between the graphene layers. In particular, it is found that for the antiparallel configuration, within the low energy region, the blocking effect is more obvious compared with the case for the parallel configuration, and even there may exist a transmission spectrum gap which can be arbitrarily tuned bymore » the field-induced interlayer bias voltage. We also demonstrate that the significant discrepancy between the conductance for both parallel and antiparallel configurations would result in a giant tunneling magnetoresistance ratio, and further the maximal magnetoresistance ratio can be strongly modified by the interlayer bias voltage. This leads to the possible realization of high-quality magnetic sensors controlled by a vertical electric field in the AA-stacked graphene bilayer.« less

Development of an ultrahigh-performance infrared detector platform for advanced spectroscopic sensing systems

NASA Astrophysics Data System (ADS)

Jain, Manish; Wicks, Gary; Marshall, Andrew; Craig, Adam; Golding, Terry; Hossain, Khalid; McEwan, Ken; Howle, Chris

2014-05-01

Laser-based stand-off sensing of threat agents (e.g. explosives, toxic industrial chemicals or chemical warfare agents), by detection of distinct infrared spectral absorption signature of these materials, has made significant advances recently. This is due in part to the availability of infrared and terahertz laser sources with significantly improved power and tunability. However, there is a pressing need for a versatile, high performance infrared sensor that can complement and enhance the recent advances achieved in laser technology. This work presents new, high performance infrared detectors based on III-V barrier diodes. Unipolar barrier diodes, such as the nBn, have been very successful in the MWIR using InAs(Sb)-based materials, and in the MWIR and LWIR using type-II InAsSb/InAs superlattice-based materials. This work addresses the extension of the barrier diode architecture into the SWIR region, using GaSb-based and InAs-based materials. The program has resulted in detectors with unmatched performance in the 2-3 μm spectral range. Temperature dependent characterization has shown dark currents to be diffusion limited and equal to, or within a factor of 5, of the Rule 07 expression for Auger-limited HgCdTe detectors. Furthermore, D* values are superior to those of existing detectors in the 2-3 μm band. Of particular significance to spectroscopic sensing systems is the ability to have near-background limited performance at operation temperatures compatible with robust and reliable solid state thermoelectric coolers.

Imbalance of gut microbiome and intestinal epithelial barrier dysfunction in patients with high blood pressure

PubMed Central

Kim, Seungbum; Goel, Ruby; Kumar, Ashok; Qi, Yanfei; Lobaton, Gil; Hosaka, Koji; Mohammed, Mohammed; Handberg, Eileen M.; Richards, Elaine M.; Pepine, Carl J.; Raizada, Mohan K.

2018-01-01

Recent evidence indicates a link between gut pathology and microbiome with hypertension (HTN) in animal models. However, whether this association exists in humans is unknown. Thus, our objectives in the present study were to test the hypotheses that high blood pressure (BP) patients have distinct gut microbiomes and that gut–epithelial barrier function markers and microbiome composition could predict systolic BP (SBP). Fecal samples, analyzed by shotgun metagenomics, displayed taxonomic and functional changes, including altered butyrate production between patients with high BP and reference subjects. Significant increases in plasma of intestinal fatty acid binding protein (I-FABP), lipopolysaccharide (LPS), and augmented gut-targetting proinflammatory T helper 17 (Th17) cells in high BP patients demonstrated increased intestinal inflammation and permeability. Zonulin, a gut epithelial tight junction protein regulator, was markedly elevated, further supporting gut barrier dysfunction in high BP. Zonulin strongly correlated with SBP (R2 = 0.5301, P<0.0001). Two models predicting SBP were built using stepwise linear regression analysis of microbiome data and circulating markers of gut health, and validated in a separate cohort by prediction of SBP from zonulin in plasma (R2 = 0.4608, P<0.0001). The mouse model of HTN, chronic angiotensin II (Ang II) infusion, was used to confirm the effects of butyrate and gut barrier function on the cardiovascular system and BP. These results support our conclusion that intestinal barrier dysfunction and microbiome function are linked to HTN in humans. They suggest that manipulation of gut microbiome and its barrier functions could be the new therapeutic and diagnostic avenues for HTN. PMID:29507058

Highly Pathogenic H5N1 Avian Influenza Viruses Exhibit Few Barriers to Gene Flow in Vietnam

PubMed Central

Carrel, Margaret; Wan, Xiu-Feng; Nguyen, Tung; Emch, Michael

2013-01-01

Locating areas where genetic change is inhibited can illuminate underlying processes that drive evolution of pathogens. The persistence of highly pathogenic H5N1 avian influenza in Vietnam since 2003, and the continuous molecular evolution of Vietnamese avian influenza viruses, indicates that local environmental factors are supportive not only of incidence but also of viral adaptation. This article explores whether gene flow is constant across Vietnam, or whether there exist boundary areas where gene flow exhibits discontinuity. Using a dataset of 125 highly pathogenic H5N1 avian influenza viruses, principal components analysis and wombling analysis are used to indicate the location, magnitude, and statistical significance of genetic boundaries. Results show that a small number of geographically minor boundaries to gene flow in highly pathogenic H5N1 avian influenza viruses exist in Vietnam, but that overall there is little division in genetic exchange. This suggests that differences in genetic characteristics of viruses from one region to another are not the result of barriers to H5N1 viral exchange in Vietnam, and that H5N1 avian influenza is able to spread relatively unimpeded across the country. PMID:22350419

Institutional and environmental aspects of geothermal energy development

NASA Technical Reports Server (NTRS)

Citron, O. R.

1977-01-01

Until recently, the majority of work in geothermal energy development has been devoted to technical considerations of resource identification and extraction technologies. The increasing interest in exploiting the variety of geothermal resources has prompted an examination of the institutional barriers to their introduction for commercial use. A significant effort was undertaken by the Jet Propulsion Laboratory as a part of a national study to identify existing constraints to geothermal development and possible remedial actions. These aspects included legislative and legal parameters plus environmental, social, and economic considerations.

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

PubMed

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

2016-02-01

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

Intersecting motivations for leaving abusive relationships, substance abuse, and transactional sex among HIV high-risk women

PubMed Central

David, Naomi S.; Hussen, Sophia A.; Comeau, Dawn L.; Kalokhe, Ameeta S.

2017-01-01

Background Women bear a significant burden of the HIV epidemic in the United States. Women classified as ‘HIV high-risk’ often bring co-existing histories of intimate partner violence (IPV), drug use, and transactional sex. To help inform future comprehensive HIV prevention strategies, we aimed to explore common motivating reasons and barriers to leaving and/or terminating engagement in each of these risk-promoting situations. Methods Between August and November 2014, in-depth interviews were conducted with 14 HIV high-risk women in Atlanta, Georgia who had experienced IPV in the previous 12 months, and used drugs and/or engaged in transactional sex in the previous five years. Participants were asked about histories of IPV, drug use, and/or engagement in transactional sex, and the motivating reasons and barriers to terminating each. Results Women reported a range of motivating reasons for leaving IPV, drug use, and transactional sex. Overlapping themes included impact on children, personal physical health/safety, and life dissatisfaction. Financial need was identified as a common barrier to leaving. Conclusions Future HIV prevention research should further explore the perceived impact of IPV, drug use, and transactional sex on physical health/safety, life dissatisfaction, one’s children, and financial need as motivators and barriers to reducing upstream HIV risk. PMID:28393140

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.

Informal and formal care infrastructure and perceived need for caregiver training for frail US veterans referred to home and community-based services.

PubMed

Van Houtven, Courtney Harold; Oddone, Eugene Z; Weinberger, Morris

2010-03-01

To describe the informal care network of US veterans referred to home and community-based services (Homemaker Home Health services, H/HHA, or Home-Based Primary Care, HBPC) at the Durham Veterans Affairs Medical Center (VAMC), including: quantity and types of tasks provided and desired content for caregiver training programs. All primary care patients referred to H/HHA or HBPC during the preceding 3 months were sent questionnaires in May 2007. Additionally, caregivers were sent questionnaires if a patient gave permission. Descriptive statistics and chi-squared tests were performed. On average, patients received 5.6 hours of VA care and 47 hours of informal care per week. 26% of patients (38% of patients with caregiver proxy respondents) and 59% of caregivers indicated the caregiver would be interested in participating in a training program by phone or on-site. Significant barriers to participation existed. The most common barriers were: transportation; no time due to caregiving or work demands; caregiver's own health limitations; and no need. Caregiver training needs to be tailored to overcome barriers to participate. Overcoming these barriers may be possible through in-home phone or internet training outside traditional business hours, and by tailoring training to accommodate limiting health problems among caregivers.

Barrier Coverage for 3D Camera Sensor Networks

PubMed Central

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

2017-01-01

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

Barrier Coverage for 3D Camera Sensor Networks.

PubMed

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

2017-08-03

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

Mental illness in Bwindi, Uganda: Understanding stakeholder perceptions of benefits and barriers to developing a community-based mental health programme.

PubMed

Sessions, Kristen L; Wheeler, Lydia; Shah, Arya; Farrell, Deenah; Agaba, Edwin; Kuule, Yusufu; Merry, Stephen P

2017-11-30

Mental illness has been increasingly recognised as a source of morbidity in low- and middle-income countries and significant treatment gaps exist worldwide. Studies have demonstrated the effectiveness of task sharing through community-based treatment models for addressing international mental health issues. This paper aims to evaluate the perceptions of a wide range of mental health stakeholders in a Ugandan community regarding the benefits and barriers to developing a community-based mental health programme. Bwindi Community Hospital (BCH) in south-west Uganda provides services through a team of community health workers to people in the Kanungu District. Thematic analysis of 13 semi-structured interviews and 6 focus group discussions involving 54 community members and 13 mental health stakeholders within the BCH catchment area. Stakeholders perceived benefits to a community-based compared to a hospital-based programme, including improved patient care, lower costs to patients and improved community understanding of mental illness. They also cited barriers including cost, insufficient workforce and a lack of community readiness. Stakeholders express interest in developing community-based mental health programmes, as they feel that it will address mental health needs in the community and improve community awareness of mental illness. However, they also report that cost is a significant barrier to programme development that will have to be addressed prior to being able to successfully establish such programming. Additionally, many community members expressed unique sociocultural beliefs regarding the nature of mental illness and those suffering from a psychiatric disease.

Falling short: how state laws can address health information exchange barriers and enablers.

PubMed

Schmit, Cason D; Wetter, Sarah A; Kash, Bita A

2018-06-01

Research on the implementation of health information exchange (HIE) organizations has identified both positive and negative effects of laws relating to governance, incentives, mandates, sustainability, stakeholder participation, patient engagement, privacy, confidentiality, and security. We fill a substantial research gap by describing whether comprehensive state and territorial HIE legal frameworks address identified legal facilitators and barriers. We used the Westlaw database to identify state and territorial laws relating to HIEs in effect on June 7, 2016 (53 jurisdictions). We blind-coded all laws and addressed coding discrepancies in peer-review meetings. We recorded a consensus code for each law in a master database. We compared 20 HIE legal attributes with identified barriers to and enablers of HIE activity in the literature. Forty-two states, the District of Columbia, and 2 territories have laws relating to HIEs. On average, jurisdictions address 8.32 of the 20 criteria selected in statutes and regulations. Twenty jurisdictions unambiguously address ≤5 criteria in statutes and regulations. None of the significant legal criteria are unambiguously addressed in >60% of the 53 jurisdictions. Laws can be barriers to or enablers of HIEs. However, jurisdictions are not addressing many significant issues identified by researchers. Consequently, there is a substantial risk that existing legal frameworks are not adequately supporting HIEs. The current evidence base is insufficient for comparative assessments or impact rankings of the various factors. However, the detailed Centers for Disease Control and Prevention dataset of HIE laws could enable investigations into the types of laws that promote or impede HIEs.

Disease management in Canada: surmounting barriers to adoption.

PubMed

Gallant, Christopher R; MacKinnon, Neil J; Sprague, Denise A

2007-01-01

Disease Management (DM) programs are used to optimize economic outcomes and improve patient outcomes. Despite this, relative to the United States, Canadian health care organizations have been slow to adopt them. The objective of this article is to examine the concept of DM programs, the existing evidence to support their use and the barriers to their adoption in Canada. Several solutions aimed at overcoming the barriers to DM in Canada are proposed.

Barriers to Decentralized Teacher Education.

ERIC Educational Resources Information Center

Stuhr, Christian

In an effort to meet the demand for off-campus postsecondary education at the degree, diploma, or certificate levels, this report examines the barriers against and reasons for offering decentralized teacher education programs from universities to colleges in rural Canadian provinces. Several reasons exist for the demand for off-campus…

Free energy barrier for melittin reorientation from a membrane-bound state to a transmembrane state.

PubMed

Irudayam, Sheeba J; Pobandt, Tobias; Berkowitz, Max L

2013-10-31

An important step in a phospholipid membrane pore formation by melittin antimicrobial peptide is a reorientation of the peptide from a surface into a transmembrane conformation. Experiments measure the fraction of peptides in the surface state and the transmembrane state, but no computational study exists that quantifies the free energy curve for the reorientation. In this work we perform umbrella sampling simulations to calculate the potential of mean force (PMF) for the reorientation of melittin from a surface-bound state to a transmembrane state and provide a molecular level insight in understanding the peptide-lipid properties that influence the existence of the free energy barrier. The PMFs were calculated for a peptide to lipid (P/L) ratio of 1/128 and 4/128. We observe that the free energy barrier is reduced when the P/L ratio increases. In addition, we study the cooperative effect; specifically we investigate if the reorientation barrier is smaller for a second melittin, given that another neighboring melittin was already in the transmembrane orientation. We observe that indeed the barrier of the PMF curve is reduced in this case, thus confirming the presence of a cooperative effect.

Two breakdown mechanisms in ultrathin alumina barrier magnetic tunnel junctions

NASA Astrophysics Data System (ADS)

Oliver, Bryan; Tuttle, Gary; He, Qing; Tang, Xuefei; Nowak, Janusz

2004-02-01

Two breakdown mechanisms are observed in magnetic tunnel junctions having an ultrathin alumina barrier. The two breakdown mechanisms manifest themselves differently when considering large ensembles of nominally identical devices under different stress conditions. The results suggest that one type of breakdown occurs because of the intrinsic breakdown of a well-formed oxide barrier that can be described by the E model of dielectric breakdown. The other is an extrinsic breakdown related to defects in the barrier rather than the failure of the oxide integrity. The characteristic of extrinsic breakdown suggests that a pre-existing pinhole in the barriers grows in area by means of dissipative (Joule) heating and/or an electric field across the pinhole circumference.

Cable-to-post attachments for use in non-proprietary high-tension cable median barrier - phase II.

DOT National Transportation Integrated Search

2016-03-24

The objective of this study was to reevaluate and improve the existing cable-to-post attachment hardware that is utilized : in the non-proprietary cable barrier being developed at MwRSF. The study focused on redesigning the bolted, tabbed : bracket (...

The Stumbling Campaign for Free-Access Buildings

ERIC Educational Resources Information Center

Building Design and Construction, 1974

1974-01-01

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

Barriers to Professional Advancement among Female Managers.

ERIC Educational Resources Information Center

O'Leary, Virginia E.

It appears that there is nothing inherently associated with femaleness which should preclude the ascendence of women into management positions. However, barriers do exist and they stem from such factors as societal sex-role stereotypes, attitudes toward women in management, attitudes toward female competence, and the prevalence of the male…

Collaboration-Focused Workshop for Interdisciplinary, Inter-Institutional Teams of College Science Faculty

ERIC Educational Resources Information Center

Hanson, Pamela K.; Stultz, Laura

2015-01-01

Many science educators know of the pedagogical benefits of inquiry- and research-based labs, yet numerous barriers to implementation exist. In this article we describe a faculty development workshop that explored interdisciplinary and inter-institutional collaborations as potential mechanisms for overcoming barriers to curricular innovation.

GEOCHEMICAL AND MICROBIAL REACTIONS AFFECTING THE LONG-TERM PERFORMANCE OF IN SITU 'IRON BARRIERS'

EPA Science Inventory

The in situ application of granular iron (Fe0) has become popular for the destruction of halogenated organic compounds for the immobilization of specific metals in groundwater. However, a knowledge gap exists concerning the long-term performance of the Fe0-barriers. The corrosi...

Noble magnetic barriers in the ASDEX UG tokamak

NASA Astrophysics Data System (ADS)

Ali, Halima; Punjabi, Alkesh; Vazquez, Justin

2010-02-01

The second-order perturbation method of creating invariant tori inside chaos in Hamiltonian systems (Ali, H.; Punjabi, A. Plasma Phys. Contr. F. 2007, 49, 1565-1582) is applied to the axially symmetric divertor experiment upgrade (ASDEX UG) tokamak to build noble irrational magnetic barriers inside chaos created by resonant magnetic perturbations (m, n)=(3, 2)+(4, 3), with m and n the poloidal and toroidal mode numbers of the Fourier expansion of the magnetic perturbation. The radial dependence of the Fourier modes is ignored. The modes are considered to be locked and have the same amplitude δ. A symplectic mathematical mapping in magnetic coordinates is used to integrate magnetic field line trajectories in the ASDEX UG. Tori with noble irrational rotational transform are the last ones to be destroyed by perturbation in Hamiltonian systems. For this reason, noble irrational magnetic barriers are built inside chaos, and the strongest noble irrational barrier is identified. Three candidate locations for the strongest noble barrier in ASDEX UG are selected. All three candidate locations are chosen to be roughly midway between the resonant rational surfaces ψ32 and ψ43. ψ is the magnetic coordinate of the flux surface. The three candidate surfaces are the noble irrational surfaces close to the surface with q value that is a mediant of q=3/2 and 4/3, q value of the physical midpoint of the two resonant surfaces, and the q value of the surface where the islands of the two perturbing modes just overlap. These q values of the candidate surfaces are denoted by q MED, q MID, and q OVERLAP. The strongest noble barrier close to q MED has the continued fraction representation (CFR) [1;2,2,1∞] and exists for δ≤2.6599×10-4; the strongest noble barrier close to q MID has CFR [1;2,2,2,1∞] and exists for δ≤4.6311×10-4; and the strongest noble barrier close to q OVERLAP has CFR [1;2,2,6,2,1∞] and exists for δ≤1.367770×10-4. From these results, the strongest noble barrier is found to be close to the surface that is located physically exactly in the middle of the two resonant surfaces.

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

PubMed Central

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

2014-01-01

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

Captive breeding of pangolins: current status, problems and future prospects.

PubMed

Hua, Liushuai; Gong, Shiping; Wang, Fumin; Li, Weiye; Ge, Yan; Li, Xiaonan; Hou, Fanghui

2015-01-01

Pangolins are unique placental mammals with eight species existing in the world, which have adapted to a highly specialized diet of ants and termites, and are of significance in the control of forest termite disaster. Besides their ecological value, pangolins are extremely important economic animals with the value as medicine and food. At present, illegal hunting and habitat destruction have drastically decreased the wild population of pangolins, pushing them to the edge of extinction. Captive breeding is an important way to protect these species, but because of pangolin's specialized behaviors and high dependence on natural ecosystem, there still exist many technical barriers to successful captive breeding programs. In this paper, based on the literatures and our practical experience, we reviewed the status and existing problems in captive breeding of pangolins, including four aspects, the naturalistic habitat, dietary husbandry, reproduction and disease control. Some recommendations are presented for effective captive breeding and protection of pangolins.

Barriers to NP Practice that Impact Healthcare Redesign.

PubMed

Hain, Debra; Fleck, Laureen M

2014-05-31

As healthcare reform evolves, nurse practitioners (NP) will play key roles in improving health outcomes of diverse populations. According to the Institute of Medicine (IOM) 2011 report, The Future of Nursing: Leading Change Advancing Health, nurses should be change advocates by caring for populations within complex healthcare systems. The IOM reports asserts, "advanced practice registered nurses (APRNs) should be able to practice to the fullest extent of their education and training" (IOM, 2011, s8). However, existing barriers in the healthcare arena limit APRN practice. This article will discuss some of these barriers and provide suggestions for possible ways to decrease the barriers.

Stochastic optimization algorithms for barrier dividend strategies

NASA Astrophysics Data System (ADS)

Yin, G.; Song, Q. S.; Yang, H.

2009-01-01

This work focuses on finding optimal barrier policy for an insurance risk model when the dividends are paid to the share holders according to a barrier strategy. A new approach based on stochastic optimization methods is developed. Compared with the existing results in the literature, more general surplus processes are considered. Precise models of the surplus need not be known; only noise-corrupted observations of the dividends are used. Using barrier-type strategies, a class of stochastic optimization algorithms are developed. Convergence of the algorithm is analyzed; rate of convergence is also provided. Numerical results are reported to demonstrate the performance of the algorithm.

Psychosocial Interventions for Families with Parental Cancer and Barriers and Facilitators to Implementation and Use – A Systematic Review

PubMed Central

Inhestern, Laura; Haller, Anne-Catherine; Wlodarczyk, Olga; Bergelt, Corinna

2016-01-01

Background Parental cancer has a significant impact on minor children and families. Psychosocial interventions for affected families can provide support where necessary. This systematic review aims at providing an overview of existing interventions and support programs and focuses on the systematic investigation of barriers and facilitators for using psychosocial interventions for families affected by parental cancer (PROSPERO; registration number CRD42014013020). Methods A search of five electronic databases (EMBASE, MEDLINE, PsycInfo, Psyndex, CINAHL) was conducted in June 2014, and updated in September 2015. We included any kind of studies reporting psychosocial support services or interventions for families affected by parental cancer. Study quality was assessed using the Mixed Method Assessment Tool. Narrative synthesis and thematic analyses were undertaken to examine the included interventions and to identify barriers and facilitators for use and implementation. Results A total of 36 studies covering 19 interventions and support services were included in the systematic review. Interventions focused on children, parents or several family members and analyses revealed a broad picture of theoretical background and primary aims. Several studies focused on developmental or implementation phases or descriptions of interventions. Other included studies reported results of evaluations using qualitative and quantitative methods. Results suggest that interventions are helpful and that participants improved in various outcomes. The thematic analyses indicate that barriers for use of support services refer to aspects concerning the patients and families, such as practical difficulties, perceived need for support or fear of stigma. Cancer patients who understood the need and benefit of support services may have used them more often. Additionally, intervention characteristics such as a flexible structure and accessibility were important to reach families affected by parental cancer. Disease characteristics and complications in collaborations were identified as potential barriers. The provision of information about interventions by clinicians and understanding the support as part of routine care seem to be key issues for implementation and use of psychosocial support. Conclusion This review identified a broad number of intervention concepts for families with minor children affected by parental cancer. Findings provide a basis for existing or future psychosocial interventions to anticipate potential barriers and facilitators to implementation and use and can help to reach a wider range of families in need for support. PMID:27276079

Barriers to reducing climate enhanced disaster risks in Least Developed Country-Small Islands through anticipatory adaptation

NASA Astrophysics Data System (ADS)

Kuruppu, N.; Willie, R.

2015-12-01

Small Island Developing States (SIDS) classified as Least Developed Countries (LDCs) are particularly vulnerable to the projected impacts of climate change. Given their particular vulnerabilities, climate adaptation investments are being made through both national and international efforts to build the capacity of various sectors and communities to reduce climate risks and associated disasters. Despite these efforts, reducing climate risks is not free of various challenges and barriers. This paper aims to synthesise a set of critical socio-economic barriers present at various spatial scales that are specific to Least Developed Country SIDS. It also aims to identify the processes that give rise to these barriers. Drawing on theories from natural hazards, a systematic literature review method was adopted to identify and organise the set of barriers by focussing both on academic papers and grey literature. The data revealed a notable lack of studies on adaptation within African and Caribbean LDC-SIDS. In general, there was a paucity of academic as well as grey literature being produced by authors from LDC-SIDS to challenge existing discourses related to adaptation barriers. The most common barriers identified included those related to governance, technical, cognitive and cultural. Three key findings can be drawn from this study in relation to formal adaptation initiatives. Firstly, the lack of focus on the adaptive capacity needs of Local Government or Island Councils and communities was a key barrier to ensuring success of adaptation interventions. Secondly, international adaptation funding modalities did little to address root causes of vulnerability or support system transformations. These funds were geared at supporting sectoral level adaptation initiatives for vulnerable natural resource sectors such as water, biodiversity and coastal zones. Thirdly, there is a need to recognise the significance of cultural knowledge and practices in shaping adaptive choices of communities in SIDS.

"Be kind to young people so they feel at home": a qualitative study of adolescents' and service providers' perceptions of youth-friendly sexual and reproductive health services in Vanuatu.

PubMed

Kennedy, Elissa C; Bulu, Siula; Harris, Jennifer; Humphreys, David; Malverus, Jayline; Gray, Natalie J

2013-10-31

Sexual activity during adolescence is common in Vanuatu, however many adolescents lack access to sexual and reproductive health (SRH) services and subsequently suffer a disproportionate burden of poor SRH. There is limited peer-reviewed research describing adolescents' SRH service delivery preferences in Vanuatu to inform policy and programs. The aim of this qualitative study was to explore the barriers preventing adolescents from accessing SRH services in Vanuatu and the features of a youth-friendly health service as defined by adolescents. Sixty-six focus group discussions were conducted with 341 male and female adolescents aged 15-19 years in rural and urban communities. Additionally, 12 semi-structured interviews were undertaken with policymakers and service providers. Data were analysed using thematic analysis. Socio-cultural norms and taboos regarding adolescent sexual behaviour were the most significant factors preventing adolescents from accessing services. These contributed to adolescents' own fear and shame, judgmental attitudes of service providers, and disapproval from parents and community gate-keepers. Lack of confidentiality and privacy, costs, and adolescents' lack of SRH knowledge were also important barriers. Adolescents and service providers identified opportunities to make existing services more youth-friendly. The most important feature of a youth-friendly health service described by adolescents was a friendly service provider. Free or affordable services, reliable commodity supply, confidentiality and privacy were also key features. The need to address socio-cultural norms and community knowledge and attitudes was also highlighted. There are significant demand and supply-side barriers contributing to low utilisation of SRH services by adolescents in Vanuatu. However, there are many opportunities to make existing SRH services more youth-friendly, such as improving service provider training. Investment is also required in strategies that aim to create a more supportive environment for adolescent SRH.

Prevalence and types of disease management programs in community pharmacies in California.

PubMed

Law, Anandi V; Okamoto, Mark P; Chang, Peter S

2005-01-01

To (1) evaluate the prevalence and types of disease management (DM) programs provided by independent and chain community pharmacies in the state of California, (2) examine the interest among community pharmacists in establishing programs, and (3) assess perceived barriers to developing a successful DM program in community pharmacy. An exploratory telephone survey was conducted from February 2003 to February 2004 to collect data from community (primarily independent and chainstore) pharmacies across California. The survey evaluated existence (or lack of) and types of DM programs in community pharmacies in California. Pharmacies that did not have a DM program were queried on their interest and decisionmaking authority in establishing new programs. Pharmacies that had existing DM programs were sent a follow-up survey to determine the details of the DM programs, including challenges in establishing DM programs, reimbursement issues, and program effectiveness. The sample comprised 1,875 pharmacies, 60 (3.2%) of which had existing DM programs. There were significantly more independent pharmacies (37) with DM programs than chain-store pharmacies (23), P<0.001. There was a statistically significant difference between independent and chain pharmacies in operating hours, number of pharmacist and nonpharmacist staff members per day, and proximity to a clinic or hospital (P<0.05). The most common type of DM program was diabetes, and the second most common type was asthma. Limited time, limited staff, and limited reimbursement were the 3 most commonly reported barriers to establishing new DM programs. About 20% of the sample that did not have a DM program reported interest in developing DM programs, and an equal percentage reported having the decision-making authority to start a program. There were no differences between independent and chain pharmacies on interest (P = 0.234); however, there were significantly more chain pharmacists that did not have the decision-making authority. Of the 18 of 60 pharmacies (30%) that had DM programs and responded to the follow-up survey, 9 respondents (50%) reported monitoring medications as part of their DM program. Fifteen of 18 (83%) perceived lack of reimbursement as a challenge to implementing DM programs. Only 2 pharmacies reported an increase in revenue as a gain from the program, and 2 reported cost savings. Improved patient satisfaction was reported by 16 of 18 respondents (89%) with DM programs, but only 8 (44%) reported that patient satisfaction was being measured. The study found that the prevalence of DM programs was very low among California community pharmacies and the interest in developing these programs moderate, attributable to several barriers such as lack of time, lack of reimbursement, and lack of trained personnel. Some of these barriers could be addressed to encourage the development and proliferation of DM programs that would improve patient outcomes and expand practice roles of pharmacists.

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.

Participation of Racial and Ethnic Minorities in Technology-Based Interventions to Self-Manage Type 2 Diabetes: A Scoping Review.

PubMed

Jang, Myoungock; Johnson, Constance M; D'Eramo-Melkus, Gail; Vorderstrasse, Allison A

2018-05-01

Strategies to decrease societal and cultural barriers for ethnic minorities to participate in health research are well established. However, limited data are available regarding participation of ethnic minorities in mobile and Internet technology-based interventions to self-manage type 2 diabetes where health disparities are predominant. Thus, the purpose was to understand the participation of ethnic minorities in technology-based intervention programs to manage type 2 diabetes. A scoping review was used to review a total of 21 intervention studies containing participant information about ethnic minorities and one qualitative study discussing participation of ethnic minorities. There was limited enrollment and participation of ethnic minorities. Technological barriers in addition to existing societal and cultural barriers were identified. Strategies to decrease the barriers were recommended. Technological barriers were identified on top of the societal and cultural barriers in traditional interventions. Further research to reduce the barriers is warranted.

International ESCO business opportunities and challenges: a Japanese case study

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

Vine, E.; Murakoshi, C.

1997-10-01

Recently, US energy service companies (ESCOs) have begun to actively explore markets outside the US. Despite the needs of many countries for ESCO involvement, ESCOs face many challenges (i.e., marketing, financial, institutional, political and cultural barriers). Consequently, most of these firms pursue international project opportunities very selectively due to the costs and risks associated with project development. Despite these barriers, some ESCOs view international work as a strategic expansion of their business, assuming that there will be adequate business in the future to repay them for their initial investment. In this paper, the authors present the findings from a recentlymore » completed study on the proposed development of an ESCO industry in Japan. The study was based on four sources of information: (1) a review of the published and unpublished literature on ESCOs; (2) interviews with 26 ESCOs in the US, the US Department of Energy, and the National Association of Energy Service Companies (NAESCO); (3) ESCO presentations at the October 1996 NAESCO meeting; and (4) informal discussions with ESCO experts in the US. They believe that the lessons learned in this study can be transferred or applied to other countries interested in developing an ESCO industry. While energy prices have remained relatively stable over the last several years in Japan and energy capacity is not perceived as a near-term problem, other ``market drivers`` necessary for the emergence of a successful and vibrant ESCO industry exist in Japan. Despite the presence of these market drivers, significant barriers to the successful development of an ESCO industry exist in Japan.« less

The role of extreme floods in estuary-coastal behaviour: contrasts between river- and tide-dominated microtidal estuaries

NASA Astrophysics Data System (ADS)

Cooper, J. A. G.

2002-06-01

Contrasting modes of sedimentation and facies arrangement in tide- and river-dominated microtidal estuaries arise from the degree to which river or tidal discharge and sediment supply influences an estuary. A distinct facies gradation exists in tide-dominated systems from sandy, barrier/tidal delta-associated environments at the coast through deep mud-dominated middle reaches to fluvial sediment in the upper reaches. In river-dominated systems, fluvial sediment extends to the barrier and flood-tidal deltas are poorly developed or absent from the estuary. A number of independent observations during extreme floods on the South African coast indicate that these types of estuary respond differently to extreme river floods and that the mode of response corresponds to estuary type. Tide-dominated systems exhibit preferential erosion of noncohesive barrier and tidal delta sediments during river floods while the middle reaches remain little modified. River-dominated systems experience consistent erosion throughout their channel length during extreme floods. The increased cohesion of riverine sediments and stabilisation of bars by vegetation in river-dominated channels means that higher magnitude floods are necessary to effect significant morphological change. Barrier erosion, including the tidal delta, results in deposition of an ephemeral delta composed almost entirely of sands from these deposits in tide-dominated estuaries. In river-dominated systems, eroded channel sediments and material from the river catchment may augment barrier sediments in the ephemeral delta deposit. Post-flood, wave-reworking of ephemeral delta sediments acts to restore barriers to pre-flood morphology within a few years; however, in river-dominated systems, the additional sediment volume may produce significant coastal progradation that requires several years or decades to redistribute. These different modes of flood response mediated by the nature of the estuary have implications for coastal behaviour at the time scale of months to several decades. Estuary-coastal behaviour at river-dominated estuaries may be influenced for several decades by post-flood morphological adjustment. Tide-dominated estuaries, however, respond more rapidly in reworking flood-eroded sediment and are typically fully adjusted to modal wave and tidal conditions within a few months to a few years. In addition, the facies arrangement within the two estuary types renders tide-dominated estuaries more responsive to minor floods, while river-dominated estuaries, by virtue of more cohesive channel sediments, require greater discharges to effect significant morphological change.

Food Environments around American Indian Reservations: A Mixed Methods Study

PubMed Central

Kodish, Stephen; Oddo, Vanessa M.; Antiporta, Daniel A.; Jock, Brittany; Jones-Smith, Jessica C.

2016-01-01

Objectives To describe the food environments experienced by American Indians living on tribal lands in California. Methods Geocoded statewide food business data were used to define and categorize existing food vendors into healthy, unhealthy, and intermediate composite categories. Distance to and density of each of the composite food vendor categories for tribal lands and nontribal lands were compared using multivariate linear regression. Quantitative results were concurrently triangulated with qualitative data from in-depth interviews with tribal members (n = 24). Results After adjusting for census tract-level urbanicity and per capita income, results indicate there were significantly fewer healthy food outlets per square mile for tribal areas compared to non-tribal areas. Density of unhealthy outlets was not significantly different for tribal versus non-tribal areas. Tribal members perceived their food environment negatively and reported barriers to the acquisition of healthy food. Conclusions Urbanicity and per capita income do not completely account for disparities in food environments among American Indians tribal lands compared to nontribal lands. This disparity in access to healthy food may present a barrier to acting on the intention to consume healthy food. PMID:27560132

Food Environments around American Indian Reservations: A Mixed Methods Study.

PubMed

Chodur, Gwen M; Shen, Ye; Kodish, Stephen; Oddo, Vanessa M; Antiporta, Daniel A; Jock, Brittany; Jones-Smith, Jessica C

2016-01-01

To describe the food environments experienced by American Indians living on tribal lands in California. Geocoded statewide food business data were used to define and categorize existing food vendors into healthy, unhealthy, and intermediate composite categories. Distance to and density of each of the composite food vendor categories for tribal lands and nontribal lands were compared using multivariate linear regression. Quantitative results were concurrently triangulated with qualitative data from in-depth interviews with tribal members (n = 24). After adjusting for census tract-level urbanicity and per capita income, results indicate there were significantly fewer healthy food outlets per square mile for tribal areas compared to non-tribal areas. Density of unhealthy outlets was not significantly different for tribal versus non-tribal areas. Tribal members perceived their food environment negatively and reported barriers to the acquisition of healthy food. Urbanicity and per capita income do not completely account for disparities in food environments among American Indians tribal lands compared to nontribal lands. This disparity in access to healthy food may present a barrier to acting on the intention to consume healthy food.

Effect of disposable infection control barriers on light output from dental curing lights.

PubMed

Scott, Barbara A; Felix, Corey A; Price, Richard B T

2004-02-01

To prevent contamination of the light guide on a dental curing light, barriers such as disposable plastic wrap or covers may be used. This study compared the effect of 3 disposable barriers on the spectral output and power density from a curing light. The hypothesis was that none of the barriers would have a significant clinical effect on the spectral output or the power density from the curing light. Three disposable barriers were tested against a control (no barrier). The spectra and power from the curing light were measured with a spectrometer attached to an integrating sphere. The measurements were repeated on 10 separate occasions in a random sequence for each barrier. Analysis of variance (ANOVA) followed by Fisher's protected least significant difference test showed that the power density was significantly less than control (by 2.4% to 6.1%) when 2 commercially available disposable barriers were used (p < 0.05). There was no significant difference in the power density when general-purpose plastic wrap was used (p > 0.05). The effect of each of the barriers on the power output was small and probably clinically insignificant. ANOVA comparisons of mean peak wavelength values indicated that none of the barriers produced a significant shift in the spectral output relative to the control ( p > 0.05). Two of the 3 disposable barriers produced a significant reduction in power density from the curing light. This drop in power was small and would probably not adversely affect the curing of composite resin. None of the barriers acted as light filters.

"Dancing on the edge of research" - What is needed to build and sustain research capacity within the massage therapy profession? A formative evaluation.

PubMed

Kania-Richmond, Ania; Menard, Martha B; Barberree, Beth; Mohring, Marvin

2017-04-01

Conducting research on massage therapy (MT) continues to be a significant challenge. To explore and identify the structures, processes, and resources required to enable viable, sustainable and high quality MT research activities in the Canadian context. Academically-based researchers and MT professionals involved in research. Formative evaluation and a descriptive qualitative approach were applied. Five main themes regarding the requirements of a productive and sustainable MT research infrastructure in Canada were identified: 1) core components, 2) variable components, 3) varying perspectives of stakeholder groups, 4) barriers to creating research infrastructure, and 5) negative metaphors. In addition, participants offered a number of recommendations on how to develop such an infrastructure. While barriers exist that require attention, participants' insights suggest there are various pathways through which a productive and sustainable MT research infrastructure can be achieved. Copyright © 2016 Elsevier Ltd. All rights reserved.

Complex capacitance spectroscopy as a probe for oxidation process of AlO{sub x}-based magnetic tunnel junctions

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

Huang, J.C.A.; Hsu, C.Y.; Taiwan SPIN Research Center, National Chung Cheng University, Chiayi, Taiwan

2004-12-13

Proper as well as under- and over-oxided CoFe-AlO{sub x}-CoFe magnetic tunnel junctions (MTJs) have been systematically investigated in a frequency range from 10{sup 2} to 10{sup 8} Hz by complex capacitance spectroscopy. The dielectric relaxation behavior of the MTJs remarkably disobeys the typical Cole-Cole arc law probably due to the existence of imperfectly blocked Schottky barrier in the metal-insulator interface. The dielectric relaxation response can be successfully modeled on the basis of Debye relaxation by incorporating an interfacial dielectric contribution. In addition, complex capacitance spectroscopy demonstrates significant sensitivity to the oxidation process of metallic Al layers, i.e., almost a fingerprintmore » of under, proper, and over oxidation. This technique provides a fast and simple method to inspect the AlO{sub x} barrier quality of MTJs.« less

Interconnecting Multidiscilinary Data Infrastructures: From Federation to Brokering Framework

NASA Astrophysics Data System (ADS)

Nativi, S.

2014-12-01

Standardization and federation activities have been played an essential role to push interoperability at the disciplinary and cross-disciplinary level. However, they demonstrated not to be sufficient to resolve important interoperability challenges, including: disciplinary heterogeneity, cross-organizations diversities, cultural differences. Significant international initiatives like GEOSS, IODE, and CEOS demonstrated that a federation system dealing with global and multi-disciplinary domain turns out to be rater complex, raising more the already high entry level barriers for both Providers and Users. In particular, GEOSS demonstrated that standardization and federation actions must be accompanied and complemented by a brokering approach. Brokering architecture and its implementing technologies are able to implement an effective interoperability level among multi-disciplinary systems, lowering the entry level barriers for both data providers and users. This presentation will discuss the brokering philosophy as a complementary approach for standardization and federation to interconnect existing and heterogeneous infrastructures and systems. The GEOSS experience will be analyzed, specially.

From office tools to community supports: The need for infrastructure to address the social determinants of health in paediatric practice.

PubMed

Fazalullasha, Fatima; Taras, Jillian; Morinis, Julia; Levin, Leo; Karmali, Karima; Neilson, Barbara; Muskat, Barbara; Bloch, Gary; Chan, Kevin; McDonald, Maureen; Makin, Sue; Ford-Jones, E Lee

2014-04-01

Previous research has highlighted the importance of addressing the social determinants of health to improve child health outcomes. However, significant barriers exist that limit the paediatrician's ability to properly address these issues. Barriers include a lack of clinical time, resources, training and education with regard to the social determinants of health; awareness of community resources; and case-management capacity. General practice recommendations to help the health care provider link patients to the community are insufficient. The objective of the current article was to present options for improving the link between the office and the community, using screening questions incorporating physician-based tools that link community resources. Simple interventions, such as routine referral to early-year centres and selected referral to public health home-visiting programs, may help to address populations with the greatest needs.

From office tools to community supports: The need for infrastructure to address the social determinants of health in paediatric practice

PubMed Central

Fazalullasha, Fatima; Taras, Jillian; Morinis, Julia; Levin, Leo; Karmali, Karima; Neilson, Barbara; Muskat, Barbara; Bloch, Gary; Chan, Kevin; McDonald, Maureen; Makin, Sue; Ford-Jones, E Lee

2014-01-01

Previous research has highlighted the importance of addressing the social determinants of health to improve child health outcomes. However, significant barriers exist that limit the paediatrician’s ability to properly address these issues. Barriers include a lack of clinical time, resources, training and education with regard to the social determinants of health; awareness of community resources; and case-management capacity. General practice recommendations to help the health care provider link patients to the community are insufficient. The objective of the current article was to present options for improving the link between the office and the community, using screening questions incorporating physician-based tools that link community resources. Simple interventions, such as routine referral to early-year centres and selected referral to public health home-visiting programs, may help to address populations with the greatest needs. PMID:24855416

Attitudes, Beliefs, and Barriers to PrEP Among Trans Men.

PubMed

Rowniak, Stefan; Ong-Flaherty, Chenit; Selix, Nancy; Kowell, Niko

2017-08-01

The study examined the attitudes and knowledge of transgender men (trans men) regarding pre-exposure prophylaxis (PrEP) for HIV. Three focus groups of trans men were conducted with a trans male facilitator for a total of 21 participants. Six themes were identified; the range of information about PrEP and possible side effects, the economic realities for trans men, finding a trans-competent provider, trans male sexuality, the importance of contraception, and condom use. Despite identified risk and some information that has been disseminated, many trans men still lack adequate information regarding PrEP. There exist significant barriers to PrEP access for trans men. Participants commented that many providers avoid important discussions regarding sexuality and contraception. The education of health care professionals must include competency in working with transgender populations. More research is needed with regard to interactions between PrEP, testosterone, and hormonal contraception.

Treating PTSD in Pregnant and Postpartum Rural Women with Substance Use Disorders

PubMed Central

Dworkin, Emily R.; Zambrano-Vazquez, Laura; Cunningham, Sarah R.; Pittenger, Samantha L.; Schumacher, Julie A.; Stasiewicz, Paul R.; Coffey, Scott F.

2016-01-01

The co-occurrence of posttraumatic stress disorder and substance use disorder (PTSD-SUD) can pose significant problems for rural pregnant and postpartum women (PPW) and the well-being of their children. Although effective treatments exist, PPW experience limitations in their ability to access and engage in treatment that may be compounded by various aspects of rural settings, so providers must be attentive to these barriers in order to address this pressing public health need. In addition, as part of increasing rural access to care, it is important to consider the costs and benefits to PPW of selecting exposure-based techniques (e.g., prolonged exposure) to disseminate. The current article discusses the treatment of PTSD-SUD in rural PPW in the context of the authors’ experiences providing an exposure-based cognitive behavioral treatment for PTSD in this population. Barriers to treatment access and engagement are discussed and recommendations are provided. PMID:28983389

Barriers of mistrust: public and private health sectors' perceptions of each other in Madhya Pradesh, India.

PubMed

De Costa, Ayesha; Johansson, Eva; Diwan, Vinod K

2008-06-01

India has one of the most highly privatized health care systems in the world. The dominant private health sector functions alongside a traditional tiered public health sector. There has been an overall lack of collaboration between the two sectors despite international policy recommendations and local initiatives. It has been postulated that "conflicting perceptions" might contribute to the uncooperative attitude between the two sectors. But there has been little empirical exploration of the existing perceptions that the private and public health sectors have of each other. We explored these perceptions among key stakeholders (who influence the direction of health policy) in the public and private health sectors in the province of Madhya Pradesh, India. The barriers of mistrust, which hinder true dialogue, are complex, and have social, moral, and economic bases. They can be best addressed by necessary structural change before any significant long-term partnership between the two sectors is possible.

Review of Federal Motor Vehicle Safety Standards (FMVSS) for Automated Vehicles : Identifying Potential Barriers and Challenges for the Certification of Automated Vehicles Using Existing FMVSS

DOT National Transportation Integrated Search

2016-03-11

The purpose of this work is to identify instances where the existing Federal Motor Vehicle Safety Standards may pose challenges to the introduction of automated vehicles. It identifies standards requiring further review - both to ensure that existing...

A Systemic Cause Analysis Model for Human Performance Technicians

ERIC Educational Resources Information Center

Sostrin, Jesse

2011-01-01

This article presents a systemic, research-based cause analysis model for use in the field of human performance technology (HPT). The model organizes the most prominent barriers to workplace learning and performance into a conceptual framework that explains and illuminates the architecture of these barriers that exist within the fabric of everyday…

Barriers to Professionalism in the Native-Speaking English Teacher Scheme in Hong Kong

ERIC Educational Resources Information Center

Moorhouse, Benjamin Luke

2017-01-01

This article reports on a small-scale exploratory study that examined how native-speaking English teachers (NETs) working in the Primary Native-speaking English Teacher (PNET) Scheme construct their professional identity(ies) and explored the barriers to their professionalism that exist within their role and context. Data were collected using…

Locating a Space of Criticality as New Scholars in Science Education

ERIC Educational Resources Information Center

Burke, Lydia E. Carol-Ann; Bazzul, Jesse

2017-01-01

As newcomers in the field of science education research we discuss our perspectives on critical scholarship in the academy. Using the metalogue approach we explore our perceptions of science education, our experiences of the barriers to critical science education research, our analyses of why these barriers exist, and imaginings about how these…

U.S. Trade Policy: A Selective Bibliography. Bibliography Series Twenty.

ERIC Educational Resources Information Center

Niu, Sarah, Comp.

1988-01-01

In February 1987, President Ronald Reagan proposed legislation to improve U.S. international trade in order to decrease the trade deficits. This legislative proposal would: (1) renew authority for negotiating agreements to remove trade barriers; (2) reduce self-imposed export barriers; (3) improve existing U.S. trade remedy laws; (4) overhaul…

Relationships between Prospective Middle Grades Mathematics Teachers' Beliefs and TPACK

ERIC Educational Resources Information Center

Smith, Ryan C.; Kim, Somin; McIntyre, Leighton

2016-01-01

As technology become more ubiquitous in the classroom, teachers need to overcome two types of barriers to use it effectively: access to resources (including the development of knowledge) and the development of appropriate beliefs. To assist teachers in overcoming these barriers, we must understand the relationships that exist among them. We…

Transforming Articulation Barriers in Nursing.

ERIC Educational Resources Information Center

Waters, Verle

Barriers to educational mobility for nurses have existed since the mid-1960s. In 1963, the National League for Nursing (NLN) adopted a position that ruled out articulation of any kind between associate degree in nursing (ADN) and bachelors in science in nursing (BSN) programs. In the mid-1970s, a countermovement took shape, supporting open…

How Does Service Learning Increase and Sustain Interest in Engineering Education for Underrepresented Pre-Engineering College Students?

ERIC Educational Resources Information Center

Bosman, Lisa; Chelberg, Kelli; Winn, Ryan

2017-01-01

Many barriers exist for American Indian students pursuing STEM degree programs. However, federally recognized Tribal Colleges and Universities (TCUs) are uniquely suited to overcome these barriers because of their shared mission to provide 21st Century educational opportunities for American Indian students. Qualitative and quantitative findings…

Barriers to asymptomatic screening and other STD services for adolescents and young adults: focus group discussions

PubMed Central

Tilson, Elizabeth C; Sanchez, Victoria; Ford, Chandra L; Smurzynski, Marlene; Leone, Peter A; Fox, Kimberley K; Irwin, Kathleen; Miller, William C

2004-01-01

Background Sexually transmitted diseases (STDs) are a major public health problem among young people and can lead to the spread of HIV. Previous studies have primarily addressed barriers to STD care for symptomatic patients. The purpose of our study was to identify perceptions about existing barriers to and ideal services for STDs, especially asymptomatic screening, among young people in a southeastern community. Methods Eight focus group discussions including 53 White, African American, and Latino youth (age 14–24) were conducted. Results Perceived barriers to care included lack of knowledge of STDs and available services, cost, shame associated with seeking services, long clinic waiting times, discrimination, and urethral specimen collection methods. Perceived features of ideal STD services included locations close to familiar places, extended hours, and urine-based screening. Television was perceived as the most effective route of disseminating STD information. Conclusions Further research is warranted to evaluate improving convenience, efficiency, and privacy of existing services; adding urine-based screening and new services closer to neighborhoods; and using mass media to disseminate STD information as strategies to increase STD screening. PMID:15189565

{sup 12}C+{sup 16}O: Properties of sub-barrier resonance {gamma}-decay

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

Goasduff, A.; Courtin, S.; Haas, F.

2012-10-20

In a recent experiment performed at Triumf using the Dragon 0 Degree-Sign spectrometer and its associated BGO array, the complete {gamma}-decay of the radiative capture channel below the Coulomb barrier has been measured for the first time. This measurement has been performed at two energies E{sub c.m.}= 6.6 and 7.2 MeV. A selective contribution of the entrance spins 2{sup +} and 3{sup -} has been evidenced which is consistent with existing results above the barrier.

Collaborate across silos: Perceived barriers to integration of care for the elderly from the perspectives of service providers.

PubMed

Lau, Janice Ying-Chui; Wong, Eliza Lai-Yi; Chung, Roger Y; Law, Stephen C K; Threapleton, Diane; Kiang, Nicole; Chau, Patsy; Wong, Samuel Y S; Woo, Jean; Yeoh, Eng-Kiong

2018-04-27

To examine the barriers that hinder collaboration between health care and social care services and to report recommendations for effective collaboration to meet the growing support and care needs of our ageing population. Data for this qualitative study were obtained from interviews with 7 key informants (n = 42) and 22 focus groups (n = 117) consisting of service providers who were from the health care or social care sectors and supporting elderly patients with multiple chronic diseases or long-term care needs. Data collection was conducted from 2015 to 2016. The data were analysed using an inductive approach on the basis of thematic analysis. Qualitative analysis reviewed a number of factors that play a significant role in setting up barriers at the operational level, including fragmentation and lack of sustainability of discharge programmes provided by non-governmental organisations, lack of capacity of homes for the elderly, limitation of time and resources, and variation of roles in supporting end-of-life care decisions between the medical and social sectors. Other barriers are those of communication to be found at the structural level and perceptual ones that exist between professionals. Of these, perceptual barriers affect attitudes and create mistrust and interprofessional stereotypes and a hierarchy between the health care and social care sectors. Health care and social care service providers recognise the need for collaborative work to enhance continuity of care and ageing in place; however, their efforts are hindered by the identified barriers that need to be dealt with in practical terms and by a change of policy. Copyright © 2018 John Wiley & Sons, Ltd.

Barriers to Medical Error Reporting for Physicians and Nurses.

PubMed

Soydemir, Dilek; Seren Intepeler, Seyda; Mert, Hatice

2017-10-01

The purpose of the study was to determine what barriers to error reporting exist for physicians and nurses. The study, of descriptive qualitative design, was conducted with physicians and nurses working at a training and research hospital. In-depth interviews were held with eight physicians and 15 nurses, a total of 23 participants. Physicians and nurses do not choose to report medical errors that they experience or witness. When barriers to error reporting were examined, it was seen that there were four main themes involved: fear, the attitude of administration, barriers related to the system, and the employees' perceptions of error. It is important in terms of preventing medical errors to identify the barriers that keep physicians and nurses from reporting errors.

Natural and Human-Induced Variability in Barrier-Island Response to Sea Level Rise

NASA Astrophysics Data System (ADS)

Miselis, Jennifer L.; Lorenzo-Trueba, Jorge

2017-12-01

Storm-driven sediment fluxes onto and behind barrier islands help coastal barrier systems keep pace with sea level rise (SLR). Understanding what controls cross-shore sediment flux magnitudes is critical for making accurate forecasts of barrier response to increased SLR rates. Here, using an existing morphodynamic model for barrier island evolution, observations are used to constrain model parameters and explore potential variability in future barrier behavior. Using modeled drowning outcomes as a proxy for vulnerability to SLR, 0%, 28%, and 100% of the barrier is vulnerable to SLR rates of 4, 7, and 10 mm/yr, respectively. When only overwash fluxes are increased in the model, drowning vulnerability increases for the same rates of SLR, suggesting that future increases in storminess may increase island vulnerability particularly where sediment resources are limited. Developed sites are more vulnerable to SLR, indicating that anthropogenic changes to overwash fluxes and estuary depths could profoundly affect future barrier response to SLR.

Natural and human-induced variability in barrier-island response to sea level rise

USGS Publications Warehouse

Miselis, Jennifer L.; Lorenzo-Trueba, Jorge

2017-01-01

Storm-driven sediment fluxes onto and behind barrier islands help coastal barrier systems keep pace with sea level rise (SLR). Understanding what controls cross-shore sediment flux magnitudes is critical for making accurate forecasts of barrier response to increased SLR rates. Here, using an existing morphodynamic model for barrier island evolution, observations are used to constrain model parameters and explore potential variability in future barrier behavior. Using modeled drowning outcomes as a proxy for vulnerability to SLR, 0%, 28%, and 100% of the barrier is vulnerable to SLR rates of 4, 7, and 10 mm/yr, respectively. When only overwash fluxes are increased in the model, drowning vulnerability increases for the same rates of SLR, suggesting that future increases in storminess may increase island vulnerability particularly where sediment resources are limited. Developed sites are more vulnerable to SLR, indicating that anthropogenic changes to overwash fluxes and estuary depths could profoundly affect future barrier response to SLR.

Enhanced spin-torque in double tunnel junctions using a nonmagnetic-metal spacer

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

Chen, C. H.; Cheng, Y. H.; Ko, C. W.

2015-10-12

This study proposes an enhancement in the spin-transfer torque of a magnetic tunnel junction (MTJ) designed with double-barrier layer structure using a nonmagnetic metal spacer, as a replacement for the ferromagnetic material, which is traditionally used in these double-barrier stacks. Our calculation results show that the spin-transfer torque and charge current density of the proposed double-barrier MTJ can be as much as two orders of magnitude larger than the traditional double-barrier one. In other words, the proposed double-barrier MTJ has a spin-transfer torque that is three orders larger than that of the single-barrier stack. This improvement may be attributed tomore » the quantum-well states that are formed in the nonmagnetic metal spacer and the resonant tunneling mechanism that exists throughout the system.« less

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

PubMed

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

2018-03-27

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

Large-scale, thick, self-assembled, nacre-mimetic brick-walls as fire barrier coatings on textiles

NASA Astrophysics Data System (ADS)

Das, Paramita; Thomas, Helga; Moeller, Martin; Walther, Andreas

2017-01-01

Highly loaded polymer/clay nanocomposites with layered structures are emerging as robust fire retardant surface coatings. However, time-intensive sequential deposition processes, e.g. layer-by-layer strategies, hinders obtaining large coating thicknesses and complicates an implementation into existing technologies. Here, we demonstrate a single-step, water-borne approach to prepare thick, self-assembling, hybrid fire barrier coatings of sodium carboxymethyl cellulose (CMC)/montmorillonite (MTM) with well-defined, bioinspired brick-wall nanostructure, and showcase their application on textile. The coating thickness on the textile is tailored using different concentrations of CMC/MTM (1-5 wt%) in the coating bath. While lower concentrations impart conformal coatings of fibers, thicker continuous coatings are obtained on the textile surface from highest concentration. Comprehensive fire barrier and fire retardancy tests elucidate the increasing fire barrier and retardancy properties with increasing coating thickness. The materials are free of halogen and heavy metal atoms, and are sourced from sustainable and partly even renewable building blocks. We further introduce an amphiphobic surface modification on the coating to impart oil and water repellency, as well as self-cleaning features. Hence, our study presents a generic, environmentally friendly, scalable, and one-pot coating approach that can be introduced into existing technologies to prepare bioinspired, thick, fire barrier nanocomposite coatings on diverse surfaces.

Changing the individual to promote health-enhancing physical activity: the difficulties of producing evidence and translating it into practice.

PubMed

Blamey, Avril; Mutrie, Nanette

2004-08-01

This paper presents conclusions from recent systematic reviews and highlights individually targeted interventions that are effective at increasing physical activity. It discusses the limitations of currently available evidence, considers what factors lead to these limitations and what barriers exist in terms of implementing the evidence as part of local and national policy and practice. Barriers present themselves in terms of getting evidence into practice and in terms of ensuring that practice informs the evidence base. These barriers include difficulties in conducting systematic reviews, disaggregating knowledge from complex interventions, making local adaptations to existing evidence, the lack of an evaluation culture, ethical and pragmatic difficulties in designing interventions, selecting appropriate outcome measures, poor designs and implementation of evidence and, finally, a recognition that policy making is not only based on the available evidence. New and more integrated approaches to evaluation and to practice are needed.

Pharmacologic studies in vulnerable populations: Using the pediatric experience.

PubMed

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

2015-11-01

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

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

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

Jiang, Like; Kang, Jian, E-mail: j.kang@sheffield.ac.uk; Schroth, Olaf

Large scale transportation projects can adversely affect the visual perception of environmental quality and require adequate visual impact assessment. In this study, we investigated the effects of the characteristics of the road project and the character of the existing landscape on the perceived visual impact of motorways, and developed a GIS-based prediction model based on the findings. An online survey using computer-visualised scenes of different motorway and landscape scenarios was carried out to obtain perception-based judgements on the visual impact. Motorway scenarios simulated included the baseline scenario without road, original motorway, motorways with timber noise barriers, transparent noise barriers andmore » tree screen; different landscape scenarios were created by changing land cover of buildings and trees in three distance zones. The landscape content of each scene was measured in GIS. The result shows that presence of a motorway especially with the timber barrier significantly decreases the visual quality of the view. The resulted visual impact tends to be lower where it is less visually pleasant with more buildings in the view, and can be slightly reduced by the visual absorption effect of the scattered trees between the motorway and the viewpoint. Based on the survey result, eleven predictors were identified for the visual impact prediction model which was applied in GIS to generate maps of visual impact of motorways in different scenarios. The proposed prediction model can be used to achieve efficient and reliable assessment of visual impact of motorways. - Highlights: • Motorways induce significant visual impact especially with timber noise barriers. • Visual impact is negatively correlated with amount of buildings in the view. • Visual impact is positively correlated with percentage of trees in the view. • Perception-based motorway visual impact prediction model using mapped predictors • Predicted visual impacts in different scenarios are mapped in GIS.« less

Informal and Formal Care Infrastructure and Perceived Need for Caregiver Training for Frail U.S. Veterans referred to Home and Community-Based Services

PubMed Central

Oddone, Eugene Z.; Weinberger, Morris

2013-01-01

Objectives To describe the informal care network of U.S. veterans referred to home and community-based services (Homemaker Home Health services, H/HHA, or Home-Based Primary Care, HBPC) at the Durham Veterans Affairs Medical Center (VAMC), including: quantity and types of tasks provided and desired content for caregiver training programs. Methods All primary care patients referred to H/HHA or HBPC during the preceding 3 months were sent questionnaires in May 2007. Additionally, caregivers were sent questionnaires if a patient gave permission. Descriptive statistics and chi-squared tests were performed. Results On average, patients received 5.6 hours of VA care and 47 hours of informal care per week. 26% of patients (38% of patients with caregiver proxy respondents) and 59% of caregivers indicated the caregiver would be interested in participating in a training program by phone or on-site. Significant barriers to participation existed. The most common barriers were: transportation; no time due to caregiving or work demands; caregiver's own health limitations; and no need. Conclusions Caregiver training needs to be tailored to overcome barriers to participate. Overcoming these barriers may be possible through in-home phone or internet training outside traditional business hours, and by tailoring training to accommodate limiting health problems among caregivers. PMID:20308351

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

PubMed

Weller, Jennifer; Boyd, Matt; Cumin, David

2014-03-01

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

Quality of Diabetes Management in Saudi Arabia: A Review of Existing Barriers.

PubMed

Almutairi, Khalid M

2015-12-01

Diabetes mellitus is a complex disorder that requires continuous management and medical care. The purpose of this review is to identify and summarize the barriers that affect diabetes management in Saudi Arabia. Studies that have examined the quality of diabetes management in Saudi Arabia were identified through online and manual literature searches. Two researchers independently searched and assessed for inclusion/exclusion criteria. All studies were screened by a specialist for the significance of the review. Studies that were included were evaluated for relevance, methodological rigor, and credibility by giving a quality score based on Russell and Gregory's criteria. This review presents an overview of the quality of diabetes management and issues and barriers concerning the improvement of diabetes care in Saudi Arabia. The online literature search yielded 11 studies which met the inclusion criteria. Factors affecting the quality of diabetes care can be categorized into patient factors (such as adherence, compliance, attitudes, beliefs, knowledge, financial resources and co-morbidities) and healthcare providers' factors (including beliefs, attitudes and knowledge, patient - provider interaction and communication). The identified barriers, both from patients and healthcare providers, will help healthcare authorities to improve diabetes management in Saudi Arabia. Improvement of health awareness about disease and disease management should be tailored through continuous patient education. Continuous training and seminars will also expand providers' knowledge that will ensure quality and effective diabetes management.

The optimization of aircraft seat cushion fire-blocking layers. Full Scale: Test description and results

NASA Technical Reports Server (NTRS)

Schutter, K. J.; Duskin, F. E.

1982-01-01

Full-scale burn tests were conducted on thirteen different seat cushion configurations in a cabin fire simulator. The fire source used was a quartz lamp radiant energy panel with a propane pilot flame. During each test, data were recorded for cushion temperatures, radiant heat flux, rate of weight loss of test specimens, and cabin temperatures. When compared to existing passenger aircraft seat cushions, the test specimens incorporating a fire barrier and those fabricated from advance materials, using improved construction methods, exhibited significantly greater fire resistance.

Black holes and Higgs stability

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

Tetradis, Nikolaos; Physics Department, Theory Unit, CERN,CH-1211 Geneva 23

We study the effect of primordial black holes on the classical rate of nucleation of AdS regions within the standard electroweak vacuum. We find that the energy barrier for transitions to the new vacuum, which characterizes the exponential suppression of the nucleation rate, can be reduced significantly in the black-hole background. A precise analysis is required in order to determine whether the the existence of primordial black holes is compatible with the form of the Higgs potential at high temperature or density in the Standard Model or its extensions.

Assessing barriers to immunization.

PubMed

Niederhauser, Victoria; Ferris, Catherine

2016-05-03

Parental barriers to childhood immunizations vary among countries, states and communities. There is a plethora of studies that exist to examine barriers to immunizations including many intervention studies designed to improve immunization rates in children. Often, intervention studies designed to minimize barriers and increase immunization uptake among children lack the inclusion of a standardized instrument to measure accurately parental barriers to childhood immunizations before and after interventions. The Searching for Hardships and Obstacles To Shots (SHOTS) survey is a standardized survey instrument to measure parental barriers to childhood immunizations. In several studies, the SHOTS survey has demonstrated consistent reliability and has been validated in diverse populations. The inclusion of the SHOTS survey instrument in studies to examine barriers to childhood immunization will provide researchers and clinicians with a better understanding of parents' individualized barriers to immunizations. Furthermore, use of the SHOTS survey instrument to collect information about parental barriers to immunizations can lead to targeted interventions to minimize these obstacles at the individual and community level and to help us to achieve our national, state and community childhood immunization goals.

Barriers and enablers for participation in healthy lifestyle programs by adolescents who are overweight: a qualitative study of the opinions of adolescents, their parents and community stakeholders

PubMed Central

2014-01-01

Background Overweight or obesity during adolescence affects almost 25% of Australian youth, yet limited research exists regarding recruitment and engagement of adolescents in weight-management or healthy lifestyle interventions, or best-practice for encouraging long-term healthy behaviour change. A sound understanding of community perceptions, including views from adolescents, parents and community stakeholders, regarding barriers and enablers to entering and engaging meaningfully in an intervention is critical to improve the design of such programs. Methods This paper reports findings from focus groups and semi-structured interviews conducted with adolescents (n?=?44), parents (n?=?12) and community stakeholders (n?=?39) in Western Australia. Three major topics were discussed to inform the design of more feasible and effective interventions: recruitment, retention in the program and maintenance of healthy change. Data were analysed using content and thematic analyses. Results Data were categorised into barriers and enablers across the three main topics. For recruitment, identified barriers included: the stigma associated with overweight, difficulty defining overweight, a lack of current health services and broader social barriers. The enablers for recruitment included: strategic marketing, a positive approach and subsidising program costs. For retention, identified barriers included: location, timing, high level of commitment needed and social barriers. Enablers for retention included: making it fun and enjoyable for adolescents, involving the family, having an on-line component, recruiting good staff and making it easy for parents to attend. For maintenance, identified barriers included: the high degree of difficulty in sustaining change and limited services to support change. Enablers for maintenance included: on-going follow up, focusing on positive change, utilisation of electronic media and transition back to community services. Conclusions This study highlights significant barriers for adolescents and parents to overcome to engage meaningfully with weight-management or healthy lifestyle programs. A number of enablers were identified to promote ongoing involvement with an intervention. This insight into specific contextual opinions from the local community can be used to inform the delivery of healthy lifestyle programs for overweight adolescents, with a focus on maximising acceptability and feasibility. PMID:24552207

Barriers and enablers for participation in healthy lifestyle programs by adolescents who are overweight: a qualitative study of the opinions of adolescents, their parents and community stakeholders.

PubMed

Smith, Kyla L; Straker, Leon M; McManus, Alexandra; Fenner, Ashley A

2014-02-19

Overweight or obesity during adolescence affects almost 25% of Australian youth, yet limited research exists regarding recruitment and engagement of adolescents in weight-management or healthy lifestyle interventions, or best-practice for encouraging long-term healthy behaviour change. A sound understanding of community perceptions, including views from adolescents, parents and community stakeholders, regarding barriers and enablers to entering and engaging meaningfully in an intervention is critical to improve the design of such programs. This paper reports findings from focus groups and semi-structured interviews conducted with adolescents (n?=?44), parents (n?=?12) and community stakeholders (n?=?39) in Western Australia. Three major topics were discussed to inform the design of more feasible and effective interventions: recruitment, retention in the program and maintenance of healthy change. Data were analysed using content and thematic analyses. Data were categorised into barriers and enablers across the three main topics. For recruitment, identified barriers included: the stigma associated with overweight, difficulty defining overweight, a lack of current health services and broader social barriers. The enablers for recruitment included: strategic marketing, a positive approach and subsidising program costs. For retention, identified barriers included: location, timing, high level of commitment needed and social barriers. Enablers for retention included: making it fun and enjoyable for adolescents, involving the family, having an on-line component, recruiting good staff and making it easy for parents to attend. For maintenance, identified barriers included: the high degree of difficulty in sustaining change and limited services to support change. Enablers for maintenance included: on-going follow up, focusing on positive change, utilisation of electronic media and transition back to community services. This study highlights significant barriers for adolescents and parents to overcome to engage meaningfully with weight-management or healthy lifestyle programs. A number of enablers were identified to promote ongoing involvement with an intervention. This insight into specific contextual opinions from the local community can be used to inform the delivery of healthy lifestyle programs for overweight adolescents, with a focus on maximising acceptability and feasibility.

Barriers to accessing palliative care for pediatric patients with cancer: A review of the literature.

PubMed

Haines, Emily R; Frost, A Corey; Kane, Heather L; Rokoske, Franziska S

2018-06-01

Although many of the 16,000 children in the United States diagnosed who are with cancer each year could benefit from pediatric palliative care, these services remain underused. Evidence regarding the barriers impeding access to comprehensive palliative care is dispersed in the literature, and evidence specific to pediatric oncology remains particularly sparse. The purpose of the current review was to synthesize the existing literature regarding these barriers and the strategies offered to address them. The authors completed a literature search using the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science databases. In total, 71 articles were reviewed. Barriers to accessing pediatric palliative care were categorized according to the 4 levels of a modified socioecological model (ie, barriers related to policy/payment, health systems, organizations, and individuals). Major themes identified at each level included: 1) the lack of consistent and adequate funding mechanisms at the policy/payment level, 2) the lack of pediatric palliative care programs and workforce at the health systems level, 3) difficulties integrating palliative care into existing pediatric oncology care models at the organizational level, and 4) the lack of knowledge about pediatric palliative care, discomfort with talking about death, and cultural differences between providers and patients and their families at the individual level. Recommendations to address each of the barriers identified in the literature are included. Cancer 2018;124:2278-88. © 2018 American Cancer Society. © 2018 American Cancer Society.

Parental Leave Policy as a Strategy to Improve Outcomes among Premature Infants.

PubMed

Greenfield, Jennifer C; Klawetter, Susanne

2016-02-01

Although gains have been made in premature birth rates among racial and ethnic minority and low socioeconomic status populations, tremendous disparities still exist in both prematurity rates and health outcomes for preterm infants. Parental involvement is known to improve health outcomes for preterm babies. However, a gap in evidence exists around whether parental involvement can help ameliorate the disparities in both short- and long-term out-comes for their preterm children. Families more likely to experience preterm birth are also less likely to have access to paid leave and thus experience significant systemic barriers to involvement, especially when their newborns are hospitalized. This article describes the research gap in this area and explores pathways by which social workers may ameliorate disparities in preterm birth outcomes through practice, policy, and research.

Sculpting bespoke mountains: Determining free energies with basis expansions

NASA Astrophysics Data System (ADS)

Whitmer, Jonathan K.; Fluitt, Aaron M.; Antony, Lucas; Qin, Jian; McGovern, Michael; de Pablo, Juan J.

2015-07-01

The intriguing behavior of a wide variety of physical systems, ranging from amorphous solids or glasses to proteins, is a direct manifestation of underlying free energy landscapes riddled with local minima separated by large barriers. Exploring such landscapes has arguably become one of statistical physics's great challenges. A new method is proposed here for uniform sampling of rugged free energy surfaces. The method, which relies on special Green's functions to approximate the Dirac delta function, improves significantly on existing simulation techniques by providing a boundary-agnostic approach that is capable of mapping complex features in multidimensional free energy surfaces. The usefulness of the proposed approach is established in the context of a simple model glass former and model proteins, demonstrating improved convergence and accuracy over existing methods.

Probiotics: immunomodulatory properties in allergy and eczema.

PubMed

Drago, L; Toscano, M; Pigatto, P D

2013-10-01

In the last decades the prevalence of allergic diseases and eczema raised significantly, and today they are the most common chronic pathologies affecting children. It has been shown that a functional intestinal mucosa provides a defensive barrier to the host against potential dangerous antigens, regulating the tolerance to them. Some inflammatory diseases of the gut weaken the barrier causing an increase in the mucosa permeability and in antigenic transition. As a consequence, there is an aberrant immune response and the release of pro-inflammatory cytokines further compromises the barrier functionality. It has been demonstrated that a correlation between allergy and eczema onset and the intestinal microflora composition exists, and in particular, it has been showed that some microorganisms are able to influence the immune response. For these reasons it has been hypothesized that probiotics may have a beneficial role in preventing and treating allergies and eczema. However, the benefits of this treatment depend on many factors, such as the bacterial strain, the duration of administration, the pathology, the patient characteristics (age, diet, allergy predisposition). The aim of this work was to review the present knowledge about the use of probiotics in allergic diseases and eczema, highlighting their role in the aforementioned pathologies.

Phenology of a Vegetation Barrier and Resulting Impacts on Near-Highway Particle Number and Black Carbon Concentrations on a School Campus.

PubMed

Fuller, Christina H; Carter, David R; Hayat, Matthew J; Baldauf, Richard; Watts Hull, Rebecca

2017-02-08

Traffic-related air pollution is a persistent concern especially in urban areas where populations live in close proximity to roadways. Innovative solutions are needed to minimize human exposure and the installation of vegetative barriers shows potential as a method to reduce near-road concentrations. This study investigates the impact of an existing stand of deciduous and evergreen trees on near-road total particle number (PNC) and black carbon (BC) concentrations across three seasons. Measurements were taken during spring, fall and winter on the campus of a middle school in the Atlanta (GA, USA) area at distances of 10 m and 50 m from a major interstate highway. We identified consistent decreases in BC concentrations, but not for PNC, with increased distance from the highway. In multivariable models, hour of day, downwind conditions, distance to highway, temperature and relative humidity significantly predicted pollutant concentrations. The magnitude of effect of these variables differed by season, however, we were not able to show a definitive impact of the vegetative barrier on near-road concentrations. More detailed studies are necessary to further examine the specific configurations and scenarios that may produce pollutant and exposure reductions.

Phenology of a Vegetation Barrier and Resulting Impacts on Near-Highway Particle Number and Black Carbon Concentrations on a School Campus

PubMed Central

Fuller, Christina H.; Carter, David R.; Hayat, Matthew J.; Baldauf, Richard; Watts Hull, Rebecca

2017-01-01

Traffic-related air pollution is a persistent concern especially in urban areas where populations live in close proximity to roadways. Innovative solutions are needed to minimize human exposure and the installation of vegetative barriers shows potential as a method to reduce near-road concentrations. This study investigates the impact of an existing stand of deciduous and evergreen trees on near-road total particle number (PNC) and black carbon (BC) concentrations across three seasons. Measurements were taken during spring, fall and winter on the campus of a middle school in the Atlanta (GA, USA) area at distances of 10 m and 50 m from a major interstate highway. We identified consistent decreases in BC concentrations, but not for PNC, with increased distance from the highway. In multivariable models, hour of day, downwind conditions, distance to highway, temperature and relative humidity significantly predicted pollutant concentrations. The magnitude of effect of these variables differed by season, however, we were not able to show a definitive impact of the vegetative barrier on near-road concentrations. More detailed studies are necessary to further examine the specific configurations and scenarios that may produce pollutant and exposure reductions. PMID:28208726

Lost in translation? Moving contingency management and cognitive behavioral therapy into clinical practice.

PubMed

Carroll, Kathleen M

2014-10-01

In the treatment of addictions, the gap between the availability of evidence-based therapies and their limited implementation in practice has not yet been bridged. Two empirically validated behavioral therapies, contingency management (CM) and cognitive behavioral therapy (CBT), exemplify this challenge. Both have a relatively strong level of empirical support but each has weak and uneven adoption in clinical practice. This review highlights examples of how barriers to their implementation in practice have been addressed systematically, using the Stage Model of Behavioral Therapies Development as an organizing framework. For CM, barriers such as cost and ideology have been addressed through the development of lower-cost and other adaptations to make it more community friendly. For CBT, barriers such as relative complexity, lack of trained providers, and need for supervision have been addressed via conversion to standardized computer-assisted versions that can serve as clinician extenders. Although these and other modifications have rendered both interventions more disseminable, diffusion of innovation remains a complex, often unpredictable process. The existing specialty addiction-treatment system may require significant reforms to fully implement CBT and CM, particularly greater focus on definable treatment goals and performance-based outcomes. © 2014 New York Academy of Sciences.

Workplace discrimination: experiences of practicing physicians.

PubMed

Coombs, Alice A Tolbert; King, Roderick K

2005-04-01

In response to a growing concern regarding physician discrimination in the workplace, this study was developed to: (1) describe the types of discrimination that exist for the practicing physician and (2) determine which groups of physicians are more likely to experience the various forms of discrimination. Surveys were mailed to 1930 practicing physicians in Massachusetts. Participants were asked if they had encountered discrimination, how significant the discrimination was against a specific group, the frequency of personal discrimination, and the type of discrimination. Factor analysis identified four types of discrimination: career advancement, punitive behaviors, practice barriers and hiring barriers. A total of 445 responses were received (a 24% response rate). Sixty-three percent of responding physicians had experienced some form of discrimination. Respondents were women (46%), racial/ethnic minorities (42%) and international medical graduates (IMGs) (40%). In addition, 26% of those classified as white were also IMGs. Over 60% of respondents believed discrimination against IMGs was very or somewhat significant. Almost 27% of males acknowledged that gender bias against females was very or somewhat significant. IMGs were more likely to indicate that discrimination against IMGs was significant in their current organization. Of U.S. medical graduates (USMGs) 44% reported that discrimination against IMGs in their current organization was significant. Nonwhites were more likely to report that discrimination based on race/ethnicity was significant. Nearly 29% of white respondents also believed that such discrimination was very or somewhat significant. Physicians practicing in academic, research, and private practice sectors experience discrimination based on gender, ethnic/racial, and IMG status.

Changes in research on language barriers in health care since 2003: A cross-sectional review study.

PubMed

Schwei, Rebecca J; Del Pozo, Sam; Agger-Gupta, Niels; Alvarado-Little, Wilma; Bagchi, Ann; Chen, Alice Hm; Diamond, Lisa; Gany, Francesca; Wong, Doreena; Jacobs, Elizabeth A

2016-02-01

Understanding how to mitigate language barriers is becoming increasingly important for health care providers around the world. Language barriers adversely affect patients in their access to health services; comprehension and adherence; quality of care; and patient and provider satisfaction. In 2003, the United States (US) government made a major change in national policy guidance that significantly affected limited English proficient patients' ability to access language services. The objectives of this paper are to describe the state of the language barriers literature inside and outside the US since 2003 and to compare the research that was conducted before and after a national policy change occurred in the US. We hypothesize that language barrier research would increase inside and outside the US but that the increase in research would be larger inside the US in response to this national policy change. We reviewed the research literature on language barriers in health care and conducted a cross sectional analysis by tabulating frequencies for geographic location, language group, methodology, research focus and specialty and compared the literature before and after 2003. Our sample included 136 studies prior to 2003 and 426 studies from 2003 to 2010. In the 2003-2010 time period there was a new interest in studying the providers' perspective instead of or in addition to the patients' perspective. The methods remained similar between periods with greater than 60% of studies being descriptive and 12% being interventions. There was an increase in research on language barriers inside and outside the US and we believe this was larger due to the change in the national policy. We suggest that researchers worldwide should move away from simply documenting the existence of language barriers and should begin to focus their research on documenting how language concordant care influences patient outcomes, providing evidence for interventions that mitigate language barriers, and evaluating the cost effectiveness of providing language concordant care to patients with language barriers. We think this is possible if funding agencies around the world begin to request proposals for these types of research studies. Together, we can begin document meaningful ways to provide high quality health care to patients with language barriers. Copyright © 2015 Elsevier Ltd. All rights reserved.

Hmong History and LGBTQ Lives: Immigrant Youth Perspectives on Being Queer and Hmong

ERIC Educational Resources Information Center

Mayo, J. B., Jr.

2013-01-01

This article highlights some of the cultural barriers that exist for Hmong people who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ), while placing these barriers in an historical context. It uncovers differences and similarities found between the experiences of queer Hmong youth and the larger population of queer youth living…

Communication Apprehension and Maths Anxiety as Barriers to Communication and Numeracy Skills Development in Accounting and Business Education

ERIC Educational Resources Information Center

Joyce, John; Hassall, Trevor; Montano, Jose Luis Arquero; Anes, Jose Antonio Donoso

2006-01-01

Purpose: To establish the existence of barriers to communication and numeracy skills development and to establish the levels of these exhibited by accounting and business students at the commencement of their courses in higher education. Design/methodology/approach: Uses questionnaires to establish the levels of communication apprehension (CA) and…

Academic Workload: The Silent Barrier to the Implementation of Technology-Enhanced Learning Strategies in Higher Education

ERIC Educational Resources Information Center

Gregory, Mary Sarah-Jane; Lodge, Jason Michael

2015-01-01

The effect of technology-enhanced learning (TEL) strategies in higher education has arguably been transformative despite the not-insignificant barriers existing in this context. Throughout the discourse very little attention has been paid to those primarily responsible for this implementation--academic teaching staff. This paper aims to highlight…

Barriers to Learning for Mature Students Studying HE in an FE College

ERIC Educational Resources Information Center

Burton, Karen; Lloyd, Mary Golding; Griffiths, Colin

2011-01-01

The aim of this study was to investigate whether recognised barriers to learning still exist for mature adult learners in a higher education (HE) centre within a further education (FE) college. Eighty-four students who attend the further education college were asked to complete a questionnaire and participate in follow-up semi-structured…

Vectors of invasions in freshwater invertebrates and fishes

USGS Publications Warehouse

Fuller, Pamela L.; Canning-Clode, João

2015-01-01

Without human assistance, the terrestrial environment and oceans represent barriers to the dispersal of freshwater aquatic organisms. The ability to overcome such barriers depends on the existence of anthropogenic vectors that can transport live organisms to new areas, and the species’ biology to survive the transportation and transplantation into the new environment (Johnson et al., 2006).

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

ERIC Educational Resources Information Center

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

2013-01-01

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

MOBILE-izing Adolescent Sexual and Reproductive Health Care: A Pilot Study Using A Mobile Health Unit in Chicago

ERIC Educational Resources Information Center

Stefansson, Lilja S.; Webb, M. Elizabeth; Hebert, Luciana E.; Masinter, Lisa; Gilliam, Melissa L.

2018-01-01

Background: Adolescents experience numerous barriers to obtaining sexual and reproductive health care (SRHC). Mobile Health Units (MHUs) can remove some barriers by traveling to the community. This pilot study developed Mobile SRHC through an iterative process on an existing MHU and evaluated it among adolescents and providers. Methods: Mobile…

Identifying Knowledge Sharing Barriers in the Collaboration of Traditional and Western Medicine Professionals in Chinese Hospitals: A Case Study

ERIC Educational Resources Information Center

Zhou, Lihong; Nunes, Miguel Baptista

2012-01-01

This paper reports on a research project that aims at identifying knowledge sharing (KS) barriers between traditional and western medicine practitioners co-existing and complementing each other in Chinese healthcare organisations. The study focuses on the tacit aspects of patient knowledge, rather than the traditional technical information shared…

Access to pain treatment as a human right.

PubMed

Lohman, Diederik; Schleifer, Rebecca; Amon, Joseph J

2010-01-20

Almost five decades ago, governments around the world adopted the 1961 Single Convention on Narcotic Drugs which, in addition to addressing the control of illicit narcotics, obligated countries to work towards universal access to the narcotic drugs necessary to alleviate pain and suffering. Yet, despite the existence of inexpensive and effective pain relief medicines, tens of millions of people around the world continue to suffer from moderate to severe pain each year without treatment. Significant barriers to effective pain treatment include: the failure of many governments to put in place functioning drug supply systems; the failure to enact policies on pain treatment and palliative care; poor training of healthcare workers; the existence of unnecessarily restrictive drug control regulations and practices; fear among healthcare workers of legal sanctions for legitimate medical practice; and the inflated cost of pain treatment. These barriers can be understood not only as a failure to provide essential medicines and relieve suffering but also as human rights abuses. According to international human rights law, countries have to provide pain treatment medications as part of their core obligations under the right to health; failure to take reasonable steps to ensure that people who suffer pain have access to adequate pain treatment may result in the violation of the obligation to protect against cruel, inhuman and degrading treatment.

Home Blood Pressure Telemonitoring: Rationale for Use, Required Elements, and Barriers to Implementation in Canada.

PubMed

Wood, Peter W; Boulanger, Pierre; Padwal, Raj S

2017-05-01

Contemporary hypertension guidelines strongly endorse the use of home blood pressure (BP) monitoring for hypertension diagnosis and management. However, barriers exist that prevent optimal use of home BP measurements. Patients might not follow the recommended home BP measurement protocol, might not take the required number of readings, and/or might report only selected readings to their providers. Providers might not calculate the mean (used for clinical decision-making) and/or incorporate home BP measurements into the medical record. Use of home BP telemonitoring, defined as the process by which home BP readings are securely teletransmitted and summarized within a health care portal or electronic medical record for provider use, might overcome these barriers. Telemonitoring, especially when combined with protocolized case management, leads to statistically significant and clinically important BP reductions, and improvements in overall BP control. Despite evidence supporting its use, home BP telemonitoring is not widely used in Canada. Barriers to adoption can be classified as structural and financial. Although technological advancements have made telemonitoring highly feasible, infrastructure is lacking, and implementation remains a challenge; this is especially true with respect to creating simple and cost-effective systems that are user-friendly and acceptable to patients as well as to providers. Ensuring data security is crucial to successful implementation, as is developing appropriate reimbursement models for providers. If these barriers can be overcome, home BP telemonitoring has the potential to make care provision easier and more convenient for patients and providers, while improving BP control in Canadians with hypertension. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Shoreline configuration and shoreline dynamics: A mesoscale analysis. [Assateague Island and Outer Banks of North Carolina

NASA Technical Reports Server (NTRS)

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

1975-01-01

The author has identified the following significant results. Atlantic coast barrier island shorelines are seldom straight, but rather sinuous. These shoreline curvatures range in size from cusps to capes. Significant relationships exist between the orientation of shoreline segments within the larger of these sinuous features and shoreline dynamics, with coefficients ranging up to .9. Orientation of the shoreline segments of Assateague Island (60 km) and the Outer Banks of North Carolina (130 km) was measured from LANDSAT 2 imagery (1:80,000) and high altitude aerial photography (1:120,000). Long term trends in shoreline dynamics were established by mapping shoreline and storm-surge penetration changes.

Review of potential subsurface permeable barrier emplacement and monitoring technologies

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

Riggsbee, W.H.; Treat, R.L.; Stansfield, H.J.

1994-02-01

This report focuses on subsurface permeable barrier technologies potentially applicable to existing waste disposal sites. This report describes candidate subsurface permeable barriers, methods for emplacing these barriers, and methods used to monitor the barrier performance. Two types of subsurface barrier systems are described: those that apply to contamination.in the unsaturated zone, and those that apply to groundwater and to mobile contamination near the groundwater table. These barriers may be emplaced either horizontally or vertically depending on waste and site characteristics. Materials for creating permeable subsurface barriers are emplaced using one of three basic methods: injection, in situ mechanical mixing, ormore » excavation-insertion. Injection is the emplacement of dissolved reagents or colloidal suspensions into the soil at elevated pressures. In situ mechanical mixing is the physical blending of the soil and the barrier material underground. Excavation-insertion is the removal of a soil volume and adding barrier materials to the space created. Major vertical barrier emplacement technologies include trenching-backfilling; slurry trenching; and vertical drilling and injection, including boring (earth augering), cable tool drilling, rotary drilling, sonic drilling, jetting methods, injection-mixing in drilled holes, and deep soil mixing. Major horizontal barrier emplacement technologies include horizontal drilling, microtunneling, compaction boring, horizontal emplacement, longwall mining, hydraulic fracturing, and jetting methods.« less

Polymer/Silicate Nanocomposites Developed for Improved Thermal Stability and Barrier Properties

NASA Technical Reports Server (NTRS)

Campbell, Sandi G.

2001-01-01

The nanoscale reinforcement of polymers is becoming an attractive means of improving the properties and stability of polymers. Polymer-silicate nanocomposites are a relatively new class of materials with phase dimensions typically on the order of a few nanometers. Because of their nanometer-size features, nanocomposites possess unique properties typically not shared by more conventional composites. Polymer-layered silicate nanocomposites can attain a certain degree of stiffness, strength, and barrier properties with far less ceramic content than comparable glass- or mineral-reinforced polymers. Reinforcement of existing and new polyimides by this method offers an opportunity to greatly improve existing polymer properties without altering current synthetic or processing procedures.

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

Preventing infections in nursing homes: A survey of infection control practices in southeast Michigan

PubMed Central

Mody, Lona; Langa, Kenneth M.; Saint, Sanjay; Bradley, Suzanne F.

2012-01-01

Background Studies on adherence to infection control policies in nursing homes (NHs) are limited. This pilot study explores the use of various infection control practices and the role of infection control practitioners in southeast Michigan NHs. Methods A 43-item self-administered questionnaire and explanatory cover letter were mailed to 105 licensed NHs in southeast Michigan. A second mailing was sent to the nonresponders 4 weeks later. Results Significant variability existed in adoption of various infection control measures with respect to time spent in infection control activities (50% of facilities having a full-time infection control practitioner), definitions used in monitoring infections, and immunization rates (influenza: range, 0%–100%; mean, 73.2%; pneumococcal: range, 0%–100%; mean, 38.5%). Conclusion Although strides have been made in infection control research in NHs, significant variations exist in implementation of infection control methods and guidelines. Future research should focus on identifying barriers to infection control in NHs. PMID:16216667

Quantitative assessment of interfacial interactions with rough membrane surface and its implications for membrane selection and fabrication in a MBR.

PubMed

Chen, Jianrong; Mei, Rongwu; Shen, Liguo; Ding, Linxian; He, Yiming; Lin, Hongjun; Hong, Huachang

2015-03-01

The interfacial interactions between a foulant particle and rough membrane surface in a submerged membrane bioreactor (MBR) were quantitatively assessed by using a new-developed method. It was found that the profile of total interaction versus separation distance was complicated. There were an energy barrier and two negative energy ranges in the profile. Further analysis showed that roughness scale significantly affected the strength and properties of interfacial interactions. It was revealed that there existed a critical range of roughness scale within which the total energy in the separation distance ranged from 0 to several nanometers was continually repulsive. Decrease in foulant size would increase the strength of specific interaction energy, but did not change the existence of a critical roughness scale range. These findings suggested the possibility to "tailor" membrane surface morphology for membrane fouling mitigation, and thus gave significant implications for membrane selection and fabrication in MBRs. Copyright © 2014 Elsevier Ltd. All rights reserved.

Benefits of barrier fuel on fuel cycle economics

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

Crowther, R.L.; Kunz, C.L.

1988-01-01

Barrier fuel rod cladding was developed to eliminate fuel rod failures from pellet/cladding stress/corrosion interaction and to eliminate the associated need to restrict the rate at which fuel rod power can be increased. The performance of barrier cladding has been demonstrated through extensive testing and through production application to many boiling water reactors (BWRs). Power reactor data have shown that barrier fuel rod cladding has a significant beneficial effect on plant capacity factor and plant operating costs and significantly increases fuel reliability. Independent of the fuel reliability benefit, it is less obvious that barrier fuel has a beneficial effect ofmore » fuel cycle costs, since barrier cladding is more costly to fabricate. Evaluations, measurements, and development activities, however, have shown that the fuel cycle cost benefits of barrier fuel are large. This paper is a summary of development activities that have shown that application of barrier fuel significantly reduces BWR fuel cycle costs.« less

Barriers to diagnosis and treatment of depression: voices from a rural African-American faith community.

PubMed

Bryant, Keneshia; Greer-Williams, Nancy; Willis, Nathaniel; Hartwig, Mary

2013-07-01

Mental health disparities exist for rural African-Americans regarding the early detection of depression and its effective treatment. Disparities that are evident in rural communities include limited mental health resources and the stigma of depression. The faith community has a long-standing history of being the initial source of help to those who experience depression. The purpose of this qualitative study was to examine how rural African-American faith communities view the barriers to diagnosis and treatment of depression. A convenience sample of 24 persons (N = 24) participated in focus groups and interviews. Four internal barriers were identified: personal business, "mindset," "denial," and "put on a front." Additionally,four external barriers were identified: "spiritual beliefs," "lack of medical resources," "lack of education about depression," and "stigma." The identified barriers supported the results from previous studies, but they also highlighted other less acknowledged barriers. In conclusion, interventions are needed to overcome these barriers in order to eliminate the depression disparities experienced by this population.

Adapting to climate change by water management organisations: Enablers and barriers

NASA Astrophysics Data System (ADS)

Azhoni, Adani; Jude, Simon; Holman, Ian

2018-04-01

Climate change will be particularly experienced though the medium of water. Water organisations, that are managing societal and ecological needs for water, are therefore likely to experience the impact the most. This study reviews the current literature regarding adaptation to climate change by water management organisations and associated barriers. Literature on adaptive capacity is growing and a general consensus is emerging on the determinants of adaptive capacity, although variations exist regarding how it is to be evaluated, enhanced and applied to policy making due to its dynamic, contextual and latent nature. Since adaptive capacity is hard to measure and successful adaptation difficult to define, some studies focus on the existence of adaptation attributes of organisations. Studies reporting successful adaptation are minimal and barriers of adaptation are being discovered as adaptation research transitions into implementation. But the root causes of these barriers are often overlooked and the interconnectedness of the barriers is poorly addressed. Increasingly, combining top-down and bottom-up approaches to adaptation is being recommended due to the limitations of each. However, knowledge regarding how organisations operating at different scales can enhance adaptive capacity of other organisations operating at another scale is lacking due to the few studies of inter-organisational networks across scales. Social networks among actors are recognised as a key factor to enable adaptation. However, network studies generally focus on individual actors and rarely between public agencies/organisations. Moreover, the current literature is inadequate to understand the relationship between adaptation enabling characteristics, barriers and adaptation manifestation. The review demonstrates that research on understanding the emergence and sustenance of barriers is urgently required. Addressing these knowledge gaps will help to improve the design of adaptation strategies, thereby improving the ability of water management to address the ongoing challenges of climate change.

Mental illness-related stigma in healthcare

PubMed Central

Mantler, Ed; Szeto, Andrew

2017-01-01

Mental illness-related stigma, including that which exists in the healthcare system and among healthcare providers, creates serious barriers to access and quality care. It is also a major concern for healthcare practitioners themselves, both as a workplace culture issue and as a barrier for help seeking. This article provides an overview of the main barriers to access and quality care created by stigmatization in healthcare, a consideration of contributing factors, and a summary of Canadian-based research into promising practices and approaches to combatting stigma in healthcare environments. PMID:28929889

Simulations of "tunnelling of the 3rd kind"

NASA Astrophysics Data System (ADS)

Mou, Zong-Gang; Saffin, Paul M.; Tognarelli, Paul; Tranberg, Anders

2017-07-01

We consider the phenomenon of "tunnelling of the 3rd kind" [1], whereby a magnetic field may traverse a classically impenetrable barrier by pair creation of unimpeded quantum fermions. These propagate through the barrier and generate a magnetic field on the other side. We study this numerically using quantum fermions coupled to a classical Higgs-gauge system, where we set up a magnetic field outside a box shielded by two superconducting barriers. We examine the magnitude of the internal magnetic field, and find agreement with existing perturbative results within a factor of two.

Building an award-winning women's health ambulatory service and beyond.

PubMed

Allen, Lisa W; Maxwell, Susan; Greene, John F

2003-01-01

Many barriers exist for the provision of high-quality health care to inner-city minority women. The barriers include access to care, compliance problems, financial concerns, system navigation issues, as well as language barriers. This article describes the transition of the Women's Ambulatory Health Services at Hartford Hospital from a traditional clinic model to a culturally sensitive private practice model. The road to transition was paved by valuable input from staff as well as patients. The final product was a much more efficient, inviting model that catered to the needs of the community.

Large-scale field testing on flexible shallow landslide barriers

NASA Astrophysics Data System (ADS)

Bugnion, Louis; Volkwein, Axel; Wendeler, Corinna; Roth, Andrea

2010-05-01

Open shallow landslides occur regularly in a wide range of natural terrains. Generally, they are difficult to predict and result in damages to properties and disruption of transportation systems. In order to improve the knowledge about the physical process itself and to develop new protection measures, large-scale field experiments were conducted in Veltheim, Switzerland. Material was released down a 30° inclined test slope into a flexible barrier. The flow as well as the impact into the barrier was monitored using various measurement techniques. Laser devices recording flow heights, a special force plate measuring normal and shear basal forces as well as load cells for impact pressures were installed along the test slope. In addition, load cells were built in the support and retaining cables of the barrier to provide data for detailed back-calculation of load distribution during impact. For the last test series an additional guiding wall in flow direction on both sides of the barrier was installed to achieve higher impact pressures in the middle of the barrier. With these guiding walls the flow is not able to spread out before hitting the barrier. A special constructed release mechanism simulating the sudden failure of the slope was designed such that about 50 m3 of mixed earth and gravel saturated with water can be released in an instant. Analysis of cable forces combined with impact pressures and velocity measurements during a test series allow us now to develop a load model for the barrier design. First numerical simulations with the software tool FARO, originally developed for rockfall barriers and afterwards calibrated for debris flow impacts, lead already to structural improvements on barrier design. Decisive for the barrier design is the first dynamic impact pressure depending on the flow velocity and afterwards the hydrostatic pressure of the complete retained material behind the barrier. Therefore volume estimation of open shallow landslides by assessing the thickness of the failure layer and the width of the possible failure are essential for the required barrier design parameter height and width. First results of the calculated drag coefficients of dynamic impact pressure measurements showed that the dynamic coefficient cw is much lower than 1.0 which is contradictory to most of existing dimensioning property protection guidelines. It appears to us that special adaptation to the system like smaller mesh sizes and special ground-barrier interface compared to normal rock-fall barriers and channelised debris flow barriers are necessary to improve the retention behavior of shallow landslide barriers. Detailed analysis of the friction coefficient in relationship with pore water pressure measurements gives interesting insights into the dynamic of fluid-solid mixed flows. Impact pressures dependencies on flow features are analyzed and discussed with respect to existing models and guidelines for shallow landslides.

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.

Congruent biogeographical disjunctions at a continent-wide scale: Quantifying and clarifying the role of biogeographic barriers in the Australian tropics.

PubMed

Edwards, Robert D; Crisp, Michael D; Cook, Dianne H; Cook, Lyn G

2017-01-01

To test whether novel and previously hypothesized biogeogaphic barriers in the Australian Tropics represent significant disjunction points or hard barriers, or both, to the distribution of plants. Australian tropics: Australian Monsoon Tropics and Australian Wet Tropics. The presence or absence of 6,861 plant species was scored across 13 putative biogeographic barriers in the Australian Tropics, including two that have not previously been recognised. Randomizations of these data were used to test whether more species showed disjunctions (gaps in distribution) or likely barriers (range limits) at these points than expected by chance. Two novel disjunctions in the Australian Tropics flora are identified in addition to eleven putative barriers previously recognized for animals. Of these, eleven disjunction points (all within the Australian Monsoon Tropics) were found to correspond to range-ending barriers to a significant number of species, while neither of the two disjunctions found within the Australian Wet Tropics limited a significant number of species' ranges. Biogeographic barriers present significant distributional limits to native plant species in the Australian Monsoon Tropics but not in the Australian Wet Tropics.

Racial differences in barriers to blood pressure control in a family practice setting.

PubMed

Scott, Jonathan M; Spees, Colleen K; Taylor, Christopher A; Wexler, Randy

2010-10-01

Hypertension prevalence in the African American community is greater than in all other ethnic groups. Cultural perceptions of health and disease introduce barriers to providing effective care. The purpose of this study was to identify racial differences in the perceived causes of hypertension, current behaviors performed to control blood pressure, and perceived barriers to preventing or treating hypertension. A self-administered survey of patients seen for medical care in a primary care network was conducted. The survey was developed to measure perceptions of hypertension etiology and treatments. Data from African American (n = 69) and Caucasian (n = 218) respondents were used to assess racial differences in perceptions of blood pressure control. About half of respondents knew their current blood pressures. African American patients were significantly less likely to believe that hypertension was caused by a lack of exercise and obesity. Significantly more Caucasians were less likely to report cutting down on table salt and taking prescription medications for blood pressure control. Both African Americans and Caucasians believed that sodium reduction was the most easily changed behavior to control their blood pressure, while both groups identified weight loss as being the most difficult. Racial differences exist in the perceived causes and treatments of high blood pressure, indicating a need for further patient education. When treating and counseling patients, physicians and support staff members must be sensitive to racial diversity and strive to offer culturally relevant solutions, especially for behaviors perceived as most difficult to change.

"It's not really worth my while": understanding contextual factors contributing to decisions to participate in community aphasia groups.

PubMed

Lanyon, Lucette; Worrall, Linda; Rose, Miranda

2018-01-10

Community aphasia groups represent a formalised opportunity for social participation. The potential barriers and facilitators to accessing and maintaining group participation remain poorly understood. The aim of this study was to explore environmental and personal factors contributing to community aphasia group participation. A framework analysis (FA) was used to analyse the semi-structured interview data from 22 current and past members of community aphasia groups. People with aphasia weigh up the benefits of group participation in the context of a range of personal and environmental factors. These include personal coping mechanisms, perceptions of existing social support as well as the practicalities of accessing the group. Understanding factors that contribute to participation experiences is critical to ensure that, people with aphasia are well supported to access and engage in community aphasia groups. This study found that people may be more able to participate when they are accepting of the chronic nature of the aphasia, when they identify tangible benefits to participation, and when they have easy access to the group. This suggests a role for speech pathologists to recognise critical periods of need and support people with aphasia and their significant others to access and engage in group services. Implications for Rehabilitation Critical stages exist when people with aphasia may feel more ready and able to participate in community aphasia groups. These critical stages include an acceptance of the chronic nature of aphasia, as well as a desire to make positive change. There is a need for clinicians to minimise barriers to participation early in the therapeutic relationship. Proliferation of community aphasia groups will function to alleviate environmental barriers associated with poor public awareness of groups and group accessibility.

Identifying a motor proficiency barrier for meeting physical activity guidelines in children.

PubMed

De Meester, An; Stodden, David; Goodway, Jacqueline; True, Larissa; Brian, Ali; Ferkel, Rick; Haerens, Leen

2018-01-01

This study examined the existence of a threshold level (proficiency barrier) of actual motor competence (MC) below which a child is not likely to attain 60min of moderate-to-vigorous physical activity (MVPA) per day. A cross-sectional study. Actual MC was assessed in 326 children (48.5% boys; age=9.50±1.24years) using the Test of Gross Motor Development-2; MVPA was measured with ActiGraph GT3X+accelerometers. Perceived MC, included as a potential mediating variable, was assessed with the Self-Perception Profile for Children. Binary logistic (mediation) regression analyses controlling for sex and a chi-squared test were used to gain insight into the relationship between (the levels of) actual MC and the percentage of children meeting the MVPA guideline. Actual MC significantly predicted the percentage of children meeting the guideline (B=.03, SE=.01, p<.001), even when controlling for sex. Perceived MC did not mediate this relationship. Children with high actual MC (65-100 percentile) were 2.46 (p=.003) times more likely to meet the guideline than children with low actual MC (0-27 percentile). The present study demonstrates the potential impact of low MC on children's MVPA levels and suggests evidence for the existence of a proficiency barrier for meeting MVPA guidelines. Almost 90% of the children whose actual MC is below the 'average' threshold do not meet the MVPA guideline. As more children with higher levels of actual MC meet the guideline than their less competent peers, it is crucial to provide opportunities to sufficiently develop children's actual MC. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

HgCdTe barrier infrared detectors

NASA Astrophysics Data System (ADS)

Kopytko, M.; Rogalski, A.

2016-05-01

In the last decade, new strategies to achieve high-operating temperature (HOT) detectors have been proposed, including barrier structures such as nBn devices, unipolar barrier photodiodes, and multistage (cascade) infrared detectors. The ability to tune the positions of the conduction and valence band edges independently in a broken-gap type-II superlattices is especially helpful in the design of unipolar barriers. This idea has been also implemented in HgCdTe ternary material system. However, the implementation of this detector structure in HgCdTe material system is not straightforward due to the existence of a valence band discontinuity (barrier) at the absorber-barrier interface. In this paper we present status of HgCdTe barrier detectors with emphasis on technological progress in fabrication of MOCVD-grown HgCdTe barrier detectors achieved recently at the Institute of Applied Physics, Military University of Technology. Their performance is comparable with state-of-the-art of HgCdTe photodiodes. From the perspective of device fabrication their important technological advantage results from less stringent surface passivation requirements and tolerance to threading dislocations.

Evaluation of manhole inserts as structural barriers to mosquito entry into belowground stormwater systems using a simulated treatment device.

PubMed

Harbison, Justin E; Metzger, Marco E; Allen, Vaikko; Hu, Renjie

2009-09-01

Belowground proprietary stormwater treatment devices can produce mosquitoes, including vectors of West Nile virus. Elimination of vertical entry points such as pick holes in manhole covers may reduce the number of mosquitoes entering and reproducing in these structures. Plastic manhole dish inserts were evaluated as structural barriers against mosquito entry through pick holes in a simulated stormwater treatment device. Inserts were 100% effective at preventing mosquito entry through covers when no other openings existed. In devices configured with an open lateral conveyance pipe, the addition of an insert under the cover reduced mosquito oviposition significantly. Subsequent trials to further elucidate mosquito entry through manhole covers found a significant positive correlation between increasing number of pick holes and mosquito oviposition. Results of the study suggest the potential for manhole dish inserts to decrease the number of mosquitoes entering belowground structures. The different available stormwater treatment systems and site-specific installations may, however, provide a much greater variety of possible alternate entry points for mosquitoes than was addressed in the current study. Further work is needed in field installations to quantify the significance of pick holes to mosquito entry and determine under what conditions, if any, manhole dish inserts would be most effective and appropriate.

Identifying Facilitators and Barriers for Home Injury Prevention Interventions for Pre-School Children: A Systematic Review of the Quantitative Literature

ERIC Educational Resources Information Center

Ingram, Jenny C.; Deave, Toity; Towner, Elizabeth; Errington, Gail; Kay, Bryony; Kendrick, Denise

2012-01-01

Injuries are the leading cause of childhood death internationally; steep social gradients exist in mortality and morbidity. The majority of pre-school injuries occur in the home, but implementing research into practice for injury prevention has received little attention. This systematic review describes key facilitators and barriers when…

Simple Things Matter! How Reassurance and Pain Management Strategies Can Improve Outcomes in Physiotherapy: A Case Report

ERIC Educational Resources Information Center

Leonard, Guillaume; Tousignant-Laflamme, Yannick; Mercier, Catherine

2013-01-01

Psychological barriers to rehabilitation are generally viewed as pre-existing patient traits that clinicians are asked to evaluate and modify. In the present case report, we provide evidence that these barriers can also be involuntarily created or perpetuated by the clinician himself when too much attention is placed on physical abnormalities.…

Career Development of Latinas in Mid-Level Community College Administration: A Phenomenological Approach

ERIC Educational Resources Information Center

Gonzalez-De Jesus, Naydeen Tyffane

2012-01-01

Glass ceilings have been identified by scholars throughout the past 20 years as barriers to the upward career mobility of women and of people of color. There is an indication that glass ceiling barriers exist in the higher education sector. Latinas, as a subgroup of women of color, occupy many of the mid-level administrative positions in community…

Evidence Synthesis for Knowledge Exchange: Balancing Responsiveness and Quality in Providing Evidence for Policy and Practice

ERIC Educational Resources Information Center

Morton, Sarah; Seditas, Karen

2018-01-01

Barriers to using research in practice are well documented. This paper describes an innovative process developed by the Centre for Research on Families and Relationships to address these barriers. We supported people to define what they needed to know; how existing evidence could help; and how to use evidence in practice. An action-focused…

Focus Groups of Alaska Native Adolescent Tobacco Users: Preferences for Tobacco Cessation Interventions and Barriers to Participation

ERIC Educational Resources Information Center

Patten, Christi A.; Enoch, Carrie; Renner, Caroline C.; Offord, Kenneth P.; Nevak, Caroline; Kelley, Stacy F.; Thomas, Janet; Decker, Paul A.; Hurt, Richard D.; Lanier, Anne; Kaur, Judith S.

2009-01-01

Tobacco cessation interventions developed for Alaska Native adolescents do not exist. This study employed focus group methodology to explore preferences for tobacco cessation interventions and barriers to participation among 49 Alaska Natives (61% female) with a mean age of 14.6 (SD = 1.6) who resided in western Alaska. Using content analysis,…

Breaking Down Cultural Barriers to Military Entry into Higher Education

ERIC Educational Resources Information Center

Hollis, Michael J.

2009-01-01

The purpose of this paper was to identify a problem in higher education that needed a new solution and draft a viable proposal for how to resolve it. I chose the problem of cultural barriers that veterans often face when attempting to return to many universities following military service. The method used was a combination of existing literature…

Large-scale, thick, self-assembled, nacre-mimetic brick-walls as fire barrier coatings on textiles

PubMed Central

Das, Paramita; Thomas, Helga; Moeller, Martin; Walther, Andreas

2017-01-01

Highly loaded polymer/clay nanocomposites with layered structures are emerging as robust fire retardant surface coatings. However, time-intensive sequential deposition processes, e.g. layer-by-layer strategies, hinders obtaining large coating thicknesses and complicates an implementation into existing technologies. Here, we demonstrate a single-step, water-borne approach to prepare thick, self-assembling, hybrid fire barrier coatings of sodium carboxymethyl cellulose (CMC)/montmorillonite (MTM) with well-defined, bioinspired brick-wall nanostructure, and showcase their application on textile. The coating thickness on the textile is tailored using different concentrations of CMC/MTM (1–5 wt%) in the coating bath. While lower concentrations impart conformal coatings of fibers, thicker continuous coatings are obtained on the textile surface from highest concentration. Comprehensive fire barrier and fire retardancy tests elucidate the increasing fire barrier and retardancy properties with increasing coating thickness. The materials are free of halogen and heavy metal atoms, and are sourced from sustainable and partly even renewable building blocks. We further introduce an amphiphobic surface modification on the coating to impart oil and water repellency, as well as self-cleaning features. Hence, our study presents a generic, environmentally friendly, scalable, and one-pot coating approach that can be introduced into existing technologies to prepare bioinspired, thick, fire barrier nanocomposite coatings on diverse surfaces. PMID:28054589

Artificial recharge in the northern part of Chino ground-water basin, upper Santa Ana Valley, California

USGS Publications Warehouse

Koehler, J.H.

1983-01-01

This study was made to help management design and implement a recharge-recapture system for State Water Project water in Chino Basin. Nine test holes were drilled in the study area. Analyses of data from these test holes and drillers ' logs of water wells indicate the presence of clay deposits. The clay deposits cannot be correlated between holes which indicates that they are in the form of discontinuous beds or lenses. The existence and location of two ground-water barriers (Barrier ' J ' and Red Hill Barrier) have been postulated in previous reports. Water-level data indicate that Barrier ' J ' is probably not effectively stopping the movement of ground water. Data are insufficient to determine the effectiveness of the Red Hill barrier. Five existing recharge facilities in the study area were previously constructed to control floodflow. Infiltration tests were conducted at three of the facilities, and results of these tests indicate infiltration rates of 2.6 feet per day at Day Creek, 2.0 feet per day at East Etiwanda, and 1.3 feet per day at San Sevaine. A total of about 9,000 acre-feet of State Water Project water was recharged between June 1980 and July 1981. Rising water levels in wells indicate that recharge water is percolating down to the water table. (USGS)

Structural barriers in access to medical marijuana in the USA-a systematic review protocol.

PubMed

Valencia, Celina I; Asaolu, Ibitola O; Ehiri, John E; Rosales, Cecilia

2017-08-07

There are 43 state medical marijuana programs in the USA, yet limited evidence is available on the demographic characteristics of the patient population accessing these programs. Moreover, insights into the social and structural barriers that inform patients' success in accessing medical marijuana are limited. A current gap in the scientific literature exists regarding generalizable data on the social, cultural, and structural mechanisms that hinder access to medical marijuana among qualifying patients. The goal of this systematic review, therefore, is to identify the aforementioned mechanisms that inform disparities in access to medical marijuana in the USA. This scoping review protocol outlines the proposed study design for the systematic review and evaluation of peer-reviewed scientific literature on structural barriers to medical marijuana access. The protocol follows the guidelines set forth by the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) checklist. The overarching goal of this study is to rigorously evaluate the existing peer-reviewed data on access to medical marijuana in the USA. Income, ethnic background, stigma, and physician preferences have been posited as the primary structural barriers influencing medical marijuana patient population demographics in the USA. Identification of structural barriers to accessing medical marijuana provides a framework for future policies and programs. Evidence-based policies and programs for increasing medical marijuana access help minimize the disparity of access among qualifying patients.

A 3-Dimensional Model of Water-Bearing Sequences in the Dominguez Gap Region, Long Beach, California

USGS Publications Warehouse

Ponti, Daniel J.; Ehman, Kenneth D.; Edwards, Brian D.; Tinsley, John C.; Hildenbrand, Thomas; Hillhouse, John W.; Hanson, Randall T.; McDougall, Kristen; Powell, Charles L.; Wan, Elmira; Land, Michael; Mahan, Shannon; Sarna-Wojcicki, Andrei M.

2007-01-01

A 3-dimensional computer model of the Quaternary sequence stratigraphy in the Dominguez gap region of Long Beach, California has been developed to provide a robust chronostratigraphic framework for hydrologic and tectonic studies. The model consists of 13 layers within a 16.5 by 16.1 km (10.25 by 10 mile) square area and extends downward to an altitude of -900 meters (-2952.76 feet). Ten sequences of late Pliocene to Holocene age are identified and correlated within the model. Primary data to build the model comes from five reference core holes, extensive high-resolution seismic data obtained in San Pedro Bay, and logs from several hundred water and oil wells drilled in the region. The model is best constrained in the vicinity of the Dominguez gap seawater intrusion barrier where a dense network of subsurface data exist. The resultant stratigraphic framework and geologic structure differs significantly from what has been proposed in earlier studies. An important new discovery from this approach is the recognition of ongoing tectonic deformation throughout nearly all of Quaternary time that has impacted the geometry and character of the sequences. Anticlinal folding along a NW-SE trend, probably associated with Quaternary reactivation of the Wilmington anticline, has uplifted and thinned deposits along the fold crest, which intersects the Dominguez gap seawater barrier near Pacific Coast Highway. A W-NW trending fault system that approximately parallels the fold crest has also been identified. This fault progressively displaces all but the youngest sequences down to the north and serves as the southern termination of the classic Silverado aquifer. Uplift and erosion of fining-upward paralic sequences along the crest of the young fold has removed or thinned many of the fine-grained beds that serve to protect the underlying Silverado aquifer from seawater contaminated shallow groundwater. As a result of this process, the potential exists for vertical migration of seawater into the producing aquifers and subsequent landward migration of intruded waters beneath the existing Dominguez barrier. Incipient invasion of the Silverado aquifer by chloride-enriched waters is observed in a recently drilled well located along the crest of the fold seaward of the barrier and at a depth of 440 feet (134 meters). These new observations and interpretations indicate that the new sequence-based approach to defining the stratigraphy of the Dominguez Gap area may have important implications for seawater intrusion management. To test this, it will be useful to overlay existing water-quality and water level data onto the framework model and to incorporate the new stratigraphy into a transport model.

Captive breeding of pangolins: current status, problems and future prospects

PubMed Central

Hua, Liushuai; Gong, Shiping; Wang, Fumin; Li, Weiye; Ge, Yan; Li, Xiaonan; Hou, Fanghui

2015-01-01

Abstract Pangolins are unique placental mammals with eight species existing in the world, which have adapted to a highly specialized diet of ants and termites, and are of significance in the control of forest termite disaster. Besides their ecological value, pangolins are extremely important economic animals with the value as medicine and food. At present, illegal hunting and habitat destruction have drastically decreased the wild population of pangolins, pushing them to the edge of extinction. Captive breeding is an important way to protect these species, but because of pangolin’s specialized behaviors and high dependence on natural ecosystem, there still exist many technical barriers to successful captive breeding programs. In this paper, based on the literatures and our practical experience, we reviewed the status and existing problems in captive breeding of pangolins, including four aspects, the naturalistic habitat, dietary husbandry, reproduction and disease control. Some recommendations are presented for effective captive breeding and protection of pangolins. PMID:26155072

The Teaching of Ethics and Professionalism in Plastic Surgery Residency: A Cross-Sectional Survey.

PubMed

Bennett, Katelyn G; Ingraham, John M; Schneider, Lisa F; Saadeh, Pierre B; Vercler, Christian J

2017-05-01

The ethical practice of medicine has always been of utmost importance, and plastic surgery is no exception. The literature is devoid of information on the teaching of ethics and professionalism in plastic surgery. In light of this, a survey was sent to ascertain the status of ethics training in plastic surgery residencies. A 21-question survey was sent from the American Council of Academic Plastic Surgeons meeting to 180 plastic surgery program directors and coordinators via email. Survey questions inquired about practice environment, number of residents, presence of a formal ethics training program, among others. Binary regression was used to determine if any relationships existed between categorical variables, and Poisson linear regression was used to assess relationships between continuous variables. Statistical significance was set at a P value of 0.05. A total of 104 members responded to the survey (58% response rate). Sixty-three percent were program directors, and most (89%) practiced in academic settings. Sixty-two percent in academics reported having a formal training program, and 60% in private practice reported having one. Only 40% of programs with fewer than 10 residents had ethics training, whereas 78% of programs with more than 20 residents did. The odds of having a training program were slightly higher (odds ratio, 1.1) with more residents (P = 0.17). Despite the lack of information in the literature, formal ethics and professionalism training does exist in many plastic surgery residencies, although barriers to implementation do exist. Plastic surgery leadership should be involved in the development of standardized curricula to help overcome these barriers.

Online information and support needs of women with advanced breast cancer: a qualitative analysis.

PubMed

Kemp, Emma; Koczwara, Bogda; Butow, Phyllis; Turner, Jane; Girgis, Afaf; Schofield, Penelope; Hulbert-Williams, Nicholas; Levesque, Janelle; Spence, Danielle; Vatandoust, Sina; Kichenadasse, Ganessan; Roy, Amitesh; Sukumaran, Shawgi; Karapetis, Christos S; Richards, Caroline; Fitzgerald, Michael; Beatty, Lisa

2018-04-24

Women with advanced breast cancer (ABC) face significant adjustment challenges, yet few resources provide them with information and support, and attendance barriers can preclude access to face-to-face psychosocial support. This paper reports on two qualitative studies examining (i) whether information and support-seeking preferences of women with ABC could be addressed in an online intervention, and (ii) how an existing intervention for patients with early stage cancer could be adapted for women with ABC. Women with ABC participated in telephone interviews about their information and support-seeking preferences (N = 21) and evaluated an online intervention focused on early-stage cancer (N = 15). Interviews were transcribed and underwent thematic analysis using the framework method to identify salient themes. Participants most commonly sought medical, lifestyle-related, and practical information/support; however, when presented with an online intervention, participants most commonly gave positive feedback on content on coping with emotional distress. Difficulty finding information and barriers to using common sources of information/support including health professionals, family and friends, and peers were reported; however, some women also reported not wanting information or support. All participants evaluating the existing intervention gave positive feedback on various components, with results suggesting an online intervention could be an effective means of providing information/support to women with ABC, given improved specificity/relevance to ABC and increased tailoring to individual circumstances and preferences. Adaptation of an existing online intervention for early stage cancer appears to be a promising avenue to address the information and support needs of women with ABC.

Emergency Medical Services Perspectives on Identifying and Reporting Victims of Elder Abuse, Neglect, and Self-Neglect.

PubMed

Rosen, Tony; Lien, Cynthia; Stern, Michael E; Bloemen, Elizabeth M; Mysliwiec, Regina; McCarthy, Thomas J; Clark, Sunday; Mulcare, Mary R; Ribaudo, Daniel S; Lachs, Mark S; Pillemer, Karl; Flomenbaum, Neal E

2017-10-01

Emergency Medical Services (EMS) providers, who perform initial assessments of ill and injured patients, often in a patient's home, are uniquely positioned to identify potential victims of elder abuse, neglect, or self-neglect. Despite this, few organized programs exist to ensure that EMS concerns are communicated to or further investigated by other health care providers, social workers, or the authorities. To explore attitudes and self-reported practices of EMS providers surrounding identification and reporting of elder mistreatment. Five semi-structured focus groups with 27 EMS providers. Participants reported believing they frequently encountered and were able to identify potential elder mistreatment victims. Many reported infrequently discussing their concerns with other health care providers or social workers and not reporting them to the authorities due to barriers: 1) lack of EMS protocols or training specific to vulnerable elders; 2) challenges in communication with emergency department providers, including social workers, who are often unavailable or not receptive; 3) time limitations; and 4) lack of follow-up when EMS providers do report concerns. Many participants reported interest in adopting protocols to assist in elder protection. Additional strategies included photographically documenting the home environment, additional training, improved direct communication with social workers, a dedicated location on existing forms or new form to document concerns, a reporting hotline, a system to provide feedback to EMS, and community paramedicine. EMS providers frequently identify potential victims of elder abuse, neglect, and self-neglect, but significant barriers to reporting exist. Strategies to empower EMS providers and improve reporting were identified. Copyright © 2017 Elsevier Inc. All rights reserved.

To Remodel or To Build?

ERIC Educational Resources Information Center

Rosenblum, Todd

2009-01-01

The question of remodeling an existing house to make it wheelchair accessible or building a new barrier-free house is a difficult decision. This article presents some initial questions and considerations followed by a list of pros and cons for remodeling an existing house vs. building a new house.

Barriers to innovation in human rabies prophylaxis and treatment: A causal analysis of insights from key opinion leaders and literature.

PubMed

van de Burgwal, L H M; Neevel, A M G; Pittens, C A C M; Osterhaus, A D M E; Rupprecht, C E; Claassen, E

2017-12-01

Rabies is an essentially 100% fatal, zoonotic disease, caused by Lyssaviruses. Currently, the disease is vaccine-preventable with pre- and post-exposure prophylaxis (PrEP and PEP). Still, rabies virus is estimated to cause up to 60,000 human deaths annually, of which the vast majority occurs in rural Asia and Africa, due to the inaccessibility of prophylaxis and non-existence of treatment. Despite these unmet clinical needs, rabies control mainly focuses on the sylvatic reservoir and drug innovation receives relatively little attention compared to other neglected tropical diseases (NTDs). As such, the lag of innovation in human rabies prophylaxis and treatment cannot be explained by limited return on investment alone. Strategies countering rabies-specific innovation barriers are important for the acceleration of innovation in human rabies prophylaxis and treatment. Barriers throughout society, science, business development and market domains were identified through literature review and 23 semi-structured interviews with key opinion leaders worldwide. A subsequent root cause analysis revealed causal relations between innovation barriers and a limited set of root causes. Finally, prioritization by experts indicated their relative importance. Root causes, which are fundamental to barriers, were aggregated into four types: market and commercial, stakeholder collaboration, public health and awareness, and disease trajectory. These were found in all domains of the innovation process and thus are relevant for all stakeholders. This study identifies barriers that were not previously described in this specific context, for example the competition for funding between medical and veterinary approaches. The results stress the existence of barriers beyond the limited return on investment and thereby explain why innovation in human rabies medication is lagging behind NTDs with a lower burden of disease. A re-orientation on the full spectrum of barriers that hinder innovation in rabies prophylaxis and treatment is necessary to meet unmet societal and medical needs. © 2017 The Authors. Zoonoses and Public Health Published by Blackwell Verlag GmbH.

Perceived Exercise Benefits and Barriers of Non-Exercising Female University Students in the United Kingdom

PubMed Central

Lovell, Geoff P; Ansari, Walid El; Parker, John K

2010-01-01

Many individuals do not engage in sufficient physical activity due to low perceived benefits and high perceived barriers to exercise. Given the increasing incidence of obesity and obesity related health disorders, this topic requires further exploration. We used the Exercise Benefits/Barriers Scale to assess perceived benefit and barrier intensities to exercise in 200 non-exercising female university students (mean age 19.3 years, SD = 1.06) in the UK. Although our participants were selected because they self reported themselves to be non-exercising, however they reported significantly higher perceived benefits from exercise than perceived barriers to exercise [t(199) = 6.18, p < 0.001], and their perceived benefit/barrier ratio was 1.33. The greatest perceived benefit from exercise was physical performance followed by the benefits of psychological outlook, preventive health, life enhancement, and then social interaction. Physical performance was rated significantly higher than all other benefits. Psychological outlook and preventive health were not rated significantly different, although both were significantly higher than life enhancement and social interaction. Life enhancement was also rated significantly higher than social interaction. The greatest perceived barrier to exercise was physical exertion, which was rated significantly higher than time expenditure, exercise milieu, and family discouragement barriers. Implications from this investigation for the design of physical activity programmes include the importance, for females, of a perception of high benefit/barrier ratio that could be conducive to participation in exercise. Applied interventions need to assist female students to ‘disengage’ from or overcome any perceived ‘unpleasantness’ of physical exertion during physical activity (decrease their perceived barriers), and to further highlight the multiple health and other benefits of regular exercising (increase their perceived benefits). PMID:20617003

Perceived exercise benefits and barriers of non-exercising female university students in the United Kingdom.

PubMed

Lovell, Geoff P; El Ansari, Walid; Parker, John K

2010-03-01

Many individuals do not engage in sufficient physical activity due to low perceived benefits and high perceived barriers to exercise. Given the increasing incidence of obesity and obesity related health disorders, this topic requires further exploration. We used the Exercise Benefits/Barriers Scale to assess perceived benefit and barrier intensities to exercise in 200 non-exercising female university students (mean age 19.3 years, SD = 1.06) in the UK. Although our participants were selected because they self reported themselves to be non-exercising, however they reported significantly higher perceived benefits from exercise than perceived barriers to exercise [t(199) = 6.18, p < 0.001], and their perceived benefit/barrier ratio was 1.33. The greatest perceived benefit from exercise was physical performance followed by the benefits of psychological outlook, preventive health, life enhancement, and then social interaction. Physical performance was rated significantly higher than all other benefits. Psychological outlook and preventive health were not rated significantly different, although both were significantly higher than life enhancement and social interaction. Life enhancement was also rated significantly higher than social interaction. The greatest perceived barrier to exercise was physical exertion, which was rated significantly higher than time expenditure, exercise milieu, and family discouragement barriers. Implications from this investigation for the design of physical activity programmes include the importance, for females, of a perception of high benefit/barrier ratio that could be conducive to participation in exercise. Applied interventions need to assist female students to 'disengage' from or overcome any perceived 'unpleasantness' of physical exertion during physical activity (decrease their perceived barriers), and to further highlight the multiple health and other benefits of regular exercising (increase their perceived benefits).

Barriers to global health development: An international quantitative survey

PubMed Central

2017-01-01

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

Oral Health Disparities and Unmet Dental Needs among Preschool Children in Chelsea, MA: Exploring Mechanisms, Defining Solutions

PubMed Central

Isong, Inyang; Dantas, Laila; Gerard, Macda; Kuhlthau, Karen

2014-01-01

Background Significant disparities exist in children’s receipt of preventive dental care (PDC) in the United States. Many of the children at greatest risk of dental disease do not receive timely PDC; when they do receive dental care, it is often more for relief of dental pain. Chelsea is a low-income, diverse Massachusetts community with high rates of untreated childhood caries. There are various dental resources available in Chelsea, yet many children do not access dental care at levels equivalent to their needs. Objective Using Chelsea as a case-study, to explore factors contributing to forgone PDC (including the age 1 dental visit) in an in-depth way. Methods We used a qualitative study design that included semi-structured interviews with parents of preschool children residing in Chelsea, and Chelsea-based providers including pediatricians, dentists, a dental hygienist and early childhood care providers. We examined: a) parents’ dental attitudes and oral health cultural beliefs; b) parents’ and providers’ perspectives on facilitators and barriers to PDC, reasons for unmet needs, and proposed solutions to address the problem. We recorded, transcribed and independently coded all interviews. Using rigorous, iterative qualitative data analyses procedures, we identified emergent themes. Results Factors perceived to facilitate receipt of PDC included Head-Start oral health policies, strong pediatric primary care/dental linkages, community outreach and advertising, and parents’ own oral health experiences. Most parents and providers perceived there to be an adequate number of accessible dental services and resources in Chelsea, including for Medicaid enrollees. However, several barriers impeded children from receiving timely PDC, the most frequently cited being insurance related problems for children and adults. Other barriers included limited dental services for children <2 years, perceived poor quality of some dental practices, lack of emphasis on prevention-based dental care, poor care-coordination, and insufficient culturally-appropriate care. Important family-level barriers included parental oral health literacy, cultural factors, limited English proficiency and competing priorities. Several solutions were proposed to address identified barriers. Conclusion Even in a community with a considerable number of dental resources, various factors may preclude access to these services by preschool-aged children. Opportunities exist to address modifiable factors through strategic oral health policies, community outreach and improved care coordination between physicians, dentists and early childhood care providers. PMID:25614878

Oral Health Disparities and Unmet Dental Needs among Preschool Children in Chelsea, MA: Exploring Mechanisms, Defining Solutions.

PubMed

Isong, Inyang; Dantas, Laila; Gerard, Macda; Kuhlthau, Karen

Significant disparities exist in children's receipt of preventive dental care (PDC) in the United States. Many of the children at greatest risk of dental disease do not receive timely PDC; when they do receive dental care, it is often more for relief of dental pain. Chelsea is a low-income, diverse Massachusetts community with high rates of untreated childhood caries. There are various dental resources available in Chelsea, yet many children do not access dental care at levels equivalent to their needs. Using Chelsea as a case-study, to explore factors contributing to forgone PDC (including the age 1 dental visit) in an in-depth way. We used a qualitative study design that included semi-structured interviews with parents of preschool children residing in Chelsea, and Chelsea-based providers including pediatricians, dentists, a dental hygienist and early childhood care providers. We examined: a) parents' dental attitudes and oral health cultural beliefs; b) parents' and providers' perspectives on facilitators and barriers to PDC, reasons for unmet needs, and proposed solutions to address the problem. We recorded, transcribed and independently coded all interviews. Using rigorous, iterative qualitative data analyses procedures, we identified emergent themes. Factors perceived to facilitate receipt of PDC included Head-Start oral health policies, strong pediatric primary care/dental linkages, community outreach and advertising, and parents' own oral health experiences. Most parents and providers perceived there to be an adequate number of accessible dental services and resources in Chelsea, including for Medicaid enrollees. However, several barriers impeded children from receiving timely PDC, the most frequently cited being insurance related problems for children and adults. Other barriers included limited dental services for children <2 years, perceived poor quality of some dental practices, lack of emphasis on prevention-based dental care, poor care-coordination, and insufficient culturally-appropriate care. Important family-level barriers included parental oral health literacy, cultural factors, limited English proficiency and competing priorities. Several solutions were proposed to address identified barriers. Even in a community with a considerable number of dental resources, various factors may preclude access to these services by preschool-aged children. Opportunities exist to address modifiable factors through strategic oral health policies, community outreach and improved care coordination between physicians, dentists and early childhood care providers.

Hydro-mechanical properties of the Red Salt Clay (T4) - Relevancy of the minimum stress criterion for barrier integrity

NASA Astrophysics Data System (ADS)

Minkley, W.; Popp, T.; Salzer, K.; Gruner, M.; Böttge, V.

The so-called Red Salt Clay (T4) is deposited as clay-rich clastic sediment at the base of the Aller-series forming a persistent lateral layer of up to 20 m thickness above the lower Zechstein-series. The clay layers may act as a protective shield in the hanging wall of gas storages or underground repositories in salt formations, thus resulting in a multi-barrier system. As a proof of its reliability comprehensive hydro-mechanical investigations were performed on clay samples recovered at different sites in Germany. Most important, rock tightness against various fluids was confirmed in the lab and field-scale. Remarkably, only if the fluid pressure equalises the acting minimal stress (i.e. violence of the “minimum stress criterion”) a significant increase of permeability is observed (“pathway dilatation”) but no macro-frac. However, the material properties from different locations showed a significant variability according to different burial depths. Thus the Red Salt Clay may act as natural analogue, representing the material variability of various indurated clays. In addition, the existing knowledge gained from practical mining activities can be used to evaluate extreme in situ loading conditions.

Qualitative Evaluation of a New Tobacco Cessation Training Curriculum for Patient Navigators

PubMed Central

Shuk, Elyse; Krebs, Paul; Lu, Wei-Hsin; Burkhalter, Jack; Cortez-Weir, Jeralyn; Rodriguez, Rian; Burnside, Vanessa N.; Lubetkin, Erica I.

2011-01-01

Treatments for tobacco dependence exist but are underutilized, particularly among low-income and minority smokers. Patient navigation has been shown to help patients overcome barriers to quality care. In preparation for testing the feasibility of integrating tobacco cessation patient navigation into primary care, this paper describes the development and qualitative evaluation of a new curriculum for training patient navigators to address cessation treatment barriers faced by low-income, minority smokers who are advised to quit by their physicians. Thematic text analysis of transcripts obtained from focus groups with experienced patient navigators (n = 19) was conducted. Participants endorsed patient navigation as a relevant strategy for addressing tobacco cessation treatment barriers and made several recommendations regarding the knowledge, core competencies, and skills needed to conduct tobacco cessation patient navigation. This curriculum could be used by existing patient navigation training centers or made available as a self-guided continuing education program for experienced navigators who wish to expand their navigation interventions to include a tobacco cessation focus. PMID:21553331

Oculocutaneous albinism: identifying and overcoming barriers to vision care in a Nigerian population.

PubMed

Udeh, N N; Eze, B I; Onwubiko, S N; Arinze, O C; Onwasigwe, E N; Umeh, R E

2014-06-01

To assess eye care service utilization, and identify access barriers in a south-eastern Nigerian albino population. The study was a population-based, cross-sectional survey conducted in Enugu state between August, 2011 and January, 2012. Using the data base of the state's Albino Foundation and tailored awareness creation, persons living with albinism were identified and recruited at two study centres. Data on participants' socio-demographics, perception of vision, visual needs, previous eye examination and or low vision assessment, use of glasses or low vision devices were collected. Reasons for non-utilisation of available vision care services were also obtained. Descriptive and comparative statistics were performed. A p < 0.05 was considered statistically significant. The participants (n = 153; males 70; females 83; sex ratio: 1:1.1) were aged 23.46 + 10.44 SD years (range 6-60 years). Most--95.4 % of the participants had no previous low vision assessment and none--0.0% had used low vision device. Of the participants, 82.4% reported previous eye examination, 33.3% had not used spectacles previously, despite the existing need. Ignorance--88.9% and poor access--8.5% were the main barriers to uptake of vision care services. In Enugu, Nigeria, there is poor awareness and low utilization of vision care services among people with albinism. The identified barriers to vision care access are amenable to awareness creation and logistic change in the provision of appropriate vision care services.

34 CFR 1200.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 3 2010-07-01 2010-07-01 false Program accessibility: Existing facilities. 1200.150 Section 1200.150 Education Regulations of the Offices of the Department of Education (Continued) NATIONAL... Architectural Barriers Act of 1968, as amended (42 U.S.C. 4151-4157), and any regulations implementing it. In...

Congruent biogeographical disjunctions at a continent-wide scale: Quantifying and clarifying the role of biogeographic barriers in the Australian tropics

PubMed Central

Crisp, Michael D.; Cook, Dianne H.; Cook, Lyn G.

2017-01-01

Aim To test whether novel and previously hypothesized biogeogaphic barriers in the Australian Tropics represent significant disjunction points or hard barriers, or both, to the distribution of plants. Location Australian tropics: Australian Monsoon Tropics and Australian Wet Tropics. Methods The presence or absence of 6,861 plant species was scored across 13 putative biogeographic barriers in the Australian Tropics, including two that have not previously been recognised. Randomizations of these data were used to test whether more species showed disjunctions (gaps in distribution) or likely barriers (range limits) at these points than expected by chance. Results Two novel disjunctions in the Australian Tropics flora are identified in addition to eleven putative barriers previously recognized for animals. Of these, eleven disjunction points (all within the Australian Monsoon Tropics) were found to correspond to range-ending barriers to a significant number of species, while neither of the two disjunctions found within the Australian Wet Tropics limited a significant number of species’ ranges. Main conclusions Biogeographic barriers present significant distributional limits to native plant species in the Australian Monsoon Tropics but not in the Australian Wet Tropics. PMID:28376094

Hacking the Silos: Eliminating Information Barriers Between Public Health and Law Enforcement

DTIC Science & Technology

2018-03-01

ELIMINATING INFORMATION BARRIERS BETWEEN PUBLIC HEALTH AND LAW ENFORCEMENT by Cody L. Minks March 2018 Thesis Advisor: Anke Richter...burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instruction, searching...existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information . Send comments regarding this

The New Digital [St]age: Barriers to the Adoption and Adaptation of New Technologies to Deliver Extension Programming and How to Address Them

ERIC Educational Resources Information Center

Seger, Jamie

2011-01-01

With the rise of social media and the need for statewide program cohesiveness, The Ohio State University Extension has the opportunity to position itself as a catalyst for technology adoption and adaptation nationwide. Unfortunately, many barriers exist to the successful use and implementation of technology, including an organizational structure…

A Comparison of Motivational Factors and Barriers to Physical Activity among Traditional versus Nontraditional College Students

ERIC Educational Resources Information Center

Kulavic, Kimberly; Hultquist, Cherilyn N.; McLester, John R.

2013-01-01

Objective: To investigate the motivational factors and the barriers to physical activity (PA) in traditional college students (TS) and nontraditional college students (NTS) and determine if differences exist between these 2 groups. Participants: A total of 746 college students; 628 were TS (19.1 [plus-minus] 1.2 years), and 118 were NTS (31.2…

Effect of annealing on microstructure evolution in CoFeB/MgO/CoFeB heterostructures by positron annihilation

NASA Astrophysics Data System (ADS)

Zhao, Chong-Jun; Lu, Xiang-An; Zhao, Zhi-Duo; Li, Ming-Hua; Zhang, Peng; Wang, Bao-Yi; Cao, Xing-Zhong; Zhang, Jing-Yan; Yu, Guang-Hua

2013-09-01

As one of the most powerful tools for investigation of defects of materials, positron annihilation spectroscopy was employed to explore the thermal effects on the film microstructure evolution in CoFeB/MgO/CoFeB heterostructures. It is found that high annealing temperature can drive vacancy defects agglomeration and ordering acceleration in the MgO barrier. Meanwhile, another important type of defects, vacancy clusters, which are formed via the agglomeration of vacancy defects in the MgO barrier after annealing, still exists inside the MgO barrier. All these behaviors in the MgO barrier could potentially impact the overall performance in MgO based magnetic tunnel junctions.

Treatment of substance misuse in older women: using a brief intervention model.

PubMed

Finfgeld-Connett, Deborah L

2004-08-01

Alcohol and benzodiazepine misuse is a significant problem in older women for a number of reasons such as physiological changes, outdated prescribing practices, and failure to identify hazardous use. In addition, treatment barriers involving the health-care system, conflicting information, and ageism also exist. Substance misuse among older women is predicted to become a bigger problem as the baby boom generation ages. Brief interventions that consist of assessment, feedback, responsibility, advice, menu, empathy, and self-efficacy, or A-FRAMES, have the potential to reduce alcohol and benzodiazepine misuse among older women in a cost-effective manner.

Leakage current and charging/discharging processes in barrier-type anodic alumina thin films for use in metal-insulator-metal capacitors

NASA Astrophysics Data System (ADS)

Hourdakis, E.; Koutsoureli, M.; Papaioannou, G.; Nassiopoulou, A. G.

2018-06-01

Barrier-type anodic alumina thin films are interesting for use in high capacitance density metal-insulator-metal capacitors due to their excellent dielectric properties at small thickness. This thickness is easily controlled by the anodization voltage. In previous papers we studied the main parameters of interest of the Al/barrier-type anodic alumina/Al structure for use in RF applications and showed the great potential of barrier-type anodic alumina in this respect. In this paper, we investigated in detail charging/discharging processes and leakage current of the above dielectric material. Two different sets of metal-insulator-metal capacitors were studied, namely, with the top Al electrode being either e-gun deposited or sputtered. The dielectric constant of the barrier-type anodic alumina was found at 9.3. Low leakage current was observed in all samples studied. Furthermore, depending on the film thickness, field emission following the Fowler-Nordheim mechanism was observed above an applied electric field. Charging of the anodic dielectric was observed, occurring in the bulk of the anodic layer. The stored charge was of the order of few μC/cm2 and the calculated trap density ˜2 × 1018 states/cm3, the most probable origin of charge traps being, in our opinion, positive electrolyte ions trapped in the dielectric during anodization. We do not think that oxygen vacancies play an important role, since their existence would have a more important impact on the leakage current characteristics, such as resistive memory effects or significant changes during annealing, which were not observed. Finally, discharging characteristic times as high as 5 × 109 s were measured.

Computational characterization of lightweight multilayer MXene Li-ion battery anodes

NASA Astrophysics Data System (ADS)

Ashton, Michael; Hennig, Richard G.; Sinnott, Susan B.

2016-01-01

MXenes, a class of two-dimensional transition metal carbides and nitrides, have shown promise experimentally and computationally for use in energy storage applications. In particular, the most lightweight members of the monolayer MXene family (M = Sc, Ti, V, or Cr) are predicted to have gravimetric capacities above 400 mAh/g, higher than graphite. Additionally, intercalation of ions into multilayer MXenes can be accomplished at low voltages, and low diffusion barriers exist for Li diffusing across monolayer MXenes. However, large discrepancies have been observed between the calculated and experimental reversible capacities of MXenes. Here, dispersion-corrected density functional theory calculations are employed to predict reversible capacities and other battery-related properties for six of the most promising members of the MXene family (O-functionalized Ti- and V-based carbide MXenes) as bilayer structures. The calculated reversible capacities of the V2CO2 and Ti2CO2 bilayers agree more closely with experiment than do previous calculations for monolayers. Additionally, the minimum energy paths and corresponding energy barriers along the in-plane [1000] and [0100] directions for Li travelling between neighboring MXene layers are determined. V4C3O2 exhibits the lowest diffusion barrier of the compositions considered, at 0.42 eV, but its reversible capacity (148 mAh/g) is dragged down by its heavy formula unit. Conversely, the V2CO2 MXene shows good reversible capacity (276 mAh/g), but a high diffusion barrier (0.82 eV). We show that the diffusion barriers of all bilayer structures are significantly higher than those calculated for the corresponding monolayers, advocating the use of dispersed monolayer MXenes instead of multilayers in high performance anodes.

Earth's inner core nucleation paradox

NASA Astrophysics Data System (ADS)

Huguet, Ludovic; Van Orman, James A.; Hauck, Steven A.; Willard, Matthew A.

2018-04-01

The conventional view of Earth's inner core is that it began to crystallize at Earth's center when the temperature dropped below the melting point of the iron alloy and has grown steadily since that time as the core continued to cool. However, this model neglects the energy barrier to the formation of the first stable crystal nucleus, which is commonly represented in terms of the critical supercooling required to overcome the barrier. Using constraints from experiments, simulations, and theory, we show that spontaneous crystallization in a homogeneous liquid iron alloy at Earth's core pressures requires a critical supercooling of order 1000 K, which is too large to be a plausible mechanism for the origin of Earth's inner core. We consider mechanisms that can lower the nucleation barrier substantially. Each has caveats, yet the inner core exists: this is the nucleation paradox. Heterogeneous nucleation on a solid metallic substrate tends to have a low energy barrier and offers the most straightforward solution to the paradox, but solid metal would probably have to be delivered from the mantle and such events are unlikely to have been common. A delay in nucleation, whether due to a substantial nucleation energy barrier, or late introduction of a low energy substrate, would lead to an initial phase of rapid inner core growth from a supercooled state. Such rapid growth may lead to distinctive crystallization texturing that might be observable seismically. It would also generate a spike in chemical and thermal buoyancy that could affect the geomagnetic field significantly. Solid metal introduced to Earth's center before it reached saturation could also provide a nucleation substrate, if large enough to escape complete dissolution. Inner core growth, in this case, could begin earlier and start more slowly than standard thermal models predict.

Tracking the Effect of Adatom Electronegativity on Systematically Modified AlGaN/GaN Schottky Interfaces.

PubMed

Reiner, Maria; Pietschnig, Rudolf; Ostermaier, Clemens

2015-10-21

The influence of surface modifications on the Schottky barrier height for gallium nitride semiconductor devices is frequently underestimated or neglected in investigations thereof. We show that a strong dependency of Schottky barrier heights for nickel/aluminum-gallium nitride (0001) contacts on the surface terminations exists: a linear correlation of increasing barrier height with increasing electronegativity of superficial adatoms is observed. The negatively charged adatoms compete with the present nitrogen over the available gallium (or aluminum) orbital to form an electrically improved surface termination. The resulting modification of the surface dipoles and hence polarization of the surface termination causes observed band bending. Our findings suggest that the greatest Schottky barrier heights are achieved by increasing the concentration of the most polarized fluorine-gallium (-aluminum) bonds at the surface. An increase in barrier height from 0.7 to 1.1 eV after a 15% fluorine termination is obtained with ideality factors of 1.10 ± 0.05. The presence of surface dipoles that are changing the surface energy is proven by the sessile drop method as the electronegativity difference and polarization influences the contact angle. The extracted decrease in the Lifshitz-van-der-Waals component from 48.8 to 40.4 mJ/m(2) with increasing electronegativity and concentration of surface adatoms confirms the presence of increasing surface dipoles: as the polarizability of equally charged anions decreases with increasing electronegativity, the diiodomethane contact angles increase significantly from 14° up to 39° after the 15% fluorine termination. Therefore, a linear correlation between increasing anion electronegativity of the (Al)GaN termination and total surface energy within a 95% confidence interval is obtained. Furthermore, our results reveal a generally strong Lewis basicity of (Al)GaN surfaces explaining the high chemical inertness of the surfaces.

Barriers and Opportunities to Broader Adoption of Integrated Demand Side Management at Electric Utilities: A Scoping Study

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

Potter, Jennifer; Stuart, Elizabeth; Cappers, P

Integrated demand-side management (IDSM) is a strategic approach to designing and delivering a portfolio of demand side management (DSM) programs to customers. IDSM typically delivers customer centric strategies with the goal of increasing the amount of DSM in the field, but doing so in a way that integrates various measures and technologies to improve their collective performance and/or penetration. Specifically, IDSM can be defined as the integrated or coordinated delivery of three or more of: (1) energy efficiency (EE), (2) demand response (DR), (3) distributed generation (DG), (4) storage, (5) electric vehicle (EV) technologies, and (6) time-based rate programs tomore » residential and commercial electric utility customers. The electric industry’s limited experience deploying IDSM to date suggests that significant barriers may exist. A Berkeley Lab report “Barriers and Opportunities to Broader Adoption of Integrated Demand Side Management at Electric Utilities: A Scoping Study” explores recent electric utility experience with IDSM to provide an assessment of the barriers and potential benefits perceived or experienced by program administrators in their attempts to implement integrated programs. The research draws on surveys and interviews with eleven staff from a sample of eight DSM program administrators and program implementers who were currently implementing or had previously attempted to implement an IDSM program or initiative. Respondents provided their perspectives on drivers for IDSM and barriers to broader deployment. They also reported on actions they had undertaken to promote expanded delivery of IDSM and provided their assessments of the most important under-tapped opportunities for expanding IDSM efforts, both for program administrator and regulatory organizations.« less

Barriers to Research and Capacity Building at Hispanic-Serving Institutions: The Case of HIV/AIDS Research at the University of Puerto Rico

PubMed Central

Ortiz-Torres, Blanca

2009-01-01

Substantive barriers to research, such as cultural, language, and methodological variables, exist in Hispanic-serving institutions. Historical and contextual variables account for the differences between academic settings with research-intensive centers and those with limited infrastructure for competitive research. We provide a case example to serve as a model for developing and strengthening the research infrastructure in Hispanic-serving institutions and for providing the mentorship Latino investigators may need to compete with other investigators in research-intensive centers. We present recommendations to reduce these barriers. PMID:19246676

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.

Monolayer borophene electrode for effective elimination of both the Schottky barrier and strong electric field effect

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

Liu, L. Z., E-mail: lzliu@nju.edu.cn, E-mail: hkxlwu@nju.edu.cn; Xiong, S. J.; Wu, X. L., E-mail: lzliu@nju.edu.cn, E-mail: hkxlwu@nju.edu.cn

2016-08-08

The formation of Schottky barriers between 2D semiconductors and traditional metallic electrodes has greatly limited the application of 2D semiconductors in nanoelectronic and optoelectronic devices. In this study, metallic borophene was used as a substitute for the traditional noble metal electrode to contact with the 2D semiconductor. Theoretical calculations demonstrated that no Schottky barrier exists in the borophene/2D semiconductor heterostructure. The contact remains ohmic even with a strong electric field applied. This finding provides a way to construct 2D electronic devices and sensors with greatly enhanced performance.

Workplace discrimination: experiences of practicing physicians.

PubMed Central

Coombs, Alice A. Tolbert; King, Roderick K.

2005-01-01

BACKGROUND: In response to a growing concern regarding physician discrimination in the workplace, this study was developed to: (1) describe the types of discrimination that exist for the practicing physician and (2) determine which groups of physicians are more likely to experience the various forms of discrimination. METHODS: Surveys were mailed to 1930 practicing physicians in Massachusetts. Participants were asked if they had encountered discrimination, how significant the discrimination was against a specific group, the frequency of personal discrimination, and the type of discrimination. Factor analysis identified four types of discrimination: career advancement, punitive behaviors, practice barriers and hiring barriers. RESULTS: A total of 445 responses were received (a 24% response rate). Sixty-three percent of responding physicians had experienced some form of discrimination. Respondents were women (46%), racial/ethnic minorities (42%) and international medical graduates (IMGs) (40%). In addition, 26% of those classified as white were also IMGs. Over 60% of respondents believed discrimination against IMGs was very or somewhat significant. Almost 27% of males acknowledged that gender bias against females was very or somewhat significant. IMGs were more likely to indicate that discrimination against IMGs was significant in their current organization. Of U.S. medical graduates (USMGs) 44% reported that discrimination against IMGs in their current organization was significant. Nonwhites were more likely to report that discrimination based on race/ethnicity was significant. Nearly 29% of white respondents also believed that such discrimination was very or somewhat significant. CONCLUSIONS: Physicians practicing in academic, research, and private practice sectors experience discrimination based on gender, ethnic/racial, and IMG status. Images Figure 3 Figure 4 Figure 5 PMID:15868767

Skin Barrier and Calcium.

PubMed

Lee, Sang Eun; Lee, Seung Hun

2018-06-01

Epidermal barrier formation and the maintenance of barrier homeostasis are essential to protect us from the external environments and organisms. Moreover, impaired keratinocytes differentiation and dysfunctional skin barrier can be the primary causes or aggravating factors for many inflammatory skin diseases including atopic dermatitis and psoriasis. Therefore, understanding the regulation mechanisms of keratinocytes differentiation and skin barrier homeostasis is important to understand many skin diseases and establish an effective treatment strategy. Calcium ions (Ca 2+ ) and their concentration gradient in the epidermis are essential in regulating many skin functions, including keratinocyte differentiation, skin barrier formation, and permeability barrier homeostasis. Recent studies have suggested that the intracellular Ca 2+ stores such as the endoplasmic reticulum (ER) are the major components that form the epidermal calcium gradient and the ER calcium homeostasis is crucial for regulating keratinocytes differentiation, intercellular junction formation, antimicrobial barrier, and permeability barrier homeostasis. Thus, both Ca 2+ release from intracellular stores, such as the ER and Ca 2+ influx mechanisms are important in skin barrier. In addition, growing evidences identified the functional existence and the role of many types of calcium channels which mediate calcium flux in keratinocytes. In this review, the origin of epidermal calcium gradient and their role in the formation and regulation of skin barrier are focused. We also focus on the role of ER calcium homeostasis in skin barrier. Furthermore, the distribution and role of epidermal calcium channels, including transient receptor potential channels, store-operated calcium entry channel Orai1, and voltage-gated calcium channels in skin barrier are discussed.

Impact of radio-frequency identification (RFID) technologies on the hospital supply chain: a literature review.

PubMed

Coustasse, Alberto; Tomblin, Shane; Slack, Chelsea

2013-01-01

Supply costs account for more than one-third of the average operating budget and constitute the second largest expenditure in hospitals. As hospitals have sought to reduce these costs, radio-frequency identification (RFID) technology has emerged as a solution. This study reviews existing literature to gauge the recent and potential impact and direction of the implementation of RFID in the hospital supply chain to determine current benefits and barriers of adoption. Findings show that the application of RFID to medical equipment and supplies tracking has resulted in efficiency increases in hospitals with lower costs and increased service quality. RFID technology can reduce costs, improve patient safety, and improve supply chain management effectiveness by increasing the ability to track and locate equipment, as well as monitoring theft prevention, distribution management, and patient billing. Despite ongoing RFID implementation in the hospital supply chain, barriers to widespread and rapid adoption include significant total expenditures, unclear return on investment, and competition with other strategic imperatives.

Changing the culture of medical training: An important step toward the implementation of competency-based medical education.

PubMed

Ferguson, Peter C; Caverzagie, Kelly J; Nousiainen, Markku T; Snell, Linda

2017-06-01

The current medical education system is steeped in tradition and has been shaped by many long-held beliefs and convictions about the essential components of training. The objective of this article is to propose initiatives to overcome biases against competency-based medical education (CBME) in the culture of medical education. At a retreat of the International Competency Based Medical Education (ICBME) Collaborators group, an intensive brainstorming session was held to determine potential barriers to adoption of CBME in the culture of medical education. This was supplemented with a review of the literature on the topic. There continues to exist significant key barriers to the widespread adoption of CBME. Change in educational culture must be embraced by all components of the medical education hierarchy. Research is essential to provide convincing evidence of the benefit of CBME. The widespread adoption of CBME will require a change in the professional, institutional, and organizational culture surrounding the training of medical professionals.

Improving adolescent knowledge of emergency contraception: challenges and solutions

PubMed Central

Seetharaman, Sujatha; Yen, Sophia; Ammerman, Seth D

2016-01-01

Globally, unintended adolescent pregnancies pose a significant burden. One of the most important tools that can help prevent unintended pregnancy is the timely use of emergency contraception (EC), which in turn will decrease the need for abortions and complications related to adolescent pregnancies. Indications for the use of EC include unprotected sexual intercourse, contraceptive failure, or sexual assault. Use of EC is recommended within 120 hours, though is most effective if used as soon as possible after unprotected sex. To use EC, adolescents need to be equipped with knowledge about the various EC methods, and how and where EC can be accessed. Great variability in the knowledge and use of EC around the world exists, which is a major barrier to its use. The aims of this paper were to 1) provide a brief overview of EC, 2) discuss key social determinants affecting knowledge and use of EC, and 3) explore best practices for overcoming the barriers of lack of knowledge, use, and access of EC. PMID:29386948

Rice Research to Break Yield Barriers

NASA Astrophysics Data System (ADS)

Verma, Vivek; Ramamoorthy, Rengasamy; Kohli, Ajay; Kumar, Prakash P.

2015-10-01

The world’s population continues to expand and it is expected to cross 9 billion by 2050. This would significantly amplify the demand for food, which will pose serious threats to global food security. Additional challenges are being imposed due to a gradual decrease in the total arable land and global environmental changes. Hence, it is of utmost importance to review and revise the existing food production strategies by incorporating novel biotechnological approaches that can help to break the crop yield barriers in the near future. In this review, we highlight some of the concerns hampering crop yield enhancements. The review also focuses on modern breeding techniques based on genomics as well as proven biotechnological approaches that enable identification and utilization of candidate genes. Another aspect of discussion is the important area of research, namely hormonal regulation of plant development, which is likely to yield valuable regulatory genes for such crop improvement efforts in the future. These strategies can serve as potential tools for developing elite crop varieties for feeding the growing billions.

Thermodynamic analysis of membrane fouling in a submerged membrane bioreactor and its implications.

PubMed

Hong, Huachang; Peng, Wei; Zhang, Meijia; Chen, Jianrong; He, Yiming; Wang, Fangyuan; Weng, Xuexiang; Yu, Haiying; Lin, Hongjun

2013-10-01

The thermodynamic interactions between membrane and sludge flocs in a submerged membrane bioreactor (MBR) were investigated. It was found that Lewis acid-base (AB) interaction predominated in the total interactions. The interaction energy composition of membrane-sludge flocs combination was quite similar to that of membrane-bovine serum albumin (BSA) combination, indicating the critical role of proteins in adhesion process. Detailed analysis revealed the existence of a repulsive energy barrier in membrane-foulants interaction. Calculation results demonstrated that small flocs possessed higher attractive interaction energy per unit mass, and therefore adhered to membrane surface more easily as compared to large flocs. Meanwhile, initial sludge adhesion would facilitate the following adhesion due to the reduced repulsive energy barrier. Membrane with high electron donor surface tension component was a favor option for membrane fouling abatement. These findings offered new insights into membrane fouling, and also provided significant implications for fouling control in MBRs. Copyright © 2013 Elsevier Ltd. All rights reserved.

Impact of Radio-Frequency Identification (RFID) Technologies on the Hospital Supply Chain: A Literature Review

PubMed Central

Coustasse, Alberto; Tomblin, Shane; Slack, Chelsea

2013-01-01

Supply costs account for more than one-third of the average operating budget and constitute the second largest expenditure in hospitals. As hospitals have sought to reduce these costs, radio-frequency identification (RFID) technology has emerged as a solution. This study reviews existing literature to gauge the recent and potential impact and direction of the implementation of RFID in the hospital supply chain to determine current benefits and barriers of adoption. Findings show that the application of RFID to medical equipment and supplies tracking has resulted in efficiency increases in hospitals with lower costs and increased service quality. RFID technology can reduce costs, improve patient safety, and improve supply chain management effectiveness by increasing the ability to track and locate equipment, as well as monitoring theft prevention, distribution management, and patient billing. Despite ongoing RFID implementation in the hospital supply chain, barriers to widespread and rapid adoption include significant total expenditures, unclear return on investment, and competition with other strategic imperatives. PMID:24159272

Housing accessibility for senior citizens in Sweden: Estimation of the effects of targeted elimination of environmental barriers.

PubMed

Pettersson, Cecilia; Slaug, Björn; Granbom, Marianne; Kylberg, Marianne; Iwarsson, Susanne

2017-01-24

To estimate the effects of targeted elimination of environmental barriers (EB) in the ordinary housing stock in Sweden, and to explore the estimated effects on accessibility at a population level in relation to (a) residents with different functional profiles, (b) different housing types and (c) building periods. Data on dwellings from existing Swedish research databases were utilized. EB and accessibility were assessed by means of the Housing Enabler instrument. In simulations of EB removal, five items that correspond to the most common housing adaptations were selected. The simulations were applied to four functional profiles of different complexity. EB known to be commonly removed by housing adaptations exist in large proportions of the existing ordinary housing stock. Estimated targeted elimination of selected barriers would have the largest accessibility effects for the more complex functional profiles. The effects would be consistently larger for one-family houses, and for all types of dwellings built before 1960. The elimination of the EB most commonly addressed by housing adaptations could result in a reduction of the housing accessibility problems that community-living older people are facing. For society to solve the housing situation for the ageing population well-informed and efficient upgrading of ordinary housing is imperative.

Evaluation of effect of different disposable infection control barriers on light intensity of light-curing unit and microhardness of composite - An in vitro study.

PubMed

Khode, Rajiv Tarachand; Shenoi, Pratima Ramakrishna; Kubde, Rajesh R; Makade, Chetana S; Wadekar, Kanchan D; Khode, Priyanka Tarachand

2017-01-01

This study evaluated effect of infection control barriers on light intensity (LI) of light-curing unit (LCU) and microhardness of composite. Four different disposable barriers ( n = 30) were tested against the control. LI for each barrier was measured with Lux meter. One hundred and fifty Teflon molds were equally divided into five groups of thirty each. Composite was filled in bulk in these molds and cured without and with barrier. Microhardness was evaluated on top and bottom surface of composite specimen with microhardness testing machine and hardness ratio (HR) was derived. One-way analysis of variance, Tukey's honestly significant difference test, and paired t -test using SPSS version 18 software. All barriers had significantly reduced the baseline LI of LCU ( P < 0.0001), but only Cure Elastic Steri-Shield and latex cut glove pieces (LCGP) significantly reduced the microhardness of the composite ( P < 0.05). However, HR determined inadequate curing only with LCGP. Although entire tested barrier significantly reduced the LI; none, except LCGP markedly affected the degree of cure of the composite.

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

PubMed

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

2017-08-01

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

Explaining the apparent impenetrable barrier to ultra-relativistic electrons in the outer Van Allen belt.

PubMed

Ozeke, Louis G; Mann, Ian R; Murphy, Kyle R; Degeling, Alex W; Claudepierre, Seth G; Spence, Harlan E

2018-05-10

Recent observations have shown the existence of an apparent impenetrable barrier at the inner edge of the ultra-relativistic outer electron radiation belt. This apparent impenetrable barrier has not been explained. However, recent studies have suggested that fast loss, such as associated with scattering into the atmosphere from man-made very-low frequency transmissions, is required to limit the Earthward extent of the belt. Here we show that the steep flux gradient at the implied barrier location is instead explained as a natural consequence of ultra-low frequency wave radial diffusion. Contrary to earlier claims, sharp boundaries in fast loss processes at the barrier are not needed. Moreover, we show that penetration to the barrier can occur on the timescale of days rather than years as previously reported, with the Earthward extent of the belt being limited by the finite duration of strong solar wind driving, which can encompass only a single geomagnetic storm.

Schottky-type grain boundaries in CCTO ceramics

NASA Astrophysics Data System (ADS)

Felix, A. A.; Orlandi, M. O.; Varela, J. A.

2011-10-01

In this work we studied electrical barriers existing at CaCu 3Ti 4O 12 (CCTO) ceramics using dc electrical measurements. CCTO pellets were produced by solid state reaction method and X-ray diffractograms showed which single phase polycrystalline samples were obtained. The samples were electrically characterized by dc and ac measurements as a function of temperature, and semiconductor theory was applied to analyze the barrier at grain boundaries. The ac results showed the sample's permittivity is almost constant ( 104) as function of temperature at low frequencies and it changes from 100 to 104 as the temperature increases at high frequencies. Using dc measurements as a function of temperature, the behavior of barriers was studied in detail. Comparison between Schottky and Poole-Frenkel models was performed, and results prove that CCTO barriers are more influenced by temperature than by electric field (Schottky barriers). Besides, the behavior of barrier width as function of temperature was also studied and experimental results confirm the theoretical assumptions.

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

The potential oral health impact of cost barriers to dental care: findings from a Canadian population-based study

PubMed Central

2014-01-01

Background Prior to the 2007/09 Canadian Health Measures Survey, there was no nationally representative clinical data on the oral health of Canadians experiencing cost barriers to dental care. The aim of this study was to determine the oral health status and dental treatment needs of Canadians reporting cost barriers to dental care. Methods A secondary data analysis of the 2007/09 Canadian Health Measures Survey was undertaken using a sample of 5,586 Canadians aged 6 to 79. Chi square tests were conducted to test the association between reporting cost barriers to care and oral health outcomes. Logistic regressions were conducted to identify predictors of reporting cost barriers. Results Individuals who reported cost barriers to dental care had poorer oral health and more treatment needs compared to their counterparts. Conclusions Avoiding dental care and/or foregoing recommended treatment because of cost may contribute to poor oral health. This study substantiates the potential likelihood of progressive dental problems caused by an inability to treat existing conditions due to financial barriers. PMID:24962622

Barriers to Diagnosis and Treatment of Depression: Voices from a Rural African-American Faith Community

PubMed Central

Bryant, Keneshia; Greer-Williams, Nancy; Willis, Nathaniel; Hartwig, Mary

2014-01-01

Mental health disparities exist for rural African-Americans regarding the early detection of depression and its effective treatment. Disparities that are evident in rural communities include limited mental health resources and the stigma of depression. The faith community has a long-standing history of being the initial source of help to those who experience depression. The purpose of this qualitative study was to examine how rural African-American faith communities view the barriers to diagnosis and treatment of depression. A convenience sample of 24 persons (N = 24) participated in focus groups and interviews. Four internal barriers were identified: personal business, “mind-set,” “denial,” and “put on a front.” Additionally, four external barriers were identified: “spiritual beliefs,” “lack of medical resources,” “lack of education about depression,” and “stigma.” The identified barriers supported the results from previous studies, but they also highlighted other less acknowledged barriers. In conclusion, interventions are needed to overcome these barriers in order to eliminate the depression disparities experienced by this population. PMID:24218871

Evaluation of the Condom Barriers Scale for Young Black Men Who Have Sex With Men: Reliability and Validity of 3 Subscales.

PubMed

Crosby, Richard A; Sanders, Stephanie A; Graham, Cynthia A; Milhausen, Robin; Yarber, William L; Mena, Leandro

2017-02-01

Reliable and valid scale measures of barriers to condom use are not available for young black men who have sex with men (YBMSM). The purpose of this study was to evaluate the Condom Barriers Scales for application with YBMSM. A clinic-based sample of 600 YBMSM completed a computer-assisted self-interview. The primary measure was a 14-item abbreviated version of the Condom Barriers Scale. Reliability and criterion validity were assessed. All 3 subscales were reliable: partner-related barriers (Cronbach α=0.73), sensation-related barriers (α=0.70), and motivation-related barriers (α =0.81). A complete absence of barriers was common: 47.0% (partner-related), 30.7% (sensation-related), and 46.5% (motivation-related). Dichotomized subscales were significantly associated with reporting any condomless insertive anal sex (all Ps < 0.001) and any condomless receptive anal sex (all Ps < 0.001). The subscales were significantly associated with these measures of condomless sex preserved at a continuous level (all Ps <0.001, except for sensation barriers associated with condomless receptive anal sex = 0.03). Further, the subscales were significantly associated with reporting any condom use problems (all Ps <0.001) and a measure of condomless oral sex (all Ps <0.001, except for partner-related barriers=0.31). Finally, the sensation-related barriers subscale was significantly associated with testing positive for Chlamydia and/or gonorrhea (P=0.049). The 3 identified subscales yielded adequate reliability and strong evidence of validity, thereby suggesting the utility of these brief measures for use in observational and experimental research with YBMSM.

Evaluation of the Condom Barriers Scale for Young Black MSM: Reliability and Validity of Three Sub-Scales

PubMed Central

Crosby, Richard; Sanders, Stephanie A.; Graham, Cynthia A.; Milhausen, Robin; Yarber, William L.; Mena, Leandro

2016-01-01

Background Reliable and valid scale measures of barriers to condom use are not available for young Black MSM (YBMSM). The purpose of this study was to evaluate the Condom Barriers Scales for application with YBMSM. Methods A clinic-based sample of 600 YBMSM completed a computer-assisted self-interview. The primary measure was a 14-item abbreviated version of the Condom Barriers Scale. Reliability and criterion validity were assessed. Results All three sub-scales were reliable: partner-related barriers (Cronbach’s alpha=.73), sensation-related barriers (alpha=.70), and motivation-related barriers (alpha=.81). A complete absence of barriers was common: 47.0% (partner-related), 30.7% (sensation-related), and 46.5% (motivation-related). Dichotomized sub-scales were significantly associated with reporting any condomless insertive anal sex (all=P < .001) and any condomless receptive anal sex (all=P < .001). The sub-scales were significantly associated with these measures of condomless sex preserved at a continuous level (all=P <.001, except for sensation barriers associated with condomless receptive anal sex =.03). Further, the sub-scales were significantly associated with reporting any condom use problems (all =P <.001) and a measure of condomless oral sex (all =P <.001, except for partner-related barriers =.31). Finally, the sensation-related barriers sub-scale was significantly associated with testing positive for Chlamydia and/or gonorrhea (P=.049). Conclusions The three identified sub-scales yielded adequate reliability and strong evidence of validity, thereby suggesting the utility of these brief measures for use in observational and experimental research with YBMSM. PMID:28081044

Patient engagement and patient-centred care in the management of advanced chronic kidney disease and chronic kidney failure.

PubMed

Bear, Robert Allan; Stockie, Suzanne

2014-01-01

The purpose of this article is to review the current status of patient-centred care (PCC) and patient engagement (PE) in the management of patients with advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD), to identify some of the barriers that exist to the achievement of PCC and PE, and to describe how these barriers can be overcome. The review is based on the professional experience of one of the authors (RB) as a Nephrologist and health care consultant, on the MBA thesis of one of the authors (SS) and on a review of pertinent internet-based information and published literature. Evidence exists that, currently, the care of patients with advanced CKD and ESRD is not fully patient-centred or fully supportive of PE. A number of barriers exist, including: conflict with other priorities; lack of training and fear of change; the unequal balance of power between patients and providers; physician culture and behaviour; the fee-for-service model of physician compensation; slow implementation of electronic health records; and, fear of accountability. These barriers can be overcome by committed leadership and the development of an information-based implementation plan. Established Renal Agencies in Canada appear interested in facilitating this work by collaborating in the development of a toolkit of recommended educational resources and preferred implementation practices for use by ESRD Programs. A limitation of this review is the absence of a substantial pre-existing literature on this topic. Receiving care that is patient-centred and that promotes PE benefits patients with serious chronic diseases such as advanced CKD and ESRD. Considerable work is required by ESRD Programs to ensure that such care is provided. Canadian Renal Agencies can play an important role by ensuring that ESRD Programs have access to essential educational material and proven implementation approaches and that implementation successes are celebrated. In this area, enabling policies are required, as are clinical research studies focusing on the measurement of outcomes.

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

PubMed

Lee, Hee Yun; Vang, Suzanne

2010-06-01

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

Systematic barriers to the effective delivery of home dialysis in the United States: a report from the Public Policy/Advocacy Committee of the North American Chapter of the International Society for Peritoneal Dialysis.

PubMed

Golper, Thomas A; Saxena, Anjali B; Piraino, Beth; Teitelbaum, Isaac; Burkart, John; Finkelstein, Fredric O; Abu-Alfa, Ali

2011-12-01

Home dialysis, currently underused in the United States compared with other industrialized countries, likely will benefit from the newly implemented US prospective payment system. Not only is home dialysis less expensive from the standpoint of pure dialysis costs, but overall health system costs may be decreased by more subtle benefits, such as reduced transportation. However, many systematic barriers exist to the successful delivery of home dialysis. We organized these barriers into the categories of educational barriers (patient and providers), governmental/regulatory barriers (state and federal), and barriers specifically related to the philosophies and business practices of dialysis providers (eg, staffing, pharmacies, supplies, space, continuous quality improvement practices, and independence). All stakeholders share the goal of delivering home dialysis therapies in the most cost- and clinically effective and least problematic manner. Identification and recognition of such barriers is the first step. In addition, we have suggested action plans to stimulate the kidney community to find even better solutions so that collectively we may overcome these barriers. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Molecular weight dependence of permselectivity to rat small intestinal blood-lymph barrier for exogenous macromolecules absorbed from lumen.

PubMed

Yoshikawa, H; Takada, K; Muranishi, S

1984-01-01

The permselectivity to the small intestinal blood-lymph barrier for the exogenous macromolecules absorbed from the lumen was investigated using in situ rat closed loop experiment. We chose the fluorescein isothiocyanate-labelled dextran (FD) as macromolecule and lipid-surfactant mixed micelles as an absorption promoter. The mean molecular weights of FDs used were 10500, 17500, 39000 and 64200 (abbreviated: FD10 , 20, 40 and 70). The lymph/plasma ratios of FDs concentrations during 5 h post administration were 0.2-1.2 ( FD10 ), 0.4-1.3 ( FD20 ), 1.3-7.2 ( FD40 ) and 2.6-11.9 ( FD70 ), respectively. The FD40 and FD70 levels in the lymph were significantly higher than those in the plasma. The cumulative amounts (% of the absorbed quantity) of FDs in the lymph from the lumen of the small intestine for 5 h after administration were 0.46% ( FD10 ), 0.51% ( FD20 ), 1.17% ( FD40 ) and 1.89% ( FD70 ), respectively. These findings suggest that the threshold molecular weight of FD for the transfer into the lymphatics with higher level compared to the blood concentration from the lumen across the small intestinal blood-lymph barrier exists between 17500 and 39000.

Education in Engineering and Ecohydrology for Fish Passage

NASA Astrophysics Data System (ADS)

Ahlfeld, D.; Towler, B.

2011-12-01

Historical fish migration routes linking feeding and spawning habitats have been significantly impacted by culverts, dikes, dams, and other barriers on waterways throughout the world. For example an estimated 2.5 million barriers to fish migration exist in the United States. In recent years, there has been an increased focus on removing or mitigating these barriers as an efficient mechanism to restore habitat. Effective design and implementation of these measures requires specialists with skills at the intersection of engineering, hydrology and biology. Recognizing the need for a cadre of engineers with the additional skills in hydraulics and ecohydrology needed to analyze and design solutions for enhancing fish passage in streams and rivers, the University of Massachusetts Amherst now offers a Master of Science in Civil Engineering (MSCE) degree with a specialization in Fish Passage Engineering. The curriculum is offered in conjunction with the U.S. Fish and Wildlife Service and is informed by the recommendations of the Curriculum Working Group of the Bioengineering Section of the American Fisheries Society. The curriculum is offered through the Department of Civil and Environmental Engineering. This presentation will describe the motivation for the degree, the content of coursework and the challenges inherent in developing an interdisciplinary education program spanning biogeosciences and engineering.

Self-stabilized discharge filament in plane-parallel barrier discharge configuration: formation, breakdown mechanism, and memory effects

NASA Astrophysics Data System (ADS)

Tschiersch, R.; Nemschokmichal, S.; Bogaczyk, M.; Meichsner, J.

2017-10-01

Single self-stabilized discharge filaments were investigated in the plane-parallel electrode configuration. The barrier discharge was operated inside a gap of 3 mm shielded by glass plates to both electrodes, using helium-nitrogen mixtures and a square-wave feeding voltage at a frequency of 2 kHz. The combined application of electrical measurements, ICCD camera imaging, optical emission spectroscopy and surface charge diagnostics via the electro-optic Pockels effect allowed the correlation of the discharge development in the volume and on the dielectric surfaces. The formation criteria and existence regimes were found by systematic variation of the nitrogen admixture to helium, the total pressure and the feeding voltage amplitude. Single self-stabilized discharge filaments can be operated over a wide parameter range, foremost, by significant reduction of the voltage amplitude after the operation in the microdischarge regime. Here, the outstanding importance of the surface charge memory effect on the long-term stability was pointed out by the recalculated spatio-temporally resolved gap voltage. The optical emission revealed discharge characteristics that are partially reminiscent of both the glow-like barrier discharge and the microdischarge regime, such as a Townsend pre-phase, a fast cathode-directed ionization front during the breakdown and radially propagating surface discharges during the afterglow.

A narrative review of mental health support for people during transition from incarceration to community: the grass can be greener on the other side of the fence.

PubMed

Smith-Merry, Jennifer; Mellifont, Damian; McKenzie, Kirsty; Clenaghan, Paul

2018-04-28

Despite significant need for mental health services targeting the requirements of inmates transitioning into the community there is little research about successful recovery-oriented or person-centred transition programs. This systematic narrative review brings together existing evidence to inform policymakers and practitioners about current practice in transition support, and barriers and facilitators of effective practice. We carried out a systematic narrative review of recovery-oriented or person-centred mental health support programs supporting transition from incarceration to the community. Results were obtained from a systematic search of Medline, PubMed and Scopus databases. We found 23 papers which met the paper inclusion criteria along with four other papers which were identified incidentally. Identified barriers to the implementation of effective transition support programs are: administrative problems leading to ineffective in-reach into correctional facilities or untimely support, lack of support for immediate needs meaning that inmates deprioritise their mental health needs, a lack of ongoing program resources and poor communication between correctional facilities and mental health services. Enablers for transition reflect the inverse of these barriers, alongside other successful strategies including medical home models, regionalised programs, programs which target connections with primary care, nurse-led patient-centred health programs and peer support initiatives.

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

PubMed

Marrocco, Anna; Krouse, Helene J

2017-05-01

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

HIV epidemic and human rights among men who have sex with men in sub-Saharan Africa: Implications for HIV prevention, care, and surveillance.

PubMed

Abara, Winston E; Garba, Ibrahim

2017-04-01

Recent research has presented evidence that men who have sex with men (MSM) bear a disproportionate burden of HIV and are at increased risk for HIV in sub-Saharan Africa (SSA). However, many countries in SSA have failed to address the needs of MSM in national HIV/AIDS programmes. Furthermore, many MSM face structural barriers to HIV prevention and care, the most significant of which include laws that criminalise male-to-male sexual contact and facilitate stigma and discrimination. This in turn increases the vulnerability of MSM to acquiring HIV and presents barriers to HIV prevention, care, and surveillance. This relationship illustrates the link between human rights, social justice, and health outcomes and presents considerable challenges to addressing the HIV epidemic among MSM in SSA. The response to the HIV epidemic in SSA requires a non-discriminatory human rights approach to all at-risk groups, including MSM. Existing international human rights treaties, to which many SSA countries are signatories, and a 'health in all policies' approach provides a strong basis to reduce structural barriers to HIV prevention, care, surveillance, and research, and to ensure that all populations in SSA, including MSM, have access to the full range of rights that help ensure equal opportunities for health and wellness.

Motivators and barriers to HIV testing among street-based female sex workers in St. Petersburg, Russia.

PubMed

King, Elizabeth J; Maman, Suzanne; Dudina, Victoria I; Moracco, Kathryn E; Bowling, J Michael

2017-07-01

Female sex workers are particularly susceptible to HIV-infection in Russia. However, a dearth of information exists on their utilisation of HIV services. A mixed-methods, cross-sectional study was conducted to examine motivators and barriers to HIV testing among street-based sex workers in St. Petersburg, Russia. The health belief model was the theoretical framework for the study. Twenty-nine sex workers participated in in-depth interviews, and 139 sex workers completed interviewer-administered surveys between February and September 2009. Barriers to getting an HIV test were fear of learning the results, worrying that other people would think they were sick, and the distance needed to travel to obtain services. Motivators for getting tested were protecting others from infection, wanting to know one's status and getting treatment if diagnosed. Logistic regression analysis demonstrated that knowing people living with HIV [aOR = 6.75, 95% CI (1.11, 41.10)] and length of time since start of injection drug use [aOR = 0.30, 95% CI (0.09, 0.97)] were significantly associated with recently getting tested. These results are important to consider when developing public health interventions to help female sex workers in Russia learn their HIV status and get linked to care and treatment services if needed.

Emergency Physician and Stroke Specialist Beliefs and Expectations Regarding Telestroke

PubMed Central

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

2010-01-01

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

Emergency physician and stroke specialist beliefs and expectations regarding telestroke.

PubMed

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

2010-04-01

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

Access to pain treatment as a human right

PubMed Central

2010-01-01

Background Almost five decades ago, governments around the world adopted the 1961 Single Convention on Narcotic Drugs which, in addition to addressing the control of illicit narcotics, obligated countries to work towards universal access to the narcotic drugs necessary to alleviate pain and suffering. Yet, despite the existence of inexpensive and effective pain relief medicines, tens of millions of people around the world continue to suffer from moderate to severe pain each year without treatment. Discussion Significant barriers to effective pain treatment include: the failure of many governments to put in place functioning drug supply systems; the failure to enact policies on pain treatment and palliative care; poor training of healthcare workers; the existence of unnecessarily restrictive drug control regulations and practices; fear among healthcare workers of legal sanctions for legitimate medical practice; and the inflated cost of pain treatment. These barriers can be understood not only as a failure to provide essential medicines and relieve suffering but also as human rights abuses. Summary According to international human rights law, countries have to provide pain treatment medications as part of their core obligations under the right to health; failure to take reasonable steps to ensure that people who suffer pain have access to adequate pain treatment may result in the violation of the obligation to protect against cruel, inhuman and degrading treatment. PMID:20089155

National survey of mentorship in Canadian general surgery residency programs: Where are we and what do we need?

PubMed Central

Delisle, Megan; Rivard, Justin; Hebbard, Pamela; McCarthy, Brendan; Wirtzfeld, Debrah

2017-01-01

Background The benefits of mentorship on residents are well established. The current state of mentorship in General Surgery (GS) residency programs in Canada is unknown. The objectives of this study were to obtain GS residents’ and program directors’ (PD) perspectives on resident mentorship. Study Design An electronic survey was developed and distributed to all 601 GS residents in Canada. All 17 PDs were invited for telephone interviews. Results A total of 179 of the 601 residents responded. Ninety-seven percent (n=173) felt mentorship was important. Only 67% (n=116) identified a mentor and only 53% (n=62) reported a mentorship program. Most who identified a mentor (n=87/110, 79%) were satisfied with the mentorship received. Significant variations in mentorship existed between demographic subgroups and mentorship program types. Overall, residents (n=121, 74%) favoured having a required mentorship program. A total of 11 out of 17 PDs participated in the telephone interviews. The majority of PDs (n=9, 82%) were satisfied with current resident mentorship but most acknowledged that barriers exist (n=8, 73%). Conclusion GS programs in Canada should ensure they are providing equal opportunities for mentorship across demographic subgroups. Programs are encouraged to examine both their program’s and their residents’ needs as well as local barriers to improve mentorship. PMID:29354196

Latino mothers' beliefs about child weight and family health.

PubMed

Martinez, Suzanna M; Rhee, Kyung E; Blanco, Estela; Boutelle, Kerri

2017-04-01

There is a need to address cultural beliefs and parenting practices regarding childhood obesity to design effective weight-control programmes for overweight/obese US Latino children. The purpose of the current study was to explore cultural beliefs about children's weight, understand parent perceptions on feeding their children, and explore barriers that interfere with a healthy lifestyle. Four focus groups were conducted in Spanish with forty-one Latino mothers of elementary school-age children from San Diego County, California between April and May 2011. Cultural viewpoints about overweight status among children and barriers to leading a healthy lifestyle were explored. Focus group discussions were analysed based on a priori and emergent themes. Three themes were identified: (i) mothers' cultural beliefs about health that are barriers to family health; (ii) mothers as primary caretakers of their family's health; and (iii) attitudes about targeting children's weight. Mothers acknowledged the idea that 'chubby is better' is a misperception, yet having a 'chubby' child was preferred and even accepted. Mothers described fatalistic beliefs that contradicted existing knowledge of chronic disease and daily demands of Western culture as barriers to practising healthy behaviours in the home as the family caretaker. These findings may be used to inform more culturally appropriate research to address US Latino health. Increasing awareness of cultural beliefs and daily circumstance could help to address obesity more directly and thereby overcome some of the potential underlying barriers that might exist when involving the Latino immigrant families in obesity treatment and prevention.

Motives for and barriers to physical activity in twin pairs discordant for leisure time physical activity for 30 years.

PubMed

Aaltonen, S; Leskinen, T; Morris, T; Alen, M; Kaprio, J; Liukkonen, J; Kujala, U

2012-02-01

Long-term persistent physical activity is important in the prevention of chronic diseases, but a large number of people do not participate in physical activity to obtain health benefits. The purpose of this study was to examine the motives and perceived barriers to long-term engagement in leisure time physical activity. Same-sex twin pairs (N=16, mean age 60) discordant for physical activity over 30 years were identified from the Finnish Twin Cohort. We evaluated participants' physical activity motivation with the 73-item Recreational Exercise Motivation Measure and assessed barriers to physical activity with a 25-item questionnaire. The characteristics of physical activity motivation and perceived barriers between the active and inactive co-twins were analysed using paired tests. Motives related to the sub-dimensions of enjoyment and physical fitness and psychological state were the most important reasons for participation in physical activity among all the twin individuals analysed. The sub-dimensions mastery (p=0.018, Cohen's d=0.76), physical fitness (p=0.029, Cohen's d=0.69), and psychological state (p=0.039, Cohen's d=0.65) differed significantly between active and inactive co-twins. More than half of the participants reported no reasons for not being physically active. If reasons existed, participation in physical activity was deterred mostly by pain and various health problems. This study found no differences in perceived barriers between active and inactive co-twins. We conclude from our results that the main factors promoting persistent leisure time physical activity were participants' wish to improve or maintain their physical skills or techniques, a feeling that exercise would improve their mental and physical health and that they found the activity enjoyable. This study helps us understand the importance of the role of motives and the minor role of perceived barriers for engagement in persistent physical activity. © Georg Thieme Verlag KG Stuttgart · New York.

HIV Risks, Testing, and Treatment in the Former Soviet Union: Challenges and Future Directions in Research and Methodology.

PubMed

Saadat, Victoria M

2015-01-01

The dissolution of the USSR resulted in independence for constituent republics but left them battling an unstable economic environment and healthcare. Increases in injection drug use, prostitution, and migration were all widespread responses to this transition and have contributed to the emergence of an HIV epidemic in the countries of former Soviet Union. Researchers have begun to identify the risks of HIV infection as well as the barriers to HIV testing and treatment in the former Soviet Union. Significant methodological challenges have arisen and need to be addressed. The objective of this review is to determine common threads in HIV research in the former Soviet Union and provide useful recommendations for future research studies. In this systematic review of the literature, Pubmed was searched for English-language studies using the key search terms "HIV", "AIDS", "human immunodeficiency virus", "acquired immune deficiency syndrome", "Central Asia", "Kazakhstan", "Kyrgyzstan", "Uzbekistan", "Tajikistan", "Turkmenistan", "Russia", "Ukraine", "Armenia", "Azerbaijan", and "Georgia". Studies were evaluated against eligibility criteria for inclusion. Thirty-nine studies were identified across the two main topic areas of HIV risk and barriers to testing and treatment, themes subsequently referred to as "risk" and "barriers". Study design was predominantly cross-sectional. The most frequently used sampling methods were peer-to-peer and non-probabilistic sampling. The most frequently reported risks were condom misuse, risky intercourse, and unsafe practices among injection drug users. Common barriers to testing included that testing was inconvenient, and that results would not remain confidential. Frequent barriers to treatment were based on a distrust in the treatment system. The findings of this review reveal methodological limitations that span the existing studies. Small sample size, cross-sectional design, and non-probabilistic sampling methods were frequently reported limitations. Future work is needed to examine barriers to testing and treatment as well as longitudinal studies on HIV risk over time in most-at-risk populations.

Overcoming Barriers in Access to High Quality Education after Matriculation: Promoting Strategies and Tactics for Engagement of Underrepresented Groups in Undergraduate Research via Institutional Diversity Action Plans

ERIC Educational Resources Information Center

Pierszalowski, Sophie; Vue, Rican; Bouwma-Gearhart, Jana

2018-01-01

Considerable work is still required to eliminate disparities in postsecondary STEM persistence and success across student groups. Engagement in faculty-mentored research has been employed as one strategy to promote personal, professional, and academic gains for undergraduate students, although barriers exist that make it more difficult for some to…

College Choice Interrupted or Facilitated: A Qualitative Case Study Examining How Social Class and Schools Structure Opportunity for Students in Urban High Schools

ERIC Educational Resources Information Center

Reavis, Tangela Blakely

2017-01-01

Although college enrollment rates have expanded over the last several decades, low-income students and students of color continue to face formidable barriers as they seek entry into higher education. While the existence of these barriers are often viewed as macro-level roadblocks that are largely systemic, much of the literature around access to…

Determination of the Rotational Barrier for Kinetically Stable Conformational Isomers via NMR and 2D TLC: An Introductory Organic Chemistry Experiment

ERIC Educational Resources Information Center

Rushton, Gregory T.; Burns, William G.; Lavin, Judi M.; Chong, Yong S.; Pellechia, Perry; Shimizu, Ken D.

2007-01-01

An experiment to determine the rotational barrier about a C[subscript aryl]-N[subscript imide] single bond that is suitable for first-semester organic chemistry students is presented. The investigation begins with the one-step synthesis of a N,N'-diaryl naphthalene diimide, which exists as two room temperature-stable atropisomers (syn and anti).…

Adoption of health information technologies by physicians for clinical practice: The Andalusian case.

PubMed

Villalba-Mora, Elena; Casas, Isabel; Lupiañez-Villanueva, Francisco; Maghiros, Ioannis

2015-07-01

We investigated the level of adoption of Health Information Technologies (HIT) services, and the factors that influence this, amongst specialised and primary care physicians; in Andalusia, Spain. We analysed the physicians' responses to an online survey. First, we performed a statistical descriptive analysis of the data; thereafter, a principal component analysis; and finally an order logit model to explain the effect of the use in the adoption and to analyse which are the existing barriers. The principal component analysis revealed three main uses of Health Information Technologies: Electronic Health Records (EHR), ePrescription and patient management and telemedicine services. Results from an ordered logit model showed that the frequency of use of HIT is associated with the physicians' perceived usefulness. Lack of financing appeared as a common barrier to the adoption of the three types of services. For ePrescription and patient management, the physician's lack of skills is still a barrier. In the case of telemedicine services, lack of security and lack of interest amongst professionals are the existing barriers. EHR functionalities are fully adopted, in terms of perceived usefulness. EPrescription and patient management are almost fully adopted, while telemedicine is in an early stage of adoption. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Examining the Benefits and Barriers of Instructional Gardening Programs to Increase Fruit and Vegetable Intake among Preschool-Age Children

PubMed Central

Davis, Kristen L.

2017-01-01

Research exists on using instructional gardening programs with school age children as a means of improving dietary quality and for obesity prevention. This article examines the potential use of instructional gardens in childcare settings to improving fruit and vegetable intake in young children. A qualitative study was conducted with childcare providers. Participants (n = 20) were recruited via e-mails, letters, and follow-up phone calls. Interviews were recorded, transcribed, and coded to identify themes within two areas (1) childcare providers perceptions of children's fruit and vegetable consumption and (2) components necessary to initiate or improve instructional gardening programs. Themes associated with provider's perceptions of child fruit and vegetable consumption included benefits of consumption, willingness to try fruits and vegetables, meeting recommendations, and influence of the home and childcare environments on child eating. Benefits, barriers, and resources needed were identified as themes related to starting or improving instructional gardening programs. Benefits to gardening with preschoolers are consistent with those found in school-age populations. While several barriers exist, resources are available to childcare providers to address these barriers. Increased knowledge and awareness of resources are necessary to improve the success of gardening programs in the childcare setting with the goal of improving child diet quality. PMID:28607563

Examining the Benefits and Barriers of Instructional Gardening Programs to Increase Fruit and Vegetable Intake among Preschool-Age Children.

PubMed

Davis, Kristen L; Brann, Lynn S

2017-01-01

Research exists on using instructional gardening programs with school age children as a means of improving dietary quality and for obesity prevention. This article examines the potential use of instructional gardens in childcare settings to improving fruit and vegetable intake in young children. A qualitative study was conducted with childcare providers. Participants ( n = 20) were recruited via e-mails, letters, and follow-up phone calls. Interviews were recorded, transcribed, and coded to identify themes within two areas (1) childcare providers perceptions of children's fruit and vegetable consumption and (2) components necessary to initiate or improve instructional gardening programs. Themes associated with provider's perceptions of child fruit and vegetable consumption included benefits of consumption, willingness to try fruits and vegetables, meeting recommendations, and influence of the home and childcare environments on child eating. Benefits, barriers, and resources needed were identified as themes related to starting or improving instructional gardening programs. Benefits to gardening with preschoolers are consistent with those found in school-age populations. While several barriers exist, resources are available to childcare providers to address these barriers. Increased knowledge and awareness of resources are necessary to improve the success of gardening programs in the childcare setting with the goal of improving child diet quality.

The Fire Effects Information System

Treesearch

William C. Fischer

1987-01-01

Lack of information regarding fire effects is perceived by many fire and resource managers as a barrier to the effective application of prescribed fire. This lack of information, in many instances, is the result of poor diffusion of existing knowledge rather than lack of knowledge. A computerized Fire Effects Information System can make existing fire effects knowledge...

Barriers and Facilitation Measures Related to People With Mental Disorders When Using the Web: A Systematic Review

PubMed Central

Sabariego, Carla; Cieza, Alarcos

2016-01-01

Background Mental disorders (MDs) affect almost 1 in 4 adults at some point during their lifetime, and coupled with substance use disorders are the fifth leading cause of disability adjusted life years worldwide. People with these disorders often use the Web as an informational resource, platform for convenient self-directed treatment, and a means for many other kinds of support. However, some features of the Web can potentially erect barriers for this group that limit their access to these benefits, and there is a lack of research looking into this eventuality. Therefore, it is important to identify gaps in knowledge about “what” barriers exist and “how” they could be addressed so that this knowledge can inform Web professionals who aim to ensure the Web is inclusive to this population. Objective The objective of this study was to provide an overview of existing evidence regarding the barriers people with mental disorders experience when using the Web and the facilitation measures used to address such barriers. Methods This study involved a systematic review of studies that have considered the difficulties people with mental disorders experience when using digital technologies. Digital technologies were included because knowledge about any barriers here would likely be also applicable to the Web. A synthesis was performed by categorizing data according to the 4 foundational principles of Web accessibility as proposed by the World Wide Web Consortium, which forms the necessary basis for anyone to gain adequate access to the Web. Facilitation measures recommended by studies were later summarized into a set of minimal recommendations. Results A total of 16 publications were included in this review, comprising 13 studies and 3 international guidelines. Findings suggest that people with mental disorders experience barriers that limit how they perceive, understand, and operate websites. Identified facilitation measures target these barriers in addition to ensuring that Web content can be reliably interpreted by a wide range of user applications. Conclusions People with mental disorders encounter barriers on the Web, and attempts have been made to remove or reduce these barriers. As forewarned by experts in the area, only a few studies investigating this issue were found. More rigorous research is needed to be exhaustive and to have a larger impact on improving the Web for people with mental disorders. PMID:27282115

Barriers and Facilitation Measures Related to People With Mental Disorders When Using the Web: A Systematic Review.

PubMed

Bernard, Renaldo; Sabariego, Carla; Cieza, Alarcos

2016-06-09

Mental disorders (MDs) affect almost 1 in 4 adults at some point during their lifetime, and coupled with substance use disorders are the fifth leading cause of disability adjusted life years worldwide. People with these disorders often use the Web as an informational resource, platform for convenient self-directed treatment, and a means for many other kinds of support. However, some features of the Web can potentially erect barriers for this group that limit their access to these benefits, and there is a lack of research looking into this eventuality. Therefore, it is important to identify gaps in knowledge about "what" barriers exist and "how" they could be addressed so that this knowledge can inform Web professionals who aim to ensure the Web is inclusive to this population. The objective of this study was to provide an overview of existing evidence regarding the barriers people with mental disorders experience when using the Web and the facilitation measures used to address such barriers. This study involved a systematic review of studies that have considered the difficulties people with mental disorders experience when using digital technologies. Digital technologies were included because knowledge about any barriers here would likely be also applicable to the Web. A synthesis was performed by categorizing data according to the 4 foundational principles of Web accessibility as proposed by the World Wide Web Consortium, which forms the necessary basis for anyone to gain adequate access to the Web. Facilitation measures recommended by studies were later summarized into a set of minimal recommendations. A total of 16 publications were included in this review, comprising 13 studies and 3 international guidelines. Findings suggest that people with mental disorders experience barriers that limit how they perceive, understand, and operate websites. Identified facilitation measures target these barriers in addition to ensuring that Web content can be reliably interpreted by a wide range of user applications. People with mental disorders encounter barriers on the Web, and attempts have been made to remove or reduce these barriers. As forewarned by experts in the area, only a few studies investigating this issue were found. More rigorous research is needed to be exhaustive and to have a larger impact on improving the Web for people with mental disorders.

The effects of using a moldable skin barrier on peristomal skin condition in persons with an ostomy: results of a prospective, observational, multinational study.

PubMed

Szewczyk, Maria Teresa; Majewska, Grazyna; Cabral, Mary V; Hölzel-Piontek, Karin

2014-12-01

Peristomal skin problems are the most commonly experienced physical complication following ostomy surgery and often are caused by leakage or a poorly fitting skin barrier. A prospective, multicenter, observational evaluation of persons with a colostomy, ileostomy, or urostomy was conducted to assess the incidence of peristomal lesions and level of patient satisfaction with moldable skin barriers. Peristomal skin was assessed using the Studio Alterazoni Cutanee Stomale (SACS™) scale, and patients were asked to rate barrier application and usage variables. During a period of 12 months, and using convenience sampling, 561 patients from 90 centers in 3 countries were enrolled: 28 in Germany, 48 in Poland, and 14 in the United States. Participants included 277 new stoma patients (average time since surgery 0.3 months; average age 64.7 ± 12.86 years) who had a colostomy (174), ileostomy (72), or urostomy (10); and 284 patients with an existing stoma (average time since surgery 18.2 months; average age 66 ± 12.62 years) who had a colostomy (174), ileostomy (88), or urostomy (22) who experienced skin complications using a traditional skin barrier (ie, a solid or flexible barrier with precut opening or one requiring cutting an opening to accommodate the stoma). All patients were assessed at baseline and after 1 and 2 months. In the patients with a new stoma, 225 (90.4%) had intact skin at baseline, 239 (95.6%) had intact skin after 2 months, and 98% rated overall satisfaction with the barrier as good or excellent. In the patients with an existing stoma, intact skin was observed in 103 patients (39.5%) at baseline and 225 (86.2%) after 2 months, with 96.5% of patients rating overall satisfaction with the barrier as good or excellent. In this group, the proportion of patients who used accessory products (eg, belt, deodorants, powder) was 73% at baseline and 64.2% at the 2-month follow-up. The moldable skin barriers evaluated were effective in preventing and healing peristomal skin complications and were rated as good or excellent by the vast majority of patients. Comparative studies are warranted to evaluate the efficacy and cost-effectiveness of this moldable skin barrier.

Influence of dislocation strain fields on the diffusion of interstitial iron impurities in silicon

NASA Astrophysics Data System (ADS)

Ziebarth, Benedikt; Mrovec, Matous; Elsässer, Christian; Gumbsch, Peter

2015-09-01

The efficiency of silicon (Si)-based solar cells is strongly affected by crystal defects and impurities. Metallic impurities, in particular interstitial iron (Fe) atoms, cause large electric losses because they act as recombination centers for photogenerated charge carriers. Here, we present a systematic first-principles density functional theory (DFT) study focusing on the influence of hydrostatic, uniaxial, and shear strains on the thermodynamic stability and the diffusivity of Fe impurities in crystalline Si. Our calculations show that the formation energy of neutral Fe interstitials in tetrahedral interstitial sites is almost unaffected by uniform deformations of the Si crystal up to strains of 5%. In contrast, the migration barrier varies significantly with strain, especially for hydrostatic deformation. In order to determine effective diffusion coefficients for different strain states, a kinetic Monte Carlo (kMC) model was set up based on the activation energy barriers and frequency factors obtained from the DFT simulations. By using the strain dependence of the migration barrier, we examined the migration of Fe interstitials in the vicinity of perfect 1 /2 <110 > screw and 60∘ mixed dislocations, and 1 /6 <112 > 90∘ and 30∘ partial dislocations. While the strain field of the perfect screw dislocation always enhances the local Fe diffusion, the existence of tensile and compressive regions around the 60∘ mixed dislocation results in a strong anisotropic diffusion profile with significantly faster and slower diffusivities on its tensile and compressive sides. The influences of the partial dislocations are qualitatively similar to that of the 60∘ mixed dislocation.

In Vitro Evaluation of the Impact of the Probiotic E. coli Nissle 1917 on Campylobacter jejuni's Invasion and Intracellular Survival in Human Colonic Cells.

PubMed

Helmy, Yosra A; Kassem, Issmat I; Kumar, Anand; Rajashekara, Gireesh

2017-01-01

Campylobacter jejuni is a leading cause of bacterial food poisoning in humans. Due to the rise in antibiotic-resistant Campylobacter , there exists a need to develop antibiotic-independent interventions to control infections in humans. Here, we evaluated the impact of Escherichia coli Nissle 1917 (EcN), a probiotic strain, on C. jejuni's invasion and intracellular survival in polarized human colonic cells (HT-29). To further understand how EcN mediates its impact, the expression of 84 genes associated with tight junctions and cell adhesion was profiled in HT-29 cells after treatment with EcN and challenge with C. jejuni . The pre-treatment of polarized HT-29 cells with EcN for 4 h showed a significant effect on C. jejuni 's invasion (∼2 log reduction) of the colonic cells. Furthermore, no intracellular C. jejuni were recovered from EcN pre-treated HT-29 cells at 24 h post-infection. Other probiotic strains tested had no significant impact on C. jejuni invasion and intracellular survival. C. jejuni decreased the expression of genes associated with epithelial cells permeability and barrier function in untreated HT-29 cells. However, EcN positively affected the expression of genes that are involved in enhanced intestinal barrier function, decreased cell permeability, and increased tight junction integrity. The results suggest that EcN impedes C. jejuni invasion and subsequent intracellular survival by affecting HT-29 cells barrier function and tight junction integrity. We conclude that EcN might be a viable alternative for controlling C. jejuni infections.

A framework for considering business models.

PubMed

Anderson, James G

2003-01-01

Information technology (IT) such as computerized physician order entry, computer-based decision support and alerting systems, and electronic prescribing can reduce medical errors and improve the quality of health care. However, the business value of these systems is frequently questioned. At present a number of barriers exist to realizing the potential of IT to improve quality of care. Some of these barriers are: the ineffectiveness of existing error reporting systems, low investment in IT infrastructure, legal impediments to reforms, and the difficulty in demonstrating a sufficient return on investment to justify expenditures for quality improvement. This paper provides an overview of these issues, a framework for considering business models, and examples of successful implementations of IT to improve quality of patient care.

A Survey of Challenges in Aerodynamic Exhaust Nozzle Technology for Aerospace Propulsion Applications

NASA Technical Reports Server (NTRS)

Shyne, Rickey J.

2002-01-01

The current paper discusses aerodynamic exhaust nozzle technology challenges for aircraft and space propulsion systems. Technology advances in computational and experimental methods have led to more accurate design and analysis tools, but many major challenges continue to exist in nozzle performance, jet noise and weight reduction. New generations of aircraft and space vehicle concepts dictate that exhaust nozzles have optimum performance, low weight and acceptable noise signatures. Numerous innovative nozzle concepts have been proposed for advanced subsonic, supersonic and hypersonic vehicle configurations such as ejector, mixer-ejector, plug, single expansion ramp, altitude compensating, lobed and chevron nozzles. This paper will discuss the technology barriers that exist for exhaust nozzles as well as current research efforts in place to address the barriers.

Barriers to the free diffusion of proteins and lipids in the plasma membrane

PubMed Central

Trimble, William S.

2015-01-01

Biological membranes segregate into specialized functional domains of distinct composition, which can persist for the entire life of the cell. How separation of their lipid and (glyco)protein components is generated and maintained is not well understood, but the existence of diffusional barriers has been proposed. Remarkably, the physical nature of such barriers and the manner whereby they impede the free diffusion of molecules in the plane of the membrane has rarely been studied in depth. Moreover, alternative mechanisms capable of generating membrane inhomogeneity are often disregarded. Here we describe prototypical biological systems where membrane segregation has been amply documented and discuss the role of diffusional barriers and other processes in the generation and maintenance of their structural and functional compartmentalization. PMID:25646084

Barriers to the free diffusion of proteins and lipids in the plasma membrane.

PubMed

Trimble, William S; Grinstein, Sergio

2015-02-02

Biological membranes segregate into specialized functional domains of distinct composition, which can persist for the entire life of the cell. How separation of their lipid and (glyco)protein components is generated and maintained is not well understood, but the existence of diffusional barriers has been proposed. Remarkably, the physical nature of such barriers and the manner whereby they impede the free diffusion of molecules in the plane of the membrane has rarely been studied in depth. Moreover, alternative mechanisms capable of generating membrane inhomogeneity are often disregarded. Here we describe prototypical biological systems where membrane segregation has been amply documented and discuss the role of diffusional barriers and other processes in the generation and maintenance of their structural and functional compartmentalization. © 2015 Trimble and Grinstein.

Effects of Building a Sand Barrier Berm to Mitigate the Effects of the Deepwater Horizon Oil Spill on Louisiana Marshes

USGS Publications Warehouse

Lavoie, Dawn; Flocks, James G.; Kindinger, Jack G.; Sallenger, A.H.; Twichell, David C.

2010-01-01

The State of Louisiana requested emergency authorization on May 11, 2010, to perform spill mitigation work on the Chandeleur Islands and on all the barrier islands from Grand Terre Island eastward to Sandy Point to enhance the capability of the islands to reduce the movement of oil from the Deepwater Horizon oil spill to the marshes. The proposed action-building a barrier berm (essentially an artificial island fronting the existing barriers and inlets) seaward of the existing barrier islands and inlets-'restores' the protective function of the islands but does not alter the islands themselves. Building a barrier berm to protect the mainland wetlands from oil is a new strategy and depends on the timeliness of construction to be successful. Prioritizing areas to be bermed, focusing on those areas that are most vulnerable and where construction can be completed most rapidly, may increase chances for success. For example, it may be easier and more efficient to berm the narrow inlets of the coastal section to the west of the Mississippi River Delta rather than the large expanses of open water to the east of the delta in the southern parts of the Breton National Wildlife Refuge (NWR). This document provides information about the potential available sand resources and effects of berm construction on the existing barrier islands. The proposed project originally involved removing sediment from a linear source approximately 1 mile (1.6 km) gulfward of the barrier islands and placing it just seaward of the islands in shallow water (~2-m depth where possible) to form a continuous berm rising approximately 6 feet (~2 m) above sea level (North American Vertical Datum of 1988-NAVD88) with an ~110-yd (~100-m) width at water level and a slope of 25:1 to the seafloor. Discussions within the U.S. Geological Survey (USGS) and with others led to the determination that point-source locations, such as Hewes Point, the St. Bernard Shoals, and Ship Shoal, were more suitable 'borrow' locations because sand content is insufficient along a linear track offshore from most of Louisiana's barrier islands. Further, mining sediment near the toe of the barrier island platform or edge of actively eroding barrier islands could create pits in the seafloor that will capture nearshore sand, thereby enhancing island erosion, and focus incoming waves (for example, through refraction processes) that could yield hotspots of erosion. In the Breton NWR, the proposed berm would be continuous from just south of Hewes Point to Breton Island for approximately 100 km with the exception of several passages for vessel access. Proposed volume estimates by sources outside of the USGS suggest that the structure in the Breton NWR would contain approximately 56 million cubic yards (42.8 m3) of sandy material. In the west, the berm would require approximately 36 million cubic yards (27.5 m3) of sandy material because this area has less open water than the area to the east of the delta. The planned berm is intended to protect the islands and inland areas from oil and would be sacrificial; that is, it will rapidly erode through natural processes. It is not part of the coastal restoration plan long discussed in Louisiana to rebuild barrier islands for hurricane protection of mainland infrastructure and habitat.

Measuring and Advancing Experimental Design Ability in an Introductory Course without Altering Existing Lab Curriculum.

PubMed

Shanks, Ryan A; Robertson, Chuck L; Haygood, Christian S; Herdliksa, Anna M; Herdliska, Heather R; Lloyd, Steven A

2017-01-01

Introductory biology courses provide an important opportunity to prepare students for future courses, yet existing cookbook labs, although important in their own way, fail to provide many of the advantages of semester-long research experiences. Engaging, authentic research experiences aid biology students in meeting many learning goals. Therefore, overlaying a research experience onto the existing lab structure allows faculty to overcome barriers involving curricular change. Here we propose a working model for this overlay design in an introductory biology course and detail a means to conduct this lab with minimal increases in student and faculty workloads. Furthermore, we conducted exploratory factor analysis of the Experimental Design Ability Test (EDAT) and uncovered two latent factors which provide valid means to assess this overlay model's ability to increase advanced experimental design abilities. In a pre-test/post-test design, we demonstrate significant increases in both basic and advanced experimental design abilities in an experimental and comparison group. We measured significantly higher gains in advanced experimental design understanding in students in the experimental group. We believe this overlay model and EDAT factor analysis contribute a novel means to conduct and assess the effectiveness of authentic research experiences in an introductory course without major changes to the course curriculum and with minimal increases in faculty and student workloads.

Movements of fluvial Bonneville cutthroat trout in the Thomas Fork of the Bear River, Idaho-Wyoming

USGS Publications Warehouse

Colyer, W.T.; Kershner, J.L.; Hilderbrand, R.H.

2005-01-01

The majority of interior subspecies of cutthroat trout Oncorhynchus clarkii have been extirpated from large rivers by anthropogenic activities that have fragmented habitats and introduced nonnative competitors. Selective pressures against migratory behaviors and main-stem river occupation, coupled with conservation strategies that isolate genetically pure populations above barriers, have restricted gene flow and prevented expression of the fluvial life history in many populations. Existing knowledge about the movements and home range requirements of fluvial cutthroat trout is, therefore, limited. Our objectives in this study were to (1) determine the extent of seasonal home ranges and mobility of Bonneville cutthroat trout O. c. utah (BCT) in the Thomas Fork and main-stem Bear River and (2) evaluate the role of a water diversion structure functioning as a seasonal migration barrier to fish movement. We implanted 55 BCT in the Thomas Fork of the Bear River, Idaho, with radio transmitters and located them bimonthly in 1999–2000 and weekly in 2000–2001. We found fish to be more mobile than previously reported. Individuals above the diversion barrier occupied substantially larger home ranges than those below the barrier (analysis of variance: P = 0.0003; median = 2,225 m above barrier; median = 500 m below barrier) throughout our study, and they moved more frequently (mean, 0.89 movements/contact; range, 0.57–1.00) from October 2000 through March 2001 than fish below the barrier (mean, 0.45 movements/contact; range, 0.00–1.00). During the spring of both years, we located radio-tagged fish in both upstream and neighboring tributaries as far as 86 km away from our study site. Our results document the existence of a fluvial component of BCT in the Bear River and its tributaries and suggest that successful efforts at conservation of these fish must focus on main-stem habitats and the maintenance of seasonal migration corridors.

"I do not have time. Is there a handout I can use?": combining physicians' needs and behavior change theory to put physical activity evidence into practice.

PubMed

Clark, R E; McArthur, C; Papaioannou, A; Cheung, A M; Laprade, J; Lee, L; Jain, R; Giangregorio, L M

2017-06-01

Guidelines for physical activity exist and following them would improve health. Physicians can advise patients on physical activity. We found barriers related to physicians' knowledge, a lack of tools and of physician incentives, and competing demands for limited time with a patient. We discuss interventions that could reduce these barriers. Uptake of physical activity (PA) guidelines would improve health and reduce mortality in older adults. However, physicians face barriers in guideline implementation, particularly when faced with needing to tailor recommendations in the presence of chronic disease. We performed a behavioral analysis of physician barriers to PA guideline implementation and to identify interventions. The Too Fit To Fracture physical activity recommendations were used as an example of disease-specific PA guidelines. Focus groups and semi-structured interviews were conducted with physicians and nurse practitioners in Ontario, stratified by type of physician, geographic area, and urban/rural, and transcribed verbatim. Two researchers coded data and identified emerging themes. Using the behavior change wheel framework, themes were categorized into capability, opportunity and motivation, and interventions were identified. Fifty-nine family physicians, specialists, and nurse practitioners participated. Barriers were as follows: Capability-lack of exercise knowledge or where to refer; Opportunity-pragmatic tools, fit within existing workflow, available programs that meet patients' needs, physical activity literacy and cultural practices; Motivation-lack of incentives, not in their scope of practice or professional identity, competing priorities, outcome expectancies. Interventions selected: education, environmental restructuring, enablement, persuasion. Policy categories: communications/marketing, service provision, guidelines. Key barriers to PA guideline implementation among physicians include knowledge on where to refer or what to say, access to pragmatic programs or resources, and things that influence motivation, such as competing priorities or lack of incentives. Future work will report on the development and evaluation of knowledge translation interventions informed by the barriers.

Perceived barriers to walking for physical activity.

PubMed

Dunton, Genevieve F; Schneider, Margaret

2006-10-01

Although the health benefits of walking for physical activity have received increasing research attention, barriers specific to walking are not well understood. In this study, questions to measure barriers to walking for physical activity were developed and tested among college students. The factor structure, test-retest and internal consistency reliability, and discriminant and criterion validity of the perceived barriers were evaluated. A total of 305 undergraduate students participated. Participants had a mean age (+/- SD) of 20.6 (+/- 3.02) years, and 70.3% were female. Participants responded to a questionnaire assessing barriers specific to walking for physical activity. Perceived barriers to vigorous exercise, walking for transportation and recreation, and participation in lifestyle activities (such as taking the stairs instead of the elevator) were also assessed. Subsamples completed the walking barriers instrument a second time after 5 days in order to determine test-retest reliability (n = 104) and wore an accelerometer to measure moderate-intensity physical activity (n = 85). Factor analyses confirmed the existence of three factors underlying the perceived barriers to walking questions: appearance (four items), footwear (three items), and situation (three items). Appearance and situational barriers demonstrated acceptable reliability, discriminant validity, and relations with physical activity criteria. After we controlled for barriers to vigorous exercise, appearance and situational barriers to walking explained additional variation in objectively-measured moderate physical activity. The prediction of walking for physical activity, especially walking that is unstructured and spontaneous, may be improved by considering appearance and situational barriers. Assessing barriers specific to walking may have important implications for interventions targeting walking as means for engaging in physical activity.

Attempting to be active: Self-efficacy and barrier limitation differentiate activity levels of working mothers.

PubMed

Gierc, Madelaine; Locke, Sean; Jung, Mary; Brawley, Lawrence

2016-07-01

Working mothers are less physically active than working women without children and mothers who do not work. The purpose of this study was to examine concurrent self-regulatory efficacy and barriers to physical activity in a sample of working mothers. Women completed a mixed-methods survey which included measures of physical activity, concurrent self-regulatory efficacy, and barriers. Sufficiently active women experienced significantly greater concurrent self-regulatory efficacy and significantly less barrier limitation and frequency. No significant group differences were found for age, domestic duties performed, and children's extracurricular activities. Thematic analysis of barriers revealed six themes of common and unique factors, including limited time and family activities. © The Author(s) 2014.

Evaluation of effect of different disposable infection control barriers on light intensity of light-curing unit and microhardness of composite - An in vitro study

PubMed Central

Khode, Rajiv Tarachand; Shenoi, Pratima Ramakrishna; Kubde, Rajesh R.; Makade, Chetana S.; Wadekar, Kanchan D.; Khode, Priyanka Tarachand

2017-01-01

Aims: This study evaluated effect of infection control barriers on light intensity (LI) of light-curing unit (LCU) and microhardness of composite. Materials and Methods: Four different disposable barriers (n = 30) were tested against the control. LI for each barrier was measured with Lux meter. One hundred and fifty Teflon molds were equally divided into five groups of thirty each. Composite was filled in bulk in these molds and cured without and with barrier. Microhardness was evaluated on top and bottom surface of composite specimen with microhardness testing machine and hardness ratio (HR) was derived. Statistical Analysis Used: One-way analysis of variance, Tukey's honestly significant difference test, and paired t-test using SPSS version 18 software. Results: All barriers had significantly reduced the baseline LI of LCU (P < 0.0001), but only Cure Elastic Steri-Shield and latex cut glove pieces (LCGP) significantly reduced the microhardness of the composite (P < 0.05). However, HR determined inadequate curing only with LCGP. Conclusions: Although entire tested barrier significantly reduced the LI; none, except LCGP markedly affected the degree of cure of the composite. PMID:29279622

Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study

PubMed Central

2013-01-01

Background Hypertension is prevalent and often sub-optimally controlled; however, interventions to improve blood pressure control have had limited success. Objectives Through implementation of an evidence-based nurse-delivered self-management phone intervention to facilitate hypertension management within large complex health systems, we sought to answer the following questions: What is the level of organizational readiness to implement the intervention? What are the specific facilitators, barriers, and contextual factors that may affect organizational readiness to change? Study design Each intervention site from three separate Veterans Integrated Service Networks (VISNs), which represent 21 geographic regions across the US, agreed to enroll 500 participants over a year with at least 0.5 full time equivalent employees of nursing time. Our mixed methods approach used a priori semi-structured interviews conducted with stakeholders (n = 27) including nurses, physicians, administrators, and information technology (IT) professionals between 2010 and 2011. Researchers iteratively identified facilitators and barriers of organizational readiness to change (ORC) and implementation. Additionally, an ORC survey was conducted with the stakeholders who were (n = 102) preparing for program implementation. Results Key ORC facilitators included stakeholder buy-in and improving hypertension. Positive organizational characteristics likely to impact ORC included: other similar programs that support buy-in, adequate staff, and alignment with the existing site environment; improved patient outcomes; is positive for the professional nurse role, and is evidence-based; understanding of the intervention; IT infrastructure and support, and utilization of existing equipment and space. The primary ORC barrier was unclear long-term commitment of nursing. Negative organizational characteristics likely to impact ORC included: added workload, competition with existing programs, implementation length, and limited available nurse staff time; buy-in is temporary until evidence shows improved outcomes; contacting patients and the logistics of integration into existing workflow is a challenge; and inadequate staffing is problematic. Findings were complementary across quantitative and qualitative analyses. Conclusions The model of organizational change identified key facilitators and barriers of organizational readiness to change and successful implementation. This study allows us to understand the needs and challenges of intervention implementation. Furthermore, examination of organizational facilitators and barriers to implementation of evidence-based interventions may inform dissemination in other chronic diseases. PMID:24010683

Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study.

PubMed

Shaw, Ryan J; Kaufman, Miriam A; Bosworth, Hayden B; Weiner, Bryan J; Zullig, Leah L; Lee, Shoou-Yih Daniel; Kravetz, Jeffrey D; Rakley, Susan M; Roumie, Christianne L; Bowen, Michael E; Del Monte, Pamela S; Oddone, Eugene Z; Jackson, George L

2013-09-08

Hypertension is prevalent and often sub-optimally controlled; however, interventions to improve blood pressure control have had limited success. Through implementation of an evidence-based nurse-delivered self-management phone intervention to facilitate hypertension management within large complex health systems, we sought to answer the following questions: What is the level of organizational readiness to implement the intervention? What are the specific facilitators, barriers, and contextual factors that may affect organizational readiness to change? Each intervention site from three separate Veterans Integrated Service Networks (VISNs), which represent 21 geographic regions across the US, agreed to enroll 500 participants over a year with at least 0.5 full time equivalent employees of nursing time. Our mixed methods approach used a priori semi-structured interviews conducted with stakeholders (n = 27) including nurses, physicians, administrators, and information technology (IT) professionals between 2010 and 2011. Researchers iteratively identified facilitators and barriers of organizational readiness to change (ORC) and implementation. Additionally, an ORC survey was conducted with the stakeholders who were (n = 102) preparing for program implementation. Key ORC facilitators included stakeholder buy-in and improving hypertension. Positive organizational characteristics likely to impact ORC included: other similar programs that support buy-in, adequate staff, and alignment with the existing site environment; improved patient outcomes; is positive for the professional nurse role, and is evidence-based; understanding of the intervention; IT infrastructure and support, and utilization of existing equipment and space.The primary ORC barrier was unclear long-term commitment of nursing. Negative organizational characteristics likely to impact ORC included: added workload, competition with existing programs, implementation length, and limited available nurse staff time; buy-in is temporary until evidence shows improved outcomes; contacting patients and the logistics of integration into existing workflow is a challenge; and inadequate staffing is problematic. Findings were complementary across quantitative and qualitative analyses. The model of organizational change identified key facilitators and barriers of organizational readiness to change and successful implementation. This study allows us to understand the needs and challenges of intervention implementation. Furthermore, examination of organizational facilitators and barriers to implementation of evidence-based interventions may inform dissemination in other chronic diseases.

78 FR 63271 - Request for Public Comments to Compile the Report on Technical Barriers to Trade

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-23

... on Technical Barriers to Trade AGENCY: Office of the United States Trade Representative. ACTION... 2014 a Report on Technical Barriers to Trade (TBT Report) identifying and analyzing significant... requesting interested persons to submit written comments to assist it in identifying significant standards...

Wearable sensors: modalities, challenges, and prospects.

PubMed

Heikenfeld, J; Jajack, A; Rogers, J; Gutruf, P; Tian, L; Pan, T; Li, R; Khine, M; Kim, J; Wang, J; Kim, J

2018-01-16

Wearable sensors have recently seen a large increase in both research and commercialization. However, success in wearable sensors has been a mix of both progress and setbacks. Most of commercial progress has been in smart adaptation of existing mechanical, electrical and optical methods of measuring the body. This adaptation has involved innovations in how to miniaturize sensing technologies, how to make them conformal and flexible, and in the development of companion software that increases the value of the measured data. However, chemical sensing modalities have experienced greater challenges in commercial adoption, especially for non-invasive chemical sensors. There have also been significant challenges in making significant fundamental improvements to existing mechanical, electrical, and optical sensing modalities, especially in improving their specificity of detection. Many of these challenges can be understood by appreciating the body's surface (skin) as more of an information barrier than as an information source. With a deeper understanding of the fundamental challenges faced for wearable sensors and of the state-of-the-art for wearable sensor technology, the roadmap becomes clearer for creating the next generation of innovations and breakthroughs.

Optimizing the performance of Ice-storage Systems in Electricity Load Management through a credit mechanism. An analytical work for Jiangsu, China

DOE PAGES

Han, Yafeng; Shen, Bo; Hu, Huajin; ...

2015-01-12

Ice-storage air-conditioning is a technique that uses ice for thermal energy storage. Replacing existing air conditioning systems with ice storage has the advantage of shifting the load from on-peak times to off-peak times that often have excess generation. However, increasing the use of ice-storage faces significant challenges in China. One major barrier is the inefficiency in the current electricity tariff structure. There is a lack of effective incentive mechanism that induces ice-storage systems from achieving optimal load-shifting results. This study presents an analysis that compares the potential impacts of ice-storage systems on load-shifting under a new credit-based incentive scheme andmore » the existing incentive arrangement in Jiangsu, China. The study indicates that by changing how ice-storage systems are incentivized in Jiangsu, load-shifting results can be improved.« less

Is Amateur Astronomers’ Astronomy Knowledge a Barrier to Successful Outreach?

NASA Astrophysics Data System (ADS)

Slater, Timothy F.; Slater, S. J.; Price, C. A.; CenterAstronomy, CAPER; Education Research, Physics

2012-01-01

Considerable effort in astronomy education research has focused on developing assessment tools in the form of multiple-choice conceptual diagnostics and content knowledge surveys. This has been critically important for establishing the initial knowledge state of students and measure impacts of innovative instructional interventions over a universe of topics. Unfortunately, few of the existing instruments were constructed upon a solid list of clearly articulated and widely agreed upon learning objectives that span an entire introductory survey course. Moving beyond the 10-year old Astronomy Diagnostics Test, scholars at the CAPER Center for Astronomy & Physics Education Research developed and validated criterion referenced assessment tool, which is tightly aligned to the consensus learning goals stated by the AAS Chair's Conference on ASTRO 101, the AAAS Project 2061 Benchmarks, and the NRC National Science Education Standards, called the Test Of Astronomy STandards (TOAST). This multiple-choice instrument has a high degree of reliability and validity and is being deployed in a number of formal and informal learning environments. A collaborative research endeavor between the CAPER Team and the American Association of Variable Star Observers measured the astronomy content knowledge amateur astronomers, relative to widely agreed upon learning targets. We uncovered that our sample of 300 amateurs have higher than expected scores on the TOAST, significantly higher than students leaving our top-tier ASTRO 101 survey courses. Given recent learning sciences research demonstrating the potential of highly specialized languages that exist within some communities and rapidly declining membership rolls of formal amateur organizations, these scores could be interpreted as a potential communication barrier existing for engaging novices who are potential future club members. These results suggest that organizations may need to strategically clarify the nature of educational experiences they provide than can serve transformative in order to nurture a more robust pipeline of members.

Modeling the effect of varying swim speeds on fish passage through velocity barriers

USGS Publications Warehouse

Castro-Santos, T.

2006-01-01

The distance fish can swim through zones of high-velocity flow is an important factor limiting the distribution and conservation of riverine and diadromous fishes. Often, these barriers are characterized by nonuniform flow conditions, and it is likely that fish will swim at varying speeds to traverse them. Existing models used to predict passage success, however, typically include the unrealistic assumption that fish swim at a constant speed regardless of the speed of flow. This paper demonstrates how the maximum distance of ascent through velocity barriers can be estimated from the swim speed-fatigue time relationship, allowing for variation in both swim speed and water velocity.

Finite-time barriers to reaction front propagation

NASA Astrophysics Data System (ADS)

Locke, Rory; Mahoney, John; Mitchell, Kevin

2015-11-01

Front propagation in advection-reaction-diffusion systems gives rise to rich geometric patterns. It has been shown for time-independent and time-periodic fluid flows that invariant manifolds, termed burning invariant manifolds (BIMs), serve as one-sided dynamical barriers to the propagation of reaction front. More recently, theoretical work has suggested that one-sided barriers, termed burning Lagrangian Coherent structures (bLCSs), exist for fluid velocity data prescribed over a finite time interval, with no assumption on the time-dependence of the flow. In this presentation, we use a time-varying fluid ``wind'' in a double-vortex channel flow to demonstrate that bLCSs form the (locally) most attracting or repelling fronts.

Development of an integrated staircase lift for home access.

PubMed

Mattie, Johanne L; Borisoff, Jaimie F; Leland, Danny; Miller, William C

2015-12-01

Stairways into buildings present a significant environmental barrier for those with mobility impairments, including older adults. A number of home access solutions that allow users to safely enter and exit the home exist, however these all have some limitations. The purpose of this work was to develop a novel, inclusive home access solution that integrates a staircase and a lift into one device. The development of an integrated staircase lift followed a structured protocol with stakeholders providing feedback at various stages in the design process, consistent with rehabilitation engineering design methods. A novel home access device was developed. The integrated staircase-lift has the following features: inclusivity, by a universal design that provides an option for either use of stairs or a lift; constant availability, with a lift platform always ready for use on either level; and potential aesthetic advantages when integrating the device into an existing home. The potential also exists for emergency descent during a power outage, and self-powered versions. By engaging stakeholders in a user centred design process, insight on the limitations of existing home access solutions and specific feedback on our design guided development of a novel home access device.

``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.

Hypoxanthine is a checkpoint stress metabolite in colonic epithelial energy modulation and barrier function.

PubMed

Lee, J Scott; Wang, Ruth X; Alexeev, Erica E; Lanis, Jordi M; Battista, Kayla D; Glover, Louise E; Colgan, Sean P

2018-04-20

Intestinal epithelial cells form a selectively permeable barrier to protect colon tissues from luminal microbiota and antigens and to mediate nutrient, fluid, and waste flux in the intestinal tract. Dysregulation of the epithelial cell barrier coincides with profound shifts in metabolic energy, especially in the colon, which exists in an energetically depleting state of physiological hypoxia. However, studies that systematically examine energy flux and adenylate metabolism during intestinal epithelial barrier development and restoration after disruption are lacking. Here, to delineate barrier-related energy flux, we developed an HPLC-based profiling method to track changes in energy flux and adenylate metabolites during barrier development and restoration. Cultured epithelia exhibited pooling of phosphocreatine and maintained ATP during barrier development. EDTA-induced epithelial barrier disruption revealed that hypoxanthine levels correlated with barrier resistance. Further studies uncovered that hypoxanthine supplementation improves barrier function and wound healing and that hypoxanthine appears to do so by increasing intracellular ATP, which improved cytoskeletal G- to F-actin polymerization. Hypoxanthine supplementation increased the adenylate energy charge in the murine colon, indicating potential to regulate adenylate energy charge-mediated metabolism in intestinal epithelial cells. Moreover, experiments in a murine colitis model disclosed that hypoxanthine loss during active inflammation correlates with markers of disease severity. In summary, our results indicate that hypoxanthine modulates energy metabolism in intestinal epithelial cells and is critical for intestinal barrier function. © 2018 by The American Society for Biochemistry and Molecular Biology, Inc.

Emergency nurses' knowledge of perceived barriers in pain management in Taiwan.

PubMed

Tsai, Feng-Ching; Tsai, Yun-Fang; Chien, Chih-Cheng; Lin, Chia-Chin

2007-11-01

To explore knowledge of and perceived barriers to pain management among emergency nurses in Taiwan. Pain is the most common patient complaint in emergency departments. Quality care of these patients depends on the pain knowledge and pain management skills of emergency nurses. However, no studies have explored emergency nurses' knowledge of and perceived barriers to pain management in Taiwan. Nurse subjects (n = 249) were recruited from nine hospitals chosen by stratified sampling across Taiwan. Data were collected using the Nurses' Knowledge and Attitudes Survey-Taiwanese version, a scale to assess perceived barriers to pain management and a background information form. The overall average correct response rate for the knowledge scale was 49.2%, with a range of 4.8-89.2% for each survey question. The top barrier to managing pain was identified by these nurses as 'the responsibility of caring for other acutely ill patients in addition to a patient with pain. Knowledge of pain management had a significant, negative relationship with perceived barriers to pain management and a significant, positive relationship with extent of clinical care experience and total hours of prior pain management education. In addition, scores for knowledge and perceived barriers differed significantly by the nursing clinical ladder. Perceived barriers also differed significantly by hospital accreditation category. Our results indicate an urgent need to strengthen pain education for emergency nurses in Taiwan. The pain education should target knowledge deficits and barriers to changing pain management approaches for Taiwanese emergency nurses.

Standardized Patient Training Programs: an Efficient Solution to the Call for Quality Improvement in Oncologist Communication Skills.

PubMed

Ju, Melody; Berman, Abigail T; Vapiwala, Neha

2015-09-01

Several key medical and oncologic professional societies have endorsed the importance of physician communication as a quality improvement metric. Despite this clear message, there remain substantial barriers to communication skills training (CST) in oncologic specialties. Herein, we describe the major barriers to communications training and propose standardized patient (SP) programs as efficient and strategic starting points and as expansion opportunities for new and existing CSTs.

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

ERIC Educational Resources Information Center

Sorensen, Elaine; Zibman, Chava

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

Health information exchange: persistent challenges and new strategies

PubMed Central

Gamm, Larry D

2010-01-01

Recent federal policies and actions support the adoption of health information exchange (HIE) in order to improve healthcare by addressing fragmented personal health information. However, concerted efforts at facilitating HIE have existed for over two decades in this country. The lessons of these experiences include a recurrence of barriers and challenges beyond those associated with technology. Without new strategies, the current support and methods of facilitating HIE may not address these barriers. PMID:20442146

Perceived barriers to weight maintenance among university students in Kuwait: the role of gender and obesity.

PubMed

Musaiger, Abdulrahman O; Al-Kandari, Fawzia I; Al-Mannai, Mariam; Al-Faraj, Alaa M; Bouriki, Fajer A; Shehab, Fatima S; Al-Dabous, Lulwa A; Al-Qalaf, Wassin B

2014-05-01

To investigate the barriers to weight maintenance among university students in Kuwait by gender and obesity. A sample of 530 students was selected at convenience from four universities in Kuwait (2 public and 2 private). The age of students ranged from 19 to 26 years. A self-reported pretested questionnaire was used to obtain the barriers, which were divided into barriers to healthy eating and barriers to physical activity. Weight and height were based on self-reporting, and the students were grouped into non-obese and obese according to the WHO classification. The response options to barriers were: very important, somewhat important and not important. The main barriers to healthy eating for both genders were: "Do not have skills to plan, shop for, prepare or cook healthy foods" and "Not having time to prepare or eat healthy food". In general, there were no significant differences between men and women in barriers to healthy eating. There were highly significant differences between men and women regarding barriers to physical activity (P values ranged from <0.001 to <0.016). "Not having time to be physically active" and "The climate is not suitable for practising exercise" were the main barriers reported. Obese men were more likely to face barriers to healthy eating than non-obese men. There were no significant differences between obese and non-obese women regarding barriers to healthy eating and physical activity. The findings of this study can be utilized in intervention activities to promote a healthy lifestyle and to combat obesity in Kuwait, and maybe in other Arab countries.

Is there a hybridization barrier between Gentiana lutea color morphs?

PubMed

Losada, María; Veiga, Tania; Guitián, Javier; Guitián, José; Guitián, Pablo; Sobral, Mar

2015-01-01

In Gentiana lutea two varieties are described: G. lutea var. aurantiaca with orange corolla colors and G. lutea var. lutea with yellow corolla colors. Both color varieties co-occur in NW Spain, and pollinators select flower color in this species. It is not known whether a hybridization barrier exists between these G. lutea color varieties. We aim to test the compatibility between flower color varieties in G. lutea and its dependence on pollen vectors. Within a sympatric population containing both flower color morphs, we analyzed differences in reproductive success (number, weight, viability and germinability of seeds) depending on fertilization treatments (autogamy and xenogamy within variety and among varieties). We found a 93% reduction in number of seeds and a 37% reduction in seed weight respectively of autogamy treatments compared to xenogamy crossings. Additionally, reproductive success is higher within color varieties than among varieties, due to a 45% seed viability reduction on hybrids from different varieties. Our results show that G. lutea reproductive success is strongly dependent on pollinators and that a partial hybridization barrier exists between G. lutea varieties.

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

PubMed

Aiello, Emilia; Flecha, Ainhoa; Serradell, Olga

2018-02-22

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

Is there a hybridization barrier between Gentiana lutea color morphs?

PubMed Central

Losada, María; Veiga, Tania; Guitián, Javier; Guitián, José; Guitián, Pablo

2015-01-01

In Gentiana lutea two varieties are described: G. lutea var. aurantiaca with orange corolla colors and G. lutea var. lutea with yellow corolla colors. Both color varieties co-occur in NW Spain, and pollinators select flower color in this species. It is not known whether a hybridization barrier exists between these G. lutea color varieties. We aim to test the compatibility between flower color varieties in G. lutea and its dependence on pollen vectors. Within a sympatric population containing both flower color morphs, we analyzed differences in reproductive success (number, weight, viability and germinability of seeds) depending on fertilization treatments (autogamy and xenogamy within variety and among varieties). We found a 93% reduction in number of seeds and a 37% reduction in seed weight respectively of autogamy treatments compared to xenogamy crossings. Additionally, reproductive success is higher within color varieties than among varieties, due to a 45% seed viability reduction on hybrids from different varieties. Our results show that G. lutea reproductive success is strongly dependent on pollinators and that a partial hybridization barrier exists between G. lutea varieties. PMID:26528404

Mobile health solutions for the aging population: A systematic narrative analysis.

PubMed

Kruse, Clemens Scott; Mileski, Michael; Moreno, Joshua

2017-05-01

Introduction The ubiquitous nature of mobile technology coupled with the acceptance of mobile health (mHealth) among the elderly offers an opportunity to augment the existing medical workforce in long-term care. The objective of this review and narrative analysis is to identify and analyse facilitators and barriers to adoption of mHealth for the elderly. Methods Studies over the last year were identified in multiple database indices, and three reviewers examined abstracts ( k = 0.82) and analysed articles for themes which were tallied in affinity diagrams to identify frequency of occurrence in the literature (n = 36). Results The three facilitators mentioned most often were independence (18%), understanding (13%), and visibility (13%). The three barriers mentioned most often were complexity (21%), limited by users (12%) and ineffective (12%). Discussion and conclusions The reviewers concluded that the work done so far illustrates that mHealth enables a perception of independence. Future research should focus on the barriers of complexity of technology and improving existing medical literacy in order to facilitate further adoption.

Development of RNAi technology for targeted therapy--a track of siRNA based agents to RNAi therapeutics.

PubMed

Zhou, Yinjian; Zhang, Chunling; Liang, Wei

2014-11-10

RNA interference (RNAi) was intensively studied in the past decades due to its potential in therapy of diseases. The target specificity and universal treatment spectrum endowed siRNA advantages over traditional small molecules and protein drugs. However, barriers exist in the blood circulation system and the diseased tissues blocked the actualization of RNAi effect, which raised function versatility requirements to siRNA therapeutic agents. Appropriate functionalization of siRNAs is necessary to break through these barriers and target diseased tissues in local or systemic targeted application. In this review, we summarized that barriers exist in the delivery process and popular functionalized technologies for siRNA such as chemical modification and physical encapsulation. Preclinical targeted siRNA delivery and the current status of siRNA based RNAi therapeutic agents in clinical trial were reviewed and finally the future of siRNA delivery was proposed. The valuable experience from the siRNA agent delivery study and the RNAi therapeutic agents in clinical trial paved ways for practical RNAi therapeutics to emerge early. Copyright © 2014 Elsevier B.V. All rights reserved.

Non-Saccharomyces yeasts protect against epithelial cell barrier disruption induced by Salmonella enterica subsp. enterica serovar Typhimurium.

PubMed

Smith, I M; Baker, A; Arneborg, N; Jespersen, L

2015-11-01

The human gastrointestinal epithelium makes up the largest barrier separating the body from the external environment. Whereas invasive pathogens cause epithelial barrier disruption, probiotic micro-organisms modulate tight junction regulation and improve epithelial barrier function. In addition, probiotic strains may be able to reduce epithelial barrier disruption caused by pathogenic species. The aim of this study was to explore non-Saccharomyces yeast modulation of epithelial cell barrier function in vitro. Benchmarking against established probiotic strains, we evaluated the ability of four nonpathogenic yeast species to modulate transepithelial electrical resistance (TER) across a monolayer of differentiated human colonocytes (Caco-2 cells). Further, we assessed yeast modulation of a Salmonella Typhimurium-induced epithelial cell barrier function insult. Our findings demonstrate distinct patterns of non-Saccharomyces yeast modulation of epithelial cell barrier function. While the established probiotic yeast Saccharomyces boulardii increased TER across a Caco-2 monolayer by 30%, Kluyveromyces marxianus exhibited significantly stronger properties of TER enhancement (50% TER increase). In addition, our data demonstrate significant yeast-mediated modulation of Salmonella-induced epithelial cell barrier disruption and identify K. marxianus and Metschnikowia gruessii as two non-Saccharomyces yeasts capable of protecting human epithelial cells from pathogen invasion. This study demonstrates distinct patterns of non-Saccharomyces yeast modulation of epithelial cell barrier function in vitro. Further, our data demonstrate significant yeast-mediated modulation of Salmonella Typhimurium-induced epithelial cell barrier disruption and identify Kluyveromyces marxianus and Metschnikowia gruessii as two non-Saccharomyces yeasts capable of protecting human epithelial cells from pathogen invasion. This study is the first to demonstrate significant non-Saccharomyces yeast-mediated epithelial cell barrier protection from Salmonella invasion, thus encouraging future efforts aimed at confirming the observed effects in vivo and driving further strain development towards novel yeast probiotics. © 2015 The Society for Applied Microbiology.

Boosters and barriers for direct cardiac reprogramming.

PubMed

Talkhabi, Mahmood; Zonooz, Elmira Rezaei; Baharvand, Hossein

2017-06-01

Heart disease is currently the most significant cause of morbidity and mortality worldwide, which accounts for approximately 33% of all deaths. Recently, a promising and alchemy-like strategy has been developed called direct cardiac reprogramming, which directly converts somatic cells such as fibroblasts to cardiac lineage cells such as cardiomyocytes (CMs), termed induced CMs or iCMs. The first in vitro cardiac reprogramming study, mediated by cardiac transcription factors (TFs)-Gata4, Tbx5 and Mef2C-, was not enough efficient to produce an adequate number of fully reprogrammed, functional iCMs. As a result, numerous combinations of cardiac TFs exist for direct cardiac reprogramming of mouse and human fibroblasts. However, the efficiency of direct cardiac reprogramming remains low. Recently, a number of cellular and molecular mechanisms have been identified to increase the efficiency of direct cardiac reprogramming and the quality of iCMs. For example, microgrooved substrate, cardiogenic growth factors [VEGF, FGF, BMP4 and Activin A], and an appropriate stoichiometry of TFs boost the direct cardiac reprogramming. On the other hand, serum, TGFβ signaling, activators of epithelial to mesenchymal transition, and some epigenetic factors (Bmi1 and Ezh2) are barriers for direct cardiac reprogramming. Manipulating these mechanisms by the application of boosters and removing barriers can increase the efficiency of direct cardiac reprogramming and possibly make iCMs reliable for cell-based therapy or other potential applications. In this review, we summarize the latest trends in cardiac TF- or miRNA-based direct cardiac reprogramming and comprehensively discuses all molecular and cellular boosters and barriers affecting direct cardiac reprogramming. Copyright © 2017 Elsevier Inc. All rights reserved.

An ethnographic study of barriers to cancer pain management and opioid availability in India.

PubMed

Lebaron, Virginia; Beck, Susan L; Maurer, Martha; Black, Fraser; Palat, Gayatri

2014-05-01

The world's global cancer burden disproportionally affects lower income countries, where 80% of patients present with late-stage disease and have limited access to palliative care and effective pain-relieving medications, such as morphine. Consequently, millions die each year with unrelieved pain. Objective. The objective of this study was to examine barriers to opioid availability and cancer pain management in India, with an emphasis on the experiences of nurses, who are often the front-line providers of palliative care. Methods. Fifty-nine participants were recruited using a purposive, snowball sampling strategy. Ethnographic data collection included in-depth, semistructured interviews (n = 54), 400+ hours of participant observation, and review of documents over 9 months at a government cancer hospital in South India. Systematic qualitative analysis led to identification of key barriers that are exemplified by representative quotes. Results. Morphine is more available at this study site than in most of India, but access is limited to patients seen by the palliative care service, and significant gaps in supply still occur. Systems to measure and improve pain outcomes are largely absent. Key barriers related to pain management include the role of nursing, opioid misperceptions, bureaucratic hurdles, and sociocultural/infrastructure challenges. Implications. Interventions must streamline process details of morphine procurement, work within the existing sociocultural infrastructure to ensure opioids reach patients most in need, target unexpected audiences for symptom management education, and account for role expectations of health care providers. Conclusion. Macro- and micro-level policy and practice changes are needed to improve opioid availability and cancer pain management in India.

An Ethnographic Study of Barriers to Cancer Pain Management and Opioid Availability in India

PubMed Central

Beck, Susan L.; Maurer, Martha; Black, Fraser; Palat, Gayatri

2014-01-01

Background. The world’s global cancer burden disproportionally affects lower income countries, where 80% of patients present with late-stage disease and have limited access to palliative care and effective pain-relieving medications, such as morphine. Consequently, millions die each year with unrelieved pain. Objective. The objective of this study was to examine barriers to opioid availability and cancer pain management in India, with an emphasis on the experiences of nurses, who are often the front-line providers of palliative care. Methods. Fifty-nine participants were recruited using a purposive, snowball sampling strategy. Ethnographic data collection included in-depth, semistructured interviews (n = 54), 400+ hours of participant observation, and review of documents over 9 months at a government cancer hospital in South India. Systematic qualitative analysis led to identification of key barriers that are exemplified by representative quotes. Results. Morphine is more available at this study site than in most of India, but access is limited to patients seen by the palliative care service, and significant gaps in supply still occur. Systems to measure and improve pain outcomes are largely absent. Key barriers related to pain management include the role of nursing, opioid misperceptions, bureaucratic hurdles, and sociocultural/infrastructure challenges. Implications. Interventions must streamline process details of morphine procurement, work within the existing sociocultural infrastructure to ensure opioids reach patients most in need, target unexpected audiences for symptom management education, and account for role expectations of health care providers. Conclusion. Macro- and micro-level policy and practice changes are needed to improve opioid availability and cancer pain management in India. PMID:24755460

Breastfeeding as a public health responsibility: a review of the evidence.

PubMed

Brown, A

2017-12-01

Although intention to breastfeed in Western culture is high, many women stop breastfeeding before they are ready. From a physiological perspective, rates of primary milk insufficiency or contraindications to breastfeed should be low. However, numerous women encounter numerous barriers to breastfeeding, many of which occur at the social, cultural and political level and are therefore outside of maternal control. This review identifies and examines the impact of these barriers and considers how public health services should play a central role in creating a supportive breastfeeding environment. A narrative review to synthesise themes in the literature was conducted, using Web of Science, PubMed and Science Direct. Barriers to breastfeeding at the societal rather than individual level were identified (e.g. in relation to health services, policies and economic factors). Only English language papers were included. Many barriers to breastfeeding exist at the societal rather than individual level. These influences are typically outside mothers' control. Five core themes were identified; the need for investment in (i) health services; (ii) population level health promotion; (iii) supporting maternal legal rights; (iv) protection of maternal wellbeing; and (v) reducing the reach of the breast milk substitute industry. Although individual support is important, breastfeeding must be considered a public health issue that requires investment at a societal level. Focusing solely on solving individual issues will not lead to the cultural changes needed to normalise breastfeeding. Countries that have adopted a multicomponent public heath strategy to increase breastfeeding levels have had significant success. These strategies must be emulated more widely. © 2017 The British Dietetic Association Ltd.

Perceived barriers to care and provider gender preferences among veteran men who have experienced military sexual trauma: a qualitative analysis.

PubMed

Turchik, Jessica A; McLean, Caitlin; Rafie, Samantha; Hoyt, Tim; Rosen, Craig S; Kimerling, Rachel

2013-05-01

Research suggests that there may be unique barriers to accessing care among men who have experienced sexual trauma. The primary goal of the current research was to elucidate potential barriers to accessing military sexual trauma (MST)-related care for male veterans. A secondary goal was to explore whether veterans have preferences regarding the gender of clinicians providing MST-related care. Qualitative analyses were used to examine data collected from semistructured interviews conducted with 20 male veterans enrolled in Veterans Health Administration care who reported MST but who had not received any MST-related mental health care. Veterans identified a number of potential barriers, with the majority of reported barriers relating to issues of stigma and gender. Regarding provider gender preferences, veterans were mixed, with 50% preferring a female provider, 25% a male provider, and 25% reporting no gender preference. These preliminary data suggest that stigma, gender, and knowledge-related barriers may exist for men regarding seeking MST-related care. Interventions to address potential barriers, such as outreach interventions and providing gender-specific psychoeducation, may increase access to care for male veterans who report MST. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Thermal model of attic systems with radiant barriers

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

Wilkes, K.E.

This report summarizes the first phase of a project to model the thermal performance of radiant barriers. The objective of this phase of the project was to develop a refined model for the thermal performance of residential house attics, with and without radiant barriers, and to verify the model by comparing its predictions against selected existing experimental thermal performance data. Models for the thermal performance of attics with and without radiant barriers have been developed and implemented on an IBM PC/AT computer. The validity of the models has been tested by comparing their predictions with ceiling heat fluxes measured inmore » a number of laboratory and field experiments on attics with and without radiant barriers. Cumulative heat flows predicted by the models were usually within about 5 to 10 percent of measured values. In future phases of the project, the models for attic/radiant barrier performance will be coupled with a whole-house model and further comparisons with experimental data will be made. Following this, the models will be utilized to provide an initial assessment of the energy savings potential of radiant barriers in various configurations and under various climatic conditions. 38 refs., 14 figs., 22 tabs.« less

Effect of electric barrier on passage and physical condition of juvenile and adult rainbow trout

USGS Publications Warehouse

Layhee, Megan J.; Sepulveda, Adam; Shaw, Amy; Smuckall, Matthew; Kapperman, Kevin; Reyes, Alejandro

2016-01-01

Electric barriers can inhibit passage and injure fish. Few data exist on electric barrier parameters that minimize these impacts and on how body size affects susceptibility, especially to nontarget fish species. The goal of this study was to determine electric barrier voltage and pulse-width settings that inhibit passage of larger bodied rainbow trout Oncorhynchus mykiss (215–410 mm fork length) while allowing passage of smaller bodied juvenile rainbow trout (52–126 mm) in a static laboratory setting. We exposed rainbow trout to 30-Hz pulsed-direct current voltage gradients (0.00–0.45 V cm−1) and pulse widths (0.0–0.7 ms) and recorded their movement, injury incidence, and mortality. No settings tested allowed all juveniles to pass while impeding all adult passage. Juvenile and adult rainbow trout avoided the barrier at higher pulse widths, and fewer rainbow trout passed the barrier at 0.7-ms pulse width compared to 0.1 ms and when the barrier was turned off. We found no effect of voltage gradient on fish passage. No mortality occurred, and we observed external bruising in 5 (7%) juvenile rainbow trout and 15 (21%) adult rainbow trout. This study may aid managers in selecting barrier settings that allow for increased juvenile passage.

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.

Caught between the global economy and local bureaucracy: the barriers to good waste management practice in South Africa.

PubMed

Godfrey, Linda; Scott, Dianne; Trois, Cristina

2013-03-01

Empirical research shows that good waste management practice in South Africa is not always under the volitional control of those tasked with its implementation. While intention to act may exist, external factors, within the distal and proximal context, create barriers to waste behaviour. In addition, these barriers differ for respondents in municipalities, private industry and private waste companies. The main barriers to implementing good waste management practice experienced by respondents in municipalities included insufficient funding for waste management and resultant lack of resources; insufficient waste knowledge; political interference in decision-making; a slow decision-making process; lack of perceived authority to act by waste staff; and a low priority afforded to waste. Barriers experienced by respondents in private industry included insufficient funding for waste and the resultant lack of resources; insufficient waste knowledge; and government bureaucracy. Whereas, barriers experienced in private waste companies included increasing costs; government bureaucracy; global markets; and availability of waste for recycling. The results suggest that respondents in public and private waste organizations are subject to different structural forces that shape, enable and constrain waste behaviour.

Barriers to education in cardiac rehabilitation within an Iranian society: a qualitative descriptive study.

PubMed

Alavi, Mousa; Irajpour, Alireza; Giles, Tracey; Rabiei, Katayoun; Sarrafzadegan, Nizal

2013-06-01

Cardiac rehabilitation programmes that include patient education aim to maximise physical, psychological and social functioning, and enable people with acute coronary syndrome to lead fulfilling and productive lives. Despite strong evidence for the benefits of patient education, various barriers exist that need to be addressed to ensure the effective delivery of care. This study explores patients/family members and health professionals' perceptions and experiences of the barriers to cardiac rehabilitation education in an Iranian context. A thematic analysis of in-depth interviews was undertaken using a constant comparative approach. Participants (10 health professionals, 15 patients/family members) were recruited from educational-medical centers and hospitals in Iran. Credibility and trustworthiness were grounded on four aspects: factual value, applicability, consistency and neutrality. Five major barriers to cardiac rehabilitation were identified relating to human resources, service provision, available educational services, unfavourable attitudes and collaboration gaps. Two main challenges exist to the provision of effective patient education; inadequate human resources in the hospital wards, specifically in terms of trained health care professionals and service users specific health related views and behaviours. Barriers to comprehensive patient education and cardiac rehabilitation in Iran must be addressed and urgent consideration should be given to the introduction and evaluation of education programmes to prepare health/support system professionals as well as service users, and cardiac rehabilitation services that employ a collaborative and individualised approach. This in turn may reduce the burden of CVD and improve the overall health and quality of life for people in Isfahan Iran.

Latino mothers’ beliefs about child weight and family health

PubMed Central

Rhee, Kyung E.; Blanco, Estela; Boutelle, Kerri

2018-01-01

Objective There is a need to address cultural beliefs and parenting practices regarding childhood obesity to design effective weight control programs for overweight/obese U.S. Latino children. The purpose of the current study was to: explore cultural beliefs about children’s weight, understand parent perceptions on feeding their children, and explore barriers that interfere with a healthy lifestyle. Study Design Four focus groups were conducted in Spanish with 41 Latino mothers of elementary school-age children from San Diego County (CA) between April and May 2011. Cultural viewpoints about overweight status among children and barriers to leading a healthy lifestyle were explored. Focus group discussions were analyzed based on a priori and emergent themes. Results Three themes were identified: mothers’ cultural beliefs about health that are barriers to family health, mothers as primary caretakers of their family’s health, and attitudes about targeting children’s weight. Mothers acknowledged the idea that “chubby is better” is a misperception, yet having a “chubby” child was preferred and even accepted. Mothers described fatalistic beliefs that contradicted existing knowledge of chronic disease and daily demands of Western culture as barriers to practicing healthy behaviors in the home as the family caretaker. Conclusion These findings may be used to inform more culturally appropriate research to address U.S. Latino health. Increasing awareness of cultural beliefs and daily circumstance could help to address obesity more directly and thereby overcome some of the potential underlying barriers that might exist when involving the children of Latino immigrant families in obesity treatment and prevention. PMID:27869046

Pharmacotherapy for alcohol dependence: perceived treatment barriers and action strategies among Veterans Health Administration service providers.

PubMed

Harris, Alex H S; Ellerbe, Laura; Reeder, Rachelle N; Bowe, Thomas; Gordon, Adam J; Hagedorn, Hildi; Oliva, Elizabeth; Lembke, Anna; Kivlahan, Daniel; Trafton, Jodie A

2013-11-01

Although access to and consideration of pharmacological treatments for alcohol dependence are consensus standards of care, receipt of these medications by patients is generally rare and highly variable across treatment settings. The goal of the present project was to survey and interview the clinicians, managers, and pharmacists affiliated with addiction treatment programs within Veterans Health Administration (VHA) facilities to learn about their perceptions of barriers and facilitators regarding greater and more reliable consideration of pharmacological treatments for alcohol dependence. Fifty-nine participants from 19 high-adopting and 11 low-adopting facilities completed the survey (facility-level response rate = 50%) and 23 participated in a structured interview. The top 4 barriers to increased consideration and use of pharmacotherapy for alcohol dependence were consistent across high- and low-adopting facilities and included perceived low patient demand, pharmacy procedures or formulary restrictions, lack of provider skills or knowledge regarding pharmacotherapy for alcohol dependence, and lack of confidence in treatment effectiveness. Low patient demand was rated as the most important barrier for oral naltrexone and disulfiram, whereas pharmacy or formulary restrictions were rated as the most important barrier for acamprosate and extended-release naltrexone. The 4 strategies rated across low- and high-adopting facilities as most likely to facilitate consideration and use of pharmacotherapy for alcohol dependence were more education to patients about existing medications, more education to health care providers about medications, increased involvement of physicians in treatment for alcohol dependence, and more compelling research on existing medications. This knowledge provides a foundation for designing, deploying, and evaluating targeted implementation efforts.

Facilitators and barriers to implementing a local policy to reduce sodium consumption in the County of Los Angeles government, California, 2009.

PubMed

Gase, Lauren N; Kuo, Tony; Dunet, Diane O; Simon, Paul A

2011-03-01

This qualitative study explores facilitators and barriers to a proposed food procurement policy that would require food purchasers, distributors, and vendors of food service in the County of Los Angeles government to meet specified nutrition standards, including limits on sodium content. We conducted 30 key informant interviews. Interviewees represented 18 organizations from the County of Los Angeles government departments that purchased, distributed, or sold food; public and private non-County entities that had previously implemented food procurement policies in their organizations; and large organizations that catered food to the County. Study participants reported 3 key facilitators: their organization's authority to impose nutrition standards, their organization's desire to provide nutritious food, and the opportunity to build on existing nutrition policies. Eight key barriers were identified: 1) unique features among food service settings, 2) costs and unavailability of low-sodium foods, 3) complexity of food service arrangements, 4) lack of consumer demand for low-sodium foods, 5) undesirable taste of low-sodium foods, 6) preference for prepackaged products, 7) lack of knowledge and experience in operationalizing sodium standards, and 8) existing multiyear contracts that are difficult to change. Despite perceived barriers, several participants indicated that their organizations have successfully implemented nutritional standards that include limits on sodium. Developing or changing policies for procuring food represents a potentially feasible strategy for reducing sodium consumption in food service venues controlled by the County of Los Angeles. The facilitators and barriers identified here can inform the formulation, adoption, implementation, and evaluation of sodium reduction policies in other jurisdictions.

Analysis of the physiotherapy industry: challenges for marketing.

PubMed

Sheppard, L

1996-01-01

The physiotherapy industry can be analysed using Porter's (1979) five forces. Physiotherapy uses medical, geographic and funding segmentation. The power of the buyers in these segments is considerable. Substitutes are posing a threat to physiotherapy with few barriers to entry to operate in the health care environment. The suppliers, particularly doctors, have significant power in referring clients. Competitive rivalry for these clients can exist between individual physiotherapists and multi-disciplinary clinics. The difference in orientation of private and public physiotherapy can also be a basis for rivalry. Repositioning to view the client as both the supplier and recipients enables the physiotherapy industry to gain competitive advantage and ensures long term growth.

Significance of independent radon entry rate and air exchange rate assessment for the purpose of radon mitigation effectiveness proper evaluation: case studies.

PubMed

Froňka, A; Jílek, K; Moučka, L; Brabec, M

2011-05-01

Two new single-family houses identified as insufficient with regard to existing radon barrier efficiency, have been selected for further examination. A complex set of radon diagnosis procedures has been applied in order to localise and quantify radon entry pathways into the indoor environment. Independent assessment of radon entry rate and air exchange rate has been carried out using the continuous indoor radon measurement and a specific tracer gas application. Simultaneous assessment of these key determining factors has turned out to be absolutely crucial in the context of major cause identification of elevated indoor radon concentration.

Depression in Home-Based Care: The Role of the Home Health Nurse.

PubMed

Groh, Carla J; Dumlao, Manuel S

2016-01-01

Depression is a major health issue among older adults receiving home-based services yet is underdiagnosed and undertreated, which can result in negative health outcomes. Despite the recognized need for improved mental health services, significant gaps and barriers exist that contribute to less than optimal home-based depression management interventions. Home healthcare clinicians are well positioned to drive this effort for improving depression care with enhanced learning. Thus, the purpose of this article is to provide guidelines on improving depression care in homebound older adults based on four clinical functions central to home healthcare: screening, assessment, medication management, and patient/family education.

Advance Care Planning: is quality end of life care really that simple?

PubMed

Johnson, Stephanie; Kerridge, Ian; Butow, Phyllis N; Tattersall, Martin H N

2017-04-01

The routine implementation of Advance Care Planning (ACP) is now a prominent feature of policy directed at improving end of life care in Australia. However, while complex ACP interventions may modestly reduce medical care at the end of life and enable more people to die at home or outside of acute hospital settings, existing legal, organisational, cultural and conceptual barriers limit the implementation and utility of ACP. We suggest that meaningful improvements in end of life care will not result from the institutionalisation of ACP but from more significant changes to the design and delivery of care. © 2017 Royal Australasian College of Physicians.

Optical control and diagnostics sensors for gas turbine machinery

NASA Astrophysics Data System (ADS)

Trolinger, James D.; Jenkins, Thomas P.; Heeg, Bauke

2012-10-01

There exists a vast range of optical techniques that have been under development for solving complex measurement problems related to gas-turbine machinery and phenomena. For instance, several optical techniques are ideally suited for studying fundamental combustion phenomena in laboratory environments. Yet other techniques hold significant promise for use as either on-line gas turbine control sensors, or as health monitoring diagnostics sensors. In this paper, we briefly summarize these and discuss, in more detail, some of the latter class of techniques, including phosphor thermometry, hyperspectral imaging and low coherence interferometry, which are particularly suited for control and diagnostics sensing on hot section components with ceramic thermal barrier coatings (TBCs).

A systematic review of barriers to medication adherence in the elderly: looking beyond cost and regimen complexity.

PubMed

Gellad, Walid F; Grenard, Jerry L; Marcum, Zachary A

2011-02-01

Medication nonadherence is a common problem among the elderly. To conduct a systematic review of the published literature describing potential nonfinancial barriers to medication adherence among the elderly. The PubMed and PsychINFO databases were searched for articles published in English between January 1998 and January 2010 that (1) described "predictors," "facilitators," or "determinants" of medication adherence or that (2) examined the "relationship" between a specific barrier and adherence for elderly patients (ie, ≥65 years of age) in the United States. A manual search of the reference lists of identified articles and the authors' files and recent review articles was conducted. The search included articles that (1) reviewed specific barriers to medication adherence and did not solely describe nonmodifiable predictors of adherence (eg, demographics, marital status), (2) were not interventions designed to address adherence, (3) defined adherence or compliance and specified its method of measurement, and (4) involved US participants only. Nonsystematic reviews were excluded, as were studies that focused specifically on people who were homeless or substance abusers, or patients with psychotic disorders, tuberculosis, or HIV infection, because of the unique circumstances that surround medication adherence for each of these populations. Nine studies met inclusion criteria for this review. Four studies used pharmacy records or claims data to assess adherence, 2 studies used pill count or electronic monitoring, and 3 studies used other methods to assess adherence. Substantial heterogeneity existed among the populations studied as well as among the measures of adherence, barriers addressed, and significant findings. Some potential barriers (ie, factors associated with nonadherence) were identified from the studies, including patient-related factors such as disease-related knowledge, health literacy, and cognitive function; drug-related factors such as adverse effects and polypharmacy; and other factors including the patient-provider relationship and various logistical barriers to obtaining medications. None of the reviewed studies examined primary nonadherence or nonpersistence. Medication nonadherence in the elderly is not well described in the literature, despite being a major cause of morbidity, and thus it is difficult to draw a systematic conclusion on potential barriers based on the current literature. Future research should focus on standardizing medication adherence measurements among the elderly to gain a better understanding of this important issue. Published by EM Inc USA.

Modeling Catastrophic Barrier Island Dynamics

NASA Astrophysics Data System (ADS)

Whitley, J. W.; McNamara, D.

2012-12-01

Barrier islands, thin strips of sand lying parallel to the mainland coastline, along the U.S. Atlantic and Gulf Coasts appear to have maintained their form for thousands of years in the face of rising sea level. The mechanisms that allow barrier islands to remain robust are transport of sediment from the ocean side of barriers to the top and backside during storms, termed island overwash, and the growth and alongshore propagation of tidal deltas near barrier island inlets. Dynamically these processes provide the necessary feedbacks to maintain a barrier island in an attractor that withstands rising sea level within a phase space of barrier island geometrical characteristics. Current barrier island configurations along the Atlantic and Gulf coasts exist among a wide range of storm climate and underlying geologic conditions and therefore the environment that forces overwash and tidal delta dynamics varies considerably. It has been suggested that barrier islands in certain locations such as those between Avon and Buxton (losing 76% of island width since 1852) and Chandeleur islands (losing 85% of its surface area since 2005) along the Atlantic and Gulf coasts, respectively, may be subject to a catastrophic shift in barrier island attractor states - more numerous inlets cutting barriers in some locations and the complete disappearance of barrier islands in other locations. In contrast to common models for barrier islands that neglect storm dynamics and often only consider cross-shore response, we use an alongshore extended model for barrier island dynamics including beach erosion, island overwash and inlet cutting during storms, and beach accretion, tidal delta growth and dune and vegetation growth between storms to explore the response of barrier islands to a wide range of environmental forcing. Results will be presented that show how barrier island attractor states are altered with variations in the rate of sea level rise, storminess, and underlying geology. We will also investigate the conditions necessary for a barrier island attractor similar to those found along the Atlantic and Gulf coasts to become unstable.

Effects of adhesive dressings on stratum corneum conductance.

PubMed

Cavallini, Maurizio; Gazzola, Riccardo; Vaienti, Luca

2012-05-01

Stratum corneum is a fundamental layer of epidermis. It acts as a barrier, with antimicrobial features, regulating skin permeability and integrity as well. Adhesive dressings and their removal could alter this layer, affecting cutaneous water balance and lipid composition of stratum corneum. These changes could be monitored by measurement of cutaneous hydration. Ninety-two patients affected by wounds dressed with adhesive tapes or plasters have been studied. Measurement of skin conductance under tape/plaster and in the surrounding healthy skin, immediately after removal of dressing has been performed. Dressing age, wound localization, and characteristics were also considered. Adhesive dressings alter significantly stratum corneum conductance. Although healthy skin hydration has significant variations throughout the body, cutaneous conductance under adhesive dressing in different areas displays no significative changes. Moreover, the increase in hydration due to adhesive tapes/plasters showed no association with wound dehiscence. Adhesive dressings cause a significative increase in stratum corneum conductance, acting as a barrier to apocrine secretions. Although different hydration levels have been observed in healthy skin throughout the body, no difference exists under adhesive dressing among different regions, suggesting no contraindications in their employment throughout the body. Increase in cutaneous hydration showed no correlations with wound dehiscence, thus confirming safety and practicality of these dressings. © 2011 John Wiley & Sons A/S.

'Is it the crime of the century?': factors for psychiatrists and service users that influence the long-term prescription of hypnosedatives.

PubMed

MacDonald, Joanna; Garvie, Christopher; Gordon, Sarah; Huthwaite, Mark; Mathieson, Fiona; Wood, Amber-Jane; Romans, Sarah

2015-07-01

Given the longstanding controversy about hypnosedative use, we aimed to investigate the attitudes of prescribing psychiatrists and service users towards long-term use of hypnosedative medication, and their perceptions of barriers to evidence-based nonmedication alternatives. Qualitative data from focus groups in Aotearoa/NZ were analysed thematically. A novel research design involved a service user researcher contributing throughout the research design and process. Service users and psychiatrists met to discuss each other's views, initially separately, and subsequently together. Analysis of the data identified four key themes: the challenge, for both parties, of sleep disturbance among service users with mental health problems; the conceptual and ethical conflicts for service users and psychiatrists in managing this challenge; the significant barriers to service users accessing evidence-based nonmedication alternatives; and the initial sense of disempowerment, shared by both service users and psychiatrists, which was transformed during the research process. Our results raise questions about the relevance of the existing guidelines for this group of service users, highlight the resource and time pressures that discourage participants from embarking on withdrawal regimes and education programmes on alternatives, highlight the lack of knowledge about alternatives and reflect the complex interaction between sleep and mental health problems, which poses a significant dilemma for service users and psychiatrists.

African trypanosomes and brain infection - the unsolved question.

PubMed

Mogk, Stefan; Boßelmann, Christian M; Mudogo, Celestin N; Stein, Jasmin; Wolburg, Hartwig; Duszenko, Michael

2017-08-01

African trypanosomes induce sleeping sickness. The parasites are transmitted during the blood meal of a tsetse fly and appear primarily in blood and lymph vessels, before they enter the central nervous system. During the latter stage, trypanosomes induce a deregulation of sleep-wake cycles and some additional neurological disorders. Historically, it was assumed that trypanosomes cross the blood-brain barrier and settle somewhere between the brain cells. The brain, however, is a strictly controlled and immune-privileged area that is completely surrounded by a dense barrier that covers the blood vessels: this is the blood-brain barrier. It is known that some immune cells are able to cross this barrier, but this requires a sophisticated mechanism and highly specific cell-cell interactions that have not been observed for trypanosomes within the mammalian host. Interestingly, trypanosomes injected directly into the brain parenchyma did not induce an infection. Likewise, after an intraperitoneal infection of rats, Trypanosoma brucei brucei was not observed within the brain, but appeared readily within the cerebrospinal fluid (CSF) and the meninges. Therefore, the parasite did not cross the blood-brain barrier, but the blood-CSF barrier, which is formed by the choroid plexus, i.e. the part of the ventricles where CSF is produced from blood. While there is no question that trypanosomes are able to invade the brain to induce a deadly encephalopathy, controversy exists about the pathway involved. This review lists experimental results that support crossing of the blood-brain barrier and of the blood-CSF barrier and discuss the implications that either pathway would have on infection progress and on the survival strategy of the parasite. For reasons discussed below, we prefer the latter pathway and suggest the existence of an additional distinct meningeal stage, from which trypanosomes could invade the brain via the Virchow-Robin space thereby bypassing the blood-brain barrier. We also consider healthy carriers, i.e. people living symptomless with the disease for up to several decades, and discuss implications the proposed meningeal stage would have for new anti-trypanosomal drug development. Considering the re-infection of blood, a process called relapse, we discuss the likely involvement of the newly described glymphatic connection between the meningeal space and the lymphatic system, that seems also be important for other infectious diseases. © 2016 Cambridge Philosophical Society.

Investigation of the Mechanical Performance of Compliant Thermal Barriers

NASA Technical Reports Server (NTRS)

DeMange, Jeffrey J.; Bott, Robert J.; Dunlap, Patrick H.

2011-01-01

Compliant thermal barriers play a pivotal role in the thermal protection systems of advanced aerospace vehicles. Both the thermal properties and mechanical performance of these barriers are critical in determining their successful implementation. Due to the custom nature of many thermal barriers, designers of advanced spacecraft have little guidance as to the design, selection, and implementation of these elements. As part of an effort to develop a more fundamental understanding of the interrelationship between thermal barrier design and performance, mechanical testing of thermal barriers was conducted. Two different types of thermal barriers with several core insulation density levels ranging from 62 to 141 kg/cu m were investigated. Room-temperature compression tests were conducted on samples to determine load performance and assess thermal barrier resiliency. Results showed that the loading behavior of these thermal barriers was similar to other porous, low-density, compliant materials, such as elastomeric foams. Additionally, the insulation density level had a significant non-linear impact on the stiffness and peak loads of the thermal barriers. In contrast, neither the thermal barrier type nor the level of insulation density significantly influenced the room-temperature resiliency of the samples.

Apoplastic domains and sub-domains in the shoots of etiolated corn seedlings

NASA Technical Reports Server (NTRS)

Epel, B. L.; Bandurski, R. S.

1990-01-01

Light Green, an apoplastic probe, was applied to the cut mesocotyl base or to the cut coleoptile apex of etiolated seedlings of Zea mays L. cv. Silver Queen. Probe transport was measured and its tissue distribution determined. In the mesocotyl, there is an apoplastic barrier between cortex and stele. This barrier creates two apoplastic domains which are non-communicating. A kinetic barrier exists between the apoplast of the mesocotyl stele and that of the coleoptile. This kinetic barrier is not absolute and there is limited communication between the apoplasts of the two regions. This kinetic barrier effectively creates two sub-domains. In the coleoptile, there is communication between the apoplast of the vascular strands and that of the surrounding cortical tissue. No apoplastic communication was observed between the coleoptile cortex and the mesocotyl cortex. Thus, the apoplastic space of the coleoptile cortex is a sub-domain of the integrated coleoptile domain and is separate from that of the apoplastic domain of the mesocotyl cortex.

Determining Barriers to Use of Edible School Gardens in Illinois.

PubMed

Loftus, Lucy; Spaulding, Aslihan D; Steffen, Richard; Kopsell, Dave; Nnakwe, Nweze

2017-01-01

The objective of this study was to gather data regarding the awareness, perceived benefits, interest in, and barriers to establishment of edible school gardens in Illinois public schools. Setting/Design: This study used an online survey design. Participants included Illinois public elementary school principals and superintendents. Region and community population, current edible garden use, perception (Likert scale) of garden benefits, interest in establishment of a school edible garden, and barriers to establishment of a school edible garden were the variables of interest. Logit regression and Kruskal-Wallis with follow-up where p < 0.05 were performed. Elementary school principals and superintendents are aware of gardens and their potential benefits to students, but many barriers exist that make their use challenging. Funding, staff and volunteer support, and class time were identified as the major barriers. Region affected likelihood of garden use, and community population size also affected the odds of having an edible school garden. Data suggest that edible garden use would increase with provision of resources and organization of dedicated supporters.

Migration mechanisms and diffusion barriers of vacancies in Ga2O3

NASA Astrophysics Data System (ADS)

Kyrtsos, Alexandros; Matsubara, Masahiko; Bellotti, Enrico

2017-06-01

We employ the nudged elastic band and the dimer methods within the standard density functional theory (DFT) formalism to study the migration of the oxygen and gallium vacancies in the monoclinic structure of β -Ga2O3 . We identify all the first nearest neighbor paths and calculate the migration barriers for the diffusion of the oxygen and gallium vacancies. We also identify the metastable sites of the gallium vacancies which are critical for the diffusion of the gallium atoms. The migration barriers for the diffusion of the gallium vacancies are lower than the migration barriers for oxygen vacancies by 1 eV on average, suggesting that the gallium vacancies are mobile at lower temperatures. Using the calculated migration barriers we estimate the annealing temperature of these defects within the harmonic transition state theory formalism, finding excellent agreement with the observed experimental annealing temperatures. Finally, we suggest the existence of percolation paths which enable the migration of the species without utilizing all the migration paths of the crystal.

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.

Iranian entrepreneur nurses' perceived barriers to entrepreneurship: A qualitative study.

PubMed

Jahani, Simin; Abedi, Heidarali; Elahi, Nasrin; Fallahi-Khoshknab, Masoud

2016-01-01

To respond efficiently to the increasing and new needs of people in health issues, it is necessary for nurses to develop their knowledge from hospital to society and to be equipped to play entrepreneur role in different levels of care. The present study was conducted to describe Iranian entrepreneur nurses' perceived barriers to entrepreneurship, in order to identify the existing barriers. This is a qualitative study in which Graneheim and Lundman's content analysis method was employed. Thirteen entrepreneur nurses were chosen purposively, and data were gathered by unstructured interviews. As a result of the data analysis, five major themes were extracted: Traditional nursing structure, legal limitations, traditional attitudes of governmental managers, unprofessional behaviors of colleagues, and immoral business. The findings of the present study show that Iranian nurses are confronted with various problems and barriers to enter entrepreneur nursing and keep going in this area. By focusing on such barriers and applying appropriate changes, policymakers and planners in health can facilitate nurses entering into this activity.

Everybody wants it done but nobody wants to do it: an exploration of the barrier and enablers of critical components towards creating a clinical pathway for anxiety and depression in cancer.

PubMed

Rankin, Nicole M; Butow, Phyllis N; Thein, Thida; Robinson, Tracy; Shaw, Joanne M; Price, Melanie A; Clover, Kerrie; Shaw, Tim; Grimison, Peter

2015-01-22

This study aimed to explore barriers to and enablers for future implementation of a draft clinical pathway for anxiety and depression in cancer patients in the Australian context. Health professionals reviewed a draft clinical pathway and participated in qualitative interviews about the delivery of psychosocial care in their setting, individual components of the draft pathway, and barriers and enablers for its future implementation. Five interrelated themes were identified: ownership; resources and responsibility; education and training; patient reluctance; and integration with health services beyond oncology. The five themes were perceived as both barriers and enablers and provide a basis for an implementation plan that includes strategies to overcome barriers. The next steps are to design and deliver the clinical pathway with specific implementation strategies that address team ownership, endorsement by leaders, education and training modules designed for health professionals and patients and identify ways to integrate the pathway into existing cancer services.

Monitoring engineered remediation with borehole radar

USGS Publications Warehouse

Lane, J.W.; Day-Lewis, F. D.; Joesten, P.K.

2007-01-01

The success of engineered remediation is predicated on correct emplacement of either amendments (e.g., vegetable-oil emulsion, lactate, molasses, etc.) or permeable reactive barriers (e.g., vegetable oil, zero-valent iron, etc.) to enhance microbial or geochemical breakdown of contaminants and treat contaminants. Currently, site managers have limited tools to provide information about the distribution of injected materials; the existence of gaps or holes in barriers; and breakdown or transformation of injected materials over time. ?? 2007 Society of Exploration Geophysicists.

A nanoscale perspective on the effects of transverse microprestress on drying creep of nanoporous solids

NASA Astrophysics Data System (ADS)

Sinko, Robert; Bažant, Zdeněk P.; Keten, Sinan

2018-01-01

The Pickett effect describes the excess non-additive strain developed during drying of a nanoporous solid material under creep. One explanation for its origins, developed using micromechanical models, is the progressive relaxation of internally developed microprestress. However, these models have not explicitly considered the effects of this microprestress on nanoscale energy barriers that govern the relative motion and displacement between nanopore walls during deformation. Here, we evaluate the nanoscale effects of transverse microprestresses on the drying creep behaviour of a nanoscale slit pore using coarse-grained molecular dynamics. We find that the underlying energy barrier depends exponentially on the transverse microprestress, which is attributed to changes in the effective viscosity and degree of nanoconfinement of molecules in the water interlayer. Specifically, as the transverse microprestress is relaxed (i.e. its magnitude decreases), the activation energy barrier is reduced, thereby leading to an acceleration of the creep behaviour and a stronger Pickett effect. Based on our simulation results, we introduce a new microprestress-dependent energy term into our existing Arrhenius model, which describes the relative displacement of pore walls as a function of the underlying activation energy barriers. Our findings further verify the existing micromechanical theories for the origin of the Pickett effect and establish a quantitative relationship between the transverse microprestress and the intensity of the Pickett effect.

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

PubMed

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

2010-11-01

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

Roadblocks in the gut: barriers to enteric infection.

PubMed

Gill, Navkiran; Wlodarska, Marta; Finlay, B Brett

2011-05-01

This review discusses the barriers an enteric pathogen encounters when establishing an infection in the intestinal tract. There are potential barriers in the lumen that increase competition for nutrients and space. The role of mucus layer, and the antimicrobial peptides and secretory IgA sequestered within it, are also significant barriers. After overcoming these defences, the pathogen encounters the epithelial layer. This layer can be broken down into various protective components including enterocytes, Paneth cells, goblet cells, M cells and pathogen recognition receptors. Collectively, these intestinal defences constitute significant barriers that pathogens must overcome to successfully colonize this important mucosal surface. © 2011 Blackwell Publishing Ltd.

Genetic and Transcriptomic Bases of Intestinal Epithelial Barrier Dysfunction in Inflammatory Bowel Disease.

PubMed

Vancamelbeke, Maaike; Vanuytsel, Tim; Farré, Ricard; Verstockt, Sare; Ferrante, Marc; Van Assche, Gert; Rutgeerts, Paul; Schuit, Frans; Vermeire, Séverine; Arijs, Ingrid; Cleynen, Isabelle

2017-10-01

Intestinal barrier defects are common in patients with inflammatory bowel disease (IBD). To identify which components could underlie these changes, we performed an in-depth analysis of epithelial barrier genes in IBD. A set of 128 intestinal barrier genes was selected. Polygenic risk scores were generated based on selected barrier gene variants that were associated with Crohn's disease (CD) or ulcerative colitis (UC) in our study. Gene expression was analyzed using microarray and quantitative reverse transcription polymerase chain reaction. Influence of barrier gene variants on expression was studied by cis-expression quantitative trait loci mapping and comparing patients with low- and high-risk scores. Barrier risk scores were significantly higher in patients with IBD than controls. At single-gene level, the associated barrier single-nucleotide polymorphisms were most significantly enriched in PTGER4 for CD and HNF4A for UC. As a group, the regulating proteins were most enriched for CD and UC. Expression analysis showed that many epithelial barrier genes were significantly dysregulated in active CD and UC, with overrepresentation of mucus layer genes. In uninflamed CD ileum and IBD colon, most barrier gene levels restored to normal, except for MUC1 and MUC4 that remained persistently increased compared with controls. Expression levels did not depend on cis-regulatory variants nor combined genetic risk. We found genetic and transcriptomic dysregulations of key epithelial barrier genes and components in IBD. Of these, we believe that mucus genes, in particular MUC1 and MUC4, play an essential role in the pathogenesis of IBD and could represent interesting targets for treatment.

The North Carolina Coastal Geology Cooperative-a Model of Federal, State, and Academic Cooperation

NASA Astrophysics Data System (ADS)

Hoffman, C. W.; Thieler, E. R.; Riggs, S. R.; Schwab, W. C.

2002-12-01

In June 1999, The U.S. and N.C. Geological Surveys hosted a meeting of coastal geologists and engineers to identify coastal geological issues of greatest importance to North Carolina and to explore the possibility of initiating a cooperative research program to address these issues. Several factors came together to allow a coordinated program to develop: keen state interest in coastal hazards following several significant hurricanes, interest on the part of the USGS in combining work in North Carolina with a similar program in South Carolina, and recognition of the strong knowledge base that existed within the coastal scientific community in N.C. The meeting resulted in a strong consensus for comprehensive study of the entire coastal system and for initiating work in the northern coastal region (the Quaternary section east of the Suffolk Scarp, focusing on the barrier-island and estuarine system). Among the most important issues to be addressed by the data and knowledge developed from this program are: coastal and estuarine shoreline erosion (controls on erosion rates, sediment transport, response of wetlands to sea level rise); sand resources (location, quality, and quantity of offshore, estuarine, or onshore sand); storm impacts (barrier island/inlet migration, estuarine water movement, relative stability of barrier island segments); sea level change (history and potential impacts); water resources (surface and groundwater); habitat (ability to sustain uses, trends, threats). The cooperative will provide a strong science foundation for management of the N.C. coastal zone. Endorsements, support, and cooperation have come from the N.C. Coastal Resources Commission, several state and federal resource agencies, and local government units who all have an interest in information the program is producing. Supplemental federal appropriations have resulted from such support and the National Park Service has provided partnership funding. Additional partnership opportunities exist and are being pursued with the Army Corps of Engineers (two feasibility studies are active in the project area), the N.C. Outer Banks Task Force, and U.S. Minerals Management Service.

A New Phylogeographic Pattern of Endemic Bufo bankorensis in Taiwan Island Is Attributed to the Genetic Variation of Populations

PubMed Central

Yu, Teng-Lang; Lin, Hung-Du; Weng, Ching-Feng

2014-01-01

Aim To comprehend the phylogeographic patterns of genetic variation in anurans at Taiwan Island, this study attempted to examine (1) the existence of various geological barriers (Central Mountain Ranges, CMRs); and (2) the genetic variation of Bufo bankorensis using mtDNA sequences among populations located in different regions of Taiwan, characterized by different climates and existing under extreme conditions when compared available sequences of related species B. gargarizans of mainland China. Methodology/Principal Findings Phylogenetic analyses of the dataset with mitochondrial DNA (mtDNA) D-loop gene (348 bp) recovered a close relationship between B. bankorensis and B. gargarizans, identified three distinct lineages. Furthermore, the network of mtDNA D-loop gene (564 bp) amplified (279 individuals, 27 localities) from Taiwan Island indicated three divergent clades within B. bankorensis (Clade W, E and S), corresponding to the geography, thereby verifying the importance of the CMRs and Kaoping River drainage as major biogeographic barriers. Mismatch distribution analysis, neutrality tests and Bayesian skyline plots revealed that a significant population expansion occurred for the total population and Clade W, with horizons dated to approximately 0.08 and 0.07 Mya, respectively. These results suggest that the population expansion of Taiwan Island species B. bankorensis might have resulted from the release of available habitat in post-glacial periods, the genetic variation on mtDNA showing habitat selection, subsequent population dispersal, and co-distribution among clades. Conclusions The multiple origins (different clades) of B. bankorensis mtDNA sequences were first evident in this study. The divergent genetic clades found within B. bankorensis could be independent colonization by previously diverged lineages; inferring B. bankorensis originated from B. gargarizans of mainland China, then dispersal followed by isolation within Taiwan Island. Highly divergent clades between W and E of B. bankorensis, implies that the CMRs serve as a genetic barrier and separated the whole island into the western and eastern phylogroups. PMID:24853679

Influence of Barrier Wind Forcing on Heat Delivery Toward the Greenland Ice Sheet

NASA Astrophysics Data System (ADS)

Fraser, Neil J.; Inall, Mark E.

2018-04-01

A high-resolution numerical hydrodynamic model of Kangerdlugssuaq Fjord and the adjacent southeast Greenland shelf region was constructed in order to investigate the dynamics of fjord-shelf exchange. Recent studies have suggested that rapid exchange flows, driven by along-shelf barrier wind events, are the dominant agent of exchange between fjord and shelf. These events are prone to occur during the winter, when freshwater forcing is minimal and observations of the fjord interior are scarce. Subglacial freshwater discharge was held at zero, so that any buoyancy-driven overturning circulation was driven by melting alone. The model described a geostrophically balanced background flow transporting water masses between the fjord mouth and the glacier terminus, indicating that rotational effects are of order-one importance. Barrier wind events were found to trigger coastally trapped internal wave activity within fjord, temporarily enhancing exchange and vertical mixing, and causing warm water to oscillate in the along-fjord direction. These internal waves were also found to enhance the background flow via Stokes' drift. Heat delivery through the fjord mouth was smaller than that recorded in summer observations, however the system is more effective at delivering this heat to the head of the fjord. There exists the potential for wintertime melting at the ice-ocean interface to be significant to the same order as summertime melting.

Distribution of endogenous albumin in the glomerular wall of proteinuric patients.

PubMed Central

Russo, P. A.; Bendayan, M.

1990-01-01

Glomerular proteinuria seems to be related, in part, to loss or impairment of the normal barrier function of the glomerular capillary wall. To investigate the functional properties of this barrier, endogenous albumin was revealed in the glomerular wall of proteinuric patients and compared with a nonproteinuric control by immunoelectron microscopy using the protein A-gold method. In the control biopsy, peaks of albumin accumulation were noted in the subendothelial area and in the inner portion of the lamina densa, with gradual tapering of the distribution toward the epithelial side of the basement membrane. The urinary space and epithelial cells were weakly labeled. In tissues from proteinuric patients, albumin was distributed throughout the entire width of the glomerular basement membrane, although the pattern of accumulation varied between patients. The urinary space showed significant labeling associated with some flocculent material. Mesangial areas were heavily labeled in tissues from both control and proteinuric patients. In the latter, lysozomes in glomerular and tubular epithelial cells also accumulated albumin, which is evidence of reabsorption. These results reveal the existence, in normal conditions, of a barrier located in the subendothelial area of the glomerular basement membrane, the loss of which, as in the idiopathic nephrotic syndrome, leads to diffuse distribution of albumin in the glomerular capillary wall. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 PMID:2260634

Blood-C.S.F. barriers dysfunction in the chronic organic brain syndrome; a R.I.A. study.

PubMed

Vardi, Y; Czerniak, P; Rabey, Y; Flechter, S; Boruchowsky, S; Streifler, M

1978-01-01

C.S.F. samples of 35 patients, who suffered from verified chronic, non-tumorous organic brain syndrome, were radioimmunoassayed for T4 and T.S.H., and were compared to C.S.F.-R.I.A. samples from a control group of patients who underwent myelography because of lumbar disc. In addition T4 and T.S.H. plasma levels were evaluated in the O.B.S. patients. C.S.F. T4 and T.S.H. levels were significantly higher in 65% of the O.B.S. group of patients than those of the control group. The average determinations for T4 were: 0.77 muh/100 ml in O.B.S. group as against 0--0.4 micrograms/100 ml in the C.S.F.'s of the control group. P greater than 0,001 T.S.H. C.S.F. levels were 1.33 microU/ml in the O.B.S. group, and 0--0.6 microU/ml in the control group (P greater than 0.005). It is suggested that the elevated R.I.A. values of these hormones in the C.S.F. of the O.B.S. patients reflect a disruption of blood-C.S.F. barriers. Therefore in the organic brain syndrome there seems to exist a pathophysiological dysfunction of brain barriers in addition of the neural damage.

Assailant Identity and Self-Reported Nondisclosure of Military Sexual Trauma in Partnered Women Veterans.

PubMed

Blais, Rebecca K; Brignone, Emily; Fargo, Jamison D; Galbreath, Nathan W; Gundlapalli, Adi V

2017-10-09

Department of Veterans Affairs estimates of military sexual trauma (MST) suggest 27% of female veterans have experienced MST. However, Department of Defense data (Department of Defense, 2014) show that a subgroup of active-duty women do not report sexual assaults to a military authority, suggesting barriers to disclosure exist among military samples. No study of female veterans has examined rates of nondisclosure among those with previous screens for MST; these data could inform screening efforts and establishment of safe havens for candid disclosures. Using an explanatory sequential mixed-methods survey, a history of MST, and postservice MST disclosures during screening and their associations with demographic, assault, and screening-setting characteristics were evaluated in 359 female veterans. Open-ended responses regarding barriers to disclosure were analyzed using editing analysis style. Eighty-one percent (n = 289) reported MST. Of these, 50% (n = 143) reported a prior screening and 25% (n = 35) reported they did not disclose their true MST status. Veterans who experienced MST by a unit-member assailant were significantly less likely to disclose (adjusted odds ratio = 4.75, 95% confidence interval = 1.20-18.30). Disclosure barriers included stigma, experiential avoidance, and discomfort with the screening setting. Creative interventions to reduce nondisclosure among female veterans, with specific attention to those assaulted by a unit member, are urgently needed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Resource Effective Strategies to Prevent and Treat Cardiovascular Disease

PubMed Central

Schwalm, Jon-David; McKee, Martin; Huffman, Mark D.; Yusuf, Salim

2016-01-01

Cardiovascular disease (CVD) is the leading cause of global deaths, with the majority occurring in low- and middle-income countries (LMIC). The primary and secondary prevention of CVD is suboptimal throughout the world, but the evidence-practice gaps are much more pronounced in LMIC. Barriers at the patient, health-care provider, and health system level prevent the implementation of optimal primary and secondary prevention. Identification of the particular barriers that exist in resource-constrained settings is necessary to inform effective strategies to reduce the identified evidence-practice gaps. Furthermore, targeting modifiable factors that contribute most significantly to the global burden of CVD, including tobacco use, hypertension, and secondary prevention for CVD will lead to the biggest gains in mortality reduction. We review a select number of novel, resource-efficient strategies to reduce premature mortality from CVD, including: (1) effective measures for tobacco control; (2) implementation of simplified screening and management algorithms for those with or at risk of CVD, (3) increasing the availability and affordability of simplified and cost-effective treatment regimens including combination CVD preventive drug therapy, and (4) simplified delivery of health care through task-sharing (non-physician health workers) and optimizing self-management (treatment supporters). Developing and deploying systems of care that address barriers related to the above, will lead to substantial reductions in CVD and related mortality. PMID:26903017

Involving Scientists in Outreach: Incentives, Barriers, and Recommendations from Research Findings

NASA Astrophysics Data System (ADS)

Melton, G.; Laursen, S.; Andrews, E.; Weaver, A.; Hanley, D.; Shamatha, J. H.

2004-12-01

Public agencies that fund scientific research are increasingly requiring that researchers invest some of their funding in education or outreach activities that have a "broader impact." Yet barriers exist that inhibit scientists' motivation to participate in K-12 outreach. We will share findings from a quantitative and qualitative study that examined the motivations, rewards, and obstacles for scientists who participate in outreach. We found that most researchers became interested in doing outreach out of a desire to contribute and an expectation of having fun and enjoying the experience. They typically gave outreach presentations away from work, acted as a resource for school teachers, or helped with teacher professional development. However, scientists viewed outreach as a form of volunteer work that was auxiliary to their other responsibilities. Thus, time constraints, a lack of information about outreach opportunities, and the lower value placed on outreach by departments constituted significant barriers to their participation. Scientists involved in outreach typically found their efforts to be rewarding, but occasionally factors left a negative impression, such as poor audience response, classroom management difficulties, organizational problems, or demonstrations not going as planned. Based upon our findings, we offer recommendations on how scientists' participation and experiences in K-12 outreach can be improved, including how to successfully recruit scientists, create a positive outreach experience, and increase institutional support for outreach work.

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

PubMed Central

Ronaldson, Patrick T.; Davis, Thomas P.

2014-01-01

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

Physician smoking status, attitudes toward smoking, and cessation advice to patients: an international survey.

PubMed

Pipe, Andrew; Sorensen, Michelle; Reid, Robert

2009-01-01

The smoking status of physicians can impact interactions with patients about smoking. The 'Smoking: The Opinions of Physicians' (STOP) survey examined whether an association existed between physician smoking status and beliefs about smoking and cessation and a physician's clinical interactions with patients relevant to smoking cessation, and perceptions of barriers to assisting with quitting. General and family practitioners across 16 countries were surveyed via telephone or face-to-face interviews using a convenience-sample methodology. Physician smoking status was self-reported. Of 4473 physicians invited, 2836 (63%) participated in the survey, 1200 (42%) of whom were smokers. Significantly fewer smoking than non-smoking physicians volunteered that smoking was a harmful activity (64% vs 77%; P<0.001). More non-smokers agreed that smoking cessation was the single biggest step to improving health (88% vs 82%; P<0.001) and discussed smoking at every visit (45% vs 34%; P<0.001). Although more non-smoking physicians identified willpower (37% vs 32%; P<0.001) and lack of interest (28% vs 22%; P<0.001) as barriers to quitting, more smoking physicians saw stress as a barrier (16% vs 10%; P<0.001). Smoking physicians are less likely to initiate cessation interventions. There is a need for specific strategies to encourage smoking physicians to quit, and to motivate all practitioners to adopt systematic approaches to assisting with smoking cessation.

Improving the management and care of refugees in Australian hospitals: a descriptive study.

PubMed

Ross, Lindsey; Harding, Catherine; Seal, Alexa; Duncan, Geraldine

2016-01-01

Objectives The aim of the present study was to investigate healthcare provider perceptions of the impact of refugee patients at two public hospitals, one rural and one urban, in designated refugee resettlement areas. Healthcare professionals' views regarding improvements that could be made in this area were also sought. Methods Two-page anonymous questionnaires containing demographic, quantitative and open-ended questions were distributed to 150 healthcare providers at each research site. Results Response rates at the rural and urban sites were 50% and 49%, respectively. Refugees were seen at least monthly by 40% of respondents. Additional support was requested by 70% of respondents. Confidence was associated with being born overseas (P=0.029) and increased time working with refugees (r s =0.418, P<0.001). Only 47% of respondents felt confident managing social and psychological needs of refugees. Midwives saw refugees more than nursing and allied healthcare staff combined, and this was significant at the rural hospital (P<0.001). Rural respondents reported that working with refugees enhanced their practice (P=0.025), although felt significantly less confident (P<0.001) than urban respondents. Themes that arose regarding barriers to care included language and cultural barriers, paucity of knowledge and issues accessing available services, including appropriate interpreters, Medicare eligibility and patient factors, including lack of patient trust in government systems. Desire for support was more pronounced in the rural setting (P=0.001). Conclusions Refugees were seen frequently in both settings and most respondents requested additional support, highlighting that caring for refugees in Australian hospitals is a significant challenge. Additional support and education should be targeted to those caring for refugees most frequently, particularly midwifery services, to reduce barriers to care. What is known about the topic? Refugees are a vulnerable group, often with complex health needs. These needs are often unmet because of issues including language and cultural barriers. What does this paper add? Refugees were seen frequently in the two public hospital settings involved in the present study and most often by midwifery services. Healthcare professionals require more support, more information about available services and better access to interpreter services. These issues were more pronounced in the rural setting where very limited research exists. What are the implications for practitioners? Implementing additional support and education regarding refugee health needs could increase knowledge and confidence when managing refugees, reducing barriers to care and improving quality of care.

Access and utilisation of maternity care for disabled women who experience domestic abuse: a systematic review

PubMed Central

2014-01-01

Background Although disabled women are significantly more likely to experience domestic abuse during pregnancy than non-disabled women, very little is known about how maternity care access and utilisation is affected by the co-existence of disability and domestic abuse. This systematic review of the literature explored how domestic abuse impacts upon disabled women’s access to maternity services. Methods Eleven articles were identified through a search of six electronic databases and data were analysed to identify: the factors that facilitate or compromise access to care; the consequences of inadequate care for pregnant women’s health and wellbeing; and the effectiveness of existing strategies for improvement. Results Findings indicate that a mental health diagnosis, poor relationships with health professionals and environmental barriers can compromise women’s utilisation of maternity services. Domestic abuse can both compromise, and catalyse, access to services and social support is a positive factor when accessing care. Delayed and inadequate care has adverse effects on women’s physical and psychological health, however further research is required to fully explore the nature and extent of these consequences. Only one study identified strategies currently being used to improve access to services for disabled women experiencing abuse. Conclusions Based upon the barriers and facilitators identified within the review, we suggest that future strategies for improvement should focus on: understanding women’s reasons for accessing care; fostering positive relationships; being women-centred; promoting environmental accessibility; and improving the strength of the evidence base. PMID:25029907

Absorption enhancement in type-II coupled quantum rings due to existence of quasi-bound states

NASA Astrophysics Data System (ADS)

Hsieh, Chi-Ti; Lin, Shih-Yen; Chang, Shu-Wei

2018-02-01

The absorption of type-II nanostructures is often weaker than type-I counterpart due to spatially separated electrons and holes. We model the bound-to-continuum absorption of type-II quantum rings (QRs) using a multiband source-radiation approach using the retarded Green function in the cylindrical coordinate system. The selection rules due to the circular symmetry for allowed transitions of absorption are utilized. The bound-tocontinuum absorptions of type-II GaSb coupled and uncoupled QRs embedded in GaAs matrix are compared here. The GaSb QRs act as energy barriers for electrons but potential wells for holes. For the coupled QR structure, the region sandwiched between two QRs forms a potential reservoir of quasi-bound electrons. Electrons in these states, though look like bound ones, would ultimately tunnel out of the reservoir through barriers. Multiband perfectly-matched layers are introduced to model the tunneling of quasi-bound states into open space. Resonance peaks are observed on the absorption spectra of type-II coupled QRs due to the formation of quasi-bound states in conduction bands, but no resonance exist in the uncoupled QR. The tunneling time of these metastable states can be extracted from the resonance and is in the order of ten femtoseconds. Absorption of coupled QRs is significantly enhanced as compared to that of uncoupled ones in certain spectral windows of interest. These features may improve the performance of photon detectors and photovoltaic devices based on type-II semiconductor nanostructures.

The effect of implementing a care coordination program on team dynamics and the patient experience.

PubMed

Di Capua, Paul; Clarke, Robin; Tseng, Chi-Hong; Wilhalme, Holly; Sednew, Renee; McDonald, Kathryn M; Skootsky, Samuel A; Wenger, Neil

2017-08-01

Care coordination programs are frequently implemented in the redesign of primary care systems, focused on improving patient outcomes and reducing utilization. However, redesign can be disruptive, affect patient experiences, and undermine elements in the patient-centered medical home, such as team-based care. Case-controlled study with difference-in-differences (DID) and cross-sectional analyses. The phased implementation of a care coordination program permitted evaluation of a natural experiment to compare measures of patient experience and teamwork in practices with and without care coordinators. Patient experience scores were compared before and after the introduction of care coordinators, using DID analyses. Cross-sectional data were used to compare teamwork, based on the relational coordination survey, and physician-perceived barriers to coordinated care between clinics with and without care coordinators. We evaluated survey responses from 459 staff and physicians and 13,441 patients in 26 primary care practices. Practices with care coordinators did not have significantly different relational coordination scores compared with practices without care coordinators, and physicians in these practices did not report reduced barriers to coordinated care. After implementation of the program, patients in practices with care coordinators reported a more positive experience with staff over time (DID, 2.6 percentage points; P = .0009). A flexible program that incorporates care coordinators into the existing care team was minimally disruptive to existing team dynamics, and the embedded care coordinators were associated with a small increase in patient ratings that reflected a more positive experience with staff.

The status of live viral vaccination in early life.

PubMed

Gans, Hayley A

2013-05-17

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

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

PubMed

Ajayi, Alex A; Syed, Moin

2014-10-01

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

Diffusion barrier properties of single- and multilayered quasi-amorphous tantalum nitride thin films against copper penetration

NASA Astrophysics Data System (ADS)

Chen, G. S.; Chen, S. T.

2000-06-01

Tantalum-related thin films containing different amounts of nitrogen are sputter deposited at different argon-to-nitrogen flow rate ratios on (100) silicon substrates. Using x-ray diffractometry, transmission electron microscopy, composition and resistivity analyses, and bending-beam stress measurement technique, this work examines the impact of varying the nitrogen flow rate, particularly on the crystal structure, composition, resistivity, and residual intrinsic stress of the deposited Ta2N thin films. With an adequate amount of controlled, reactive nitrogen in the sputtering gas, thin films of the tantalum nitride of nominal formula Ta2N are predominantly amorphous and can exist over a range of nitrogen concentrations slightly deviated from stoichiometry. The single-layered quasi-amorphous Ta2N (a-Ta2N) thin films yield intrinsic compressive stresses in the range 3-5 GPa. In addition, the use of the 40-nm-thick a-Ta2N thin films with different nitrogen atomic concentrations (33% and 36%) and layering designs as diffusion barriers between silicon and copper are also evaluated. When subjected to high-temperature annealing, the single-layered a-Ta2N barrier layers degrade primarily by an amorphous-to-crystalline transition of the barrier layers. Crystallization of the single-layered stoichiometric a-Ta2N (Ta67N33) diffusion barriers occurs at temperatures as low as 450 °C. Doing so allows copper to preferentially penetrate through the grain boundaries or thermal-induced microcracks of the crystallized barriers and react with silicon, sequentially forming {111}-facetted pyramidal Cu3Si precipitates and TaSi2 Overdoping nitrogen into the amorphous matrix can dramatically increase the crystallization temperature to 600 °C. This temperature increase slows down the inward diffusion of copper and delays the formation of both silicides. The nitrogen overdoped Ta2N (Ta64N36) diffusion barriers can thus be significantly enhanced so as to yield a failure temperature 100 °C greater than that of the Ta67N33 diffusion barriers. Moreover, multilayered films, formed by alternately stacking the Ta67N33 and Ta64N36 layers with an optimized bilayer thickness (λ) of 10 nm, can dramatically reduce the intrinsic compressive stress to only 0.7 GPa and undergo high-temperature annealing without crystallization. Therefore, the Ta67N33/Ta64N36 multilayered films exhibit a much better barrier performance than the highly crystallization-resistant Ta64N36 single-layered films.

Endurance of rockfall protection fences

NASA Astrophysics Data System (ADS)

Gerber, W.; Meyer, M.

2009-04-01

Research on rockfall protection systems usually focuses on the performance of flexible barriers regarding their limit or design energy retention capacity. This research increased the maximum retention by a factor 15 within the last 15-20 years. Today rockfall energies up to 5'000 kJ can be retained. But this is relevant only for actual projects and newly erected barriers. However, the majority of all barriers installed in the alpine area were built many years ago and there is little knowledge on their long-term performance. Among others this includes not only the consideration of maintenance works such as man and machine power as well as yearly costs, but also the endurance of such barriers over the years. Such information normally stays at the authority or institution that initiated the construction of a protection system and/or is responsible for the maintenance of the object. But even if an institution maintains a large number of barriers, there mostly does not exist a general inventory because the barriers were installed over a time period of sometimes more than 30 years enduring many changes in the inventory procedures, drawings and documentations. Therefore, an actual investigation of all rockfall barriers protecting a sector of the Swiss railways (SBB) was performed in order to obtain an overview of their conditions. This project delivers both a detailed analysis of more than 100 single barriers and a statistically evaluable overview. It also allows a comparison between different generations of barrier types, independently from the different producers of the barriers. In a first step existing catalogues and data belonging to the relevant barriers were evaluated, summarized and mapped into topographic maps using GIS allowing a proper planning of the field trip, optimised regarding route, time consumption and possibly necessary closures of rail tracks. During the field investigations each barrier was inspected and all details regarding structural system, geometry, age, retained rockfall volume, probable remaining load capacity, damages, mistakes during erection, sufficient distance to rail tracks for the stopping process of the falling rock etc. were logged and photographically documented. The posterior analyses then lead to an overall classification of the single barriers into the three groups good/sufficent/insufficent resulting in different priority levels regarding the next suggested maintenance steps. The classification depends on whether a barrier can stop a frequent and a medium-sized rockfall event or not. The analysis gives a general overview of all barriers as well as a separate describtion of all criticised barriers to enable a proper planning of the repair tasks. The final summary over all barriers within the investigated sector can also be used to predict the expenditure on repairs for other areas assuming that the investigated barriers reflect the average of barriers installed in other areas. It also revealed that the barriers can be divided into two main groups older and younger than 1990. Around this date the rockfall retention techniques changed completely from more or less rigid fences towards full dynamically operating systems with net curtain effects along support ropes and special energy absorbing devices. For the first time, such an extensive inventory has been compiled and revealed its necessity to now have a unified data basis. The investigation also showed - and this will be shown more closely in the presentation - an in general good status of the protection systems after many years of operation. Although most of the modern flexible barriers are general in a good status, too, it has to be pointed out, that they are not necessarily appropriate to protect the railway infrastructure if they are erected to close to the tracks. The required stopping distance of the barriers has to be taken into account.

2 kV slanted tri-gate GaN-on-Si Schottky barrier diodes with ultra-low leakage current

NASA Astrophysics Data System (ADS)

Ma, Jun; Matioli, Elison

2018-01-01

This letter reports lateral GaN-on-Si power Schottky barrier diodes (SBDs) with unprecedented voltage-blocking performance by integrating 3-dimensionally a hybrid of tri-anode and slanted tri-gate architectures in their anode. The hybrid tri-anode pins the voltage drop at the Schottky junction (VSCH), despite a large applied reverse bias, fixing the reverse leakage current (IR) of the SBD. Such architecture led to an ultra-low IR of 51 ± 5.9 nA/mm at -1000 V, in addition to a small turn-on voltage (VON) of 0.61 ± 0.03 V. The slanted tri-gate effectively distributes the electric field in OFF state, leading to a remarkably high breakdown voltage (VBR) of -2000 V at 1 μA/mm, constituting a significant breakthrough from existing technologies. The approach pursued in this work reduces the IR and increases the VBR without sacrificing the VON, which provides a technology for high-voltage SBDs, and unveils the unique advantage of tri-gates for advanced power applications.

Low-energy nuclear reaction of the 14N+169Tm system: Incomplete fusion

NASA Astrophysics Data System (ADS)

Kumar, R.; Sharma, Vijay R.; Yadav, Abhishek; Singh, Pushpendra P.; Agarwal, Avinash; Appannababu, S.; Mukherjee, S.; Singh, B. P.; Ali, R.; Bhowmik, R. K.

2017-11-01

Excitation functions of reaction residues produced in the 14N+169Tm system have been measured to high precision at energies above the fusion barrier, ranging from 1.04 VB to 1.30 VB , and analyzed in the framework of the statistical model code pace4. Analysis of α -emitting channels points toward the onset of incomplete fusion even at slightly above-barrier energies where complete fusion is supposed to be one of the dominant processes. The onset and strength of incomplete fusion have been deduced and studied in terms of various entrance channel parameters. Present results together with the reanalysis of existing data for various projectile-target combinations conclusively suggest strong influence of projectile structure on the onset of incomplete fusion. Also, a strong dependence on the Coulomb effect (ZPZT) has been observed for the present system along with different projectile-target combinations available in the literature. It is concluded that the fraction of incomplete fusion linearly increases with ZPZT and is found to be more for larger ZPZT values, indicating significantly important linear systematics.

Family planning and contraceptive decision-making by economically disadvantaged, African-American women

PubMed Central

Hodgson, Eric J.; Collier, Charlene; Hayes, Laura; Curry, Leslie; Fraenkel, Liana

2013-01-01

Background Significant racial disparities exist in the US unplanned pregnancy rate. We conducted a qualitative study using the theory of planned behavior as a framework to describe how low-income, African-American women approach family planning. Study Design Structured focus groups were held with adult, low-income, non-pregnant, African-American women in Connecticut. Data were collected using a standardized discussion guide, and audio-taped and transcribed. Four, independent researchers coded the transcripts using the constant comparative method. Codes were organized into over-arching themes. Results Contraceptive knowledge was limited with formal education often occurring after sexual debut. Attitudes about contraception were overtly negative with method effectiveness being judged by the experience of side effects. Family and friends strongly influence contraceptive decisions while male partners are primarily seen as a barrier. Contraceptive pills are perceived as readily accessible although compliance is considered a barrier. Conclusions Contraception education should occur before sexual debut, should involve trusted family and community members, and should positively frame issues in terms of achieving life goals. PMID:23177266

Vida Calma: CBT for Anxiety with a Spanish-Speaking Hispanic Adult.

PubMed

Ramos, Katherine; Cortes, Jose; Wilson, Nancy; Kunik, Mark E; Stanley, Melinda A

2017-01-01

Hispanic adults aged 55 years and older are the fastest growing ethnic minority group in the United States facing significant mental health disparities. Barriers in accessing care have been attributed to low income, poor education, language barriers, and stigma. Cultural adaptations to existing evidence-based treatments have been encouraged to improve access. However, little is known about mental health treatments translated from English to Spanish targeting anxiety among this Hispanic age group. Objctive: This case study offers an example of how an established, manualized, cognitive-behavioral treatment for adults 55 years and older with generalized anxiety disorder (known as "Calmer Life") was translated to Spanish ("Vida Calma") and delivered to a monolingual, Hispanic 55-year-old woman. Pre- and post-treatment measures showed improvements in symptoms of anxiety, depression, and life satisfaction. Findings suggest Vida Calma is a feasible treatment to use with a 55-year-old Spanish-speaking adult woman. Vida Calma, a Spanish language version of Calmer Life, was acceptable and feasible to deliver with a 55-year-old participant with GAD. Treatment outcomes demonstrate that Vida Calma improved the participant's anxiety, depression, and life satisfaction.

Reconnecting Eye to Brain

PubMed Central

2016-01-01

Although much is known about the regenerative capacity of retinal ganglion cells, very significant barriers remain in our ability to restore visual function following traumatic injury or disease-induced degeneration. Here we summarize our current understanding of the factors regulating axon guidance and target engagement in regenerating axons, and review the state of the field of neural regeneration, focusing on the visual system and highlighting studies using other model systems that can inform analysis of visual system regeneration. This overview is motivated by a Society for Neuroscience Satellite meeting, “Reconnecting Neurons in the Visual System,” held in October 2015 sponsored by the National Eye Institute as part of their “Audacious Goals Initiative” and co-organized by Carol Mason (Columbia University) and Michael Crair (Yale University). The collective wisdom of the conference participants pointed to important gaps in our knowledge and barriers to progress in promoting the restoration of visual system function. This article is thus a summary of our existing understanding of visual system regeneration and provides a blueprint for future progress in the field. PMID:27798125

Effectiveness of antimicrobial food packaging materials.

PubMed

Cooksey, K

2005-10-01

Antimicrobial additives have been used successfully for many years as direct food additives. The literature provides evidence that some of these additives may be effective as indirect food additives incorporated into food packaging materials. Antimicrobial food packaging is directed toward the reduction of surface contamination of processed, prepared foods such as sliced meats and Frankfurter sausages (hot dogs). The use of such packaging materials is not meant to be a substitute for good sanitation practices, but it should enhance the safety of food as an additional hurdle for the growth of pathogenic and/or spoilage microorganisms. Studies have focused on establishing methods for coating low-density polyethylene film or barrier films with methyl cellulose as a carrier for nisin. These films have significantly reduced the presence of Listeria monocytogenes in solutions and in vacuum packaged hot dogs. Other research has focused on the use of chitosan to inhibit L. monocytogenes and chlorine dioxide sachets for the reduction of Salmonella on modified atmosphere-packaged fresh chicken breasts. Overall, antimicrobial packaging shows promise as an effective method for the inhibition of certain bacteria in foods, but barriers to their commercial implementation continue to exist.

Measured responses of internal enclosures and cables due to burnthrough penetration of weapon cases by lightning

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

Schnetzer, G.H.; Fisher, R.J.; Dinallo, M.A.

1994-08-01

The electrical effects of lightning penetration of the outer case of a weapon on internal structures, such as a firing set housing, and on samples of a flat, flexline detonator cable have been investigated experimentally. Maximum open-circuit voltages measured on either simulated structures (126 V) or the cable (46 V) located directly behind the point of penetration were well below any level that is foreseen to create a threat to nuclear safety. On the other hand, it was found that once full burnthrough of the barrier occurred, significant fractions of the incident continuing currents coupled to both the simulated internalmore » structure (up to 300 A) or to the cable sample (69 A) when each was electrically connected internally to case ground. No occurrence was observed of the injection of large amplitude currents from return strokes occurring after barrier penetration. Under circumstances in which small volumes of trapped gases exist behind penetration sites, rapid heating of the gas by return strokes occurring after burnthrough has been shown to produced large mechanical impulses to the adjacent surfaces.« less

Excess seawater nutrients, enlarged algal symbiont densities and bleaching sensitive reef locations: 1. Identifying thresholds of concern for the Great Barrier Reef, Australia.

PubMed

Wooldridge, Scott A

2016-05-23

Here, I contribute new insight into why excess seawater nutrients are an increasingly identified feature at reef locations that have low resistance to thermal stress. Specifically, I link this unfavourable synergism to the development of enlarged (suboptimal) zooxanthellae densities that paradoxically limit the capacity of the host coral to build tissue energy reserves needed to combat periods of stress. I explain how both theoretical predictions and field observations support the existence of species-specific 'optimal' zooxanthellae densities ~1.0-3.0×10 6 cellscm- 2 . For the central Great Barrier Reef (GBR), excess seawater nutrients that permit enlarged zooxanthellae densities beyond this optimum range are linked with seawater chlorophyll a>0.45μg·L -1 ; a eutrophication threshold previously shown to correlate with a significant loss in species for hard corals and phototrophic octocorals on the central GBR, and herein shown to correlate with enhanced bleaching sensitivity during the 1998 and 2002 mass bleaching events. Copyright © 2016 Elsevier Ltd. All rights reserved.

Interplanetary Radio Transmission Through Serial Ionospheric and Material Barriers

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

Fields, David; Kennedy, Robert G; Roy, Kenneth I

2013-01-01

A usual first principle in planning radio astronomy observations from the earth is that monitoring must be carried out well above the ionospheric plasma cutoff frequency (~5 MHz). Before space probes existed, radio astronomy was almost entirely done above 6 MHz, and this value is considered a practical lower limit by most radio astronomers. Furthermore, daytime ionization (especially D-layer formation) places additional constraints on wave propagation, and waves of frequency below 10-20 MHz suffer significant attenuation. More careful calculations of wave propagation through the earth s ionosphere suggest that for certain conditions (primarily the presence of a magnetic field) theremore » may be a transmission window well below this assumed limit. Indeed, for receiving extraterrestrial radiation below the ionospheric plasma cutoff frequency, a choice of VLF frequency appears optimal to minimize loss. The calculation, experimental validation, and conclusions are presented here. This work demonstrates the possibility of VLF transmission through the ionosphere and various subsequent material barriers. Implications include development of a new robust communications channel, communications with submerged or subterranean receivers / instruments on or offworld, and a new approach to SETI.« less

Glial cell line-derived neurotrophic factor promotes barrier maturation and wound healing in intestinal epithelial cells in vitro.

PubMed

Meir, Michael; Flemming, Sven; Burkard, Natalie; Bergauer, Lisa; Metzger, Marco; Germer, Christoph-Thomas; Schlegel, Nicolas

2015-10-15

Recent data suggest that neurotrophic factors from the enteric nervous system are involved in intestinal epithelial barrier regulation. In this context the glial cell line-derived neurotrophic factor (GDNF) was shown to affect gut barrier properties in vivo directly or indirectly by largely undefined processes in a model of inflammatory bowel disease (IBD). We further investigated the potential role and mechanisms of GDNF in the regulation of intestinal barrier functions. Immunostaining of human gut specimen showed positive GDNF staining in enteric neuronal plexus and in enterocytes. In Western blots of the intestinal epithelial cell lines Caco2 and HT29B6, significant amounts of GDNF were detected, suggesting that enterocytes represent an additional source of GDNF. Application of recombinant GDNF on Caco2 and HT29B6 cells for 24 h resulted in significant epithelial barrier stabilization in monolayers with immature barrier functions. Wound-healing assays showed a significantly faster closure of the wounded areas after GDNF application. GDNF augmented cAMP levels and led to significant inactivation of p38 MAPK in immature cells. Activation of p38 MAPK signaling by SB-202190 mimicked GDNF-induced barrier maturation, whereas the p38 MAPK activator anisomycin blocked GDNF-induced effects. Increasing cAMP levels had adverse effects on barrier maturation, as revealed by permeability measurements. However, increased cAMP augmented the proliferation rate in Caco2 cells, and GDNF-induced proliferation of epithelial cells was abrogated by the PKA inhibitor H89. Our data show that enterocytes represent an additional source of GDNF synthesis. GDNF contributes to wound healing in a cAMP/PKA-dependent manner and promotes barrier maturation in immature enterocytes cells by inactivation of p38 MAPK signaling. Copyright © 2015 the American Physiological Society.

Al embedded MgO barrier MTJ: A first principle study for application in fast and compact STT-MRAMs

NASA Astrophysics Data System (ADS)

Yadav, Manoj Kumar; Gupta, Santosh Kumar; Rai, Sanjeev; Pandey, Avinash C.

2017-03-01

The first principle comparative study of a novel single Al sheet embedded MgO and pure MgO barrier having Fe electrodes magnetic tunnel junction has been presented. Al embedded MgO is reported to provide enhanced spin polarised tunnelling current due to increase of spin-polarized density of states at Fermi energy in the barrier region. This novel MTJ provides a current density and resistance area (RA) product of 94.497 ×107 A / cm2 and 0.105  Ω - μm2 respectively. With such a low RA product; it allows higher deriving current due to which switching time of magnetization reversal reduces without inducing barrier related breakdowns in non-volatile magnetic random access memories. The low RA product and high current density of the proposed MTJ may have possible applications in integration with existing MOS circuits.

Gap Junction Proteins in the Blood-Brain Barrier Control Nutrient-Dependent Reactivation of Drosophila Neural Stem Cells

PubMed Central

Spéder, Pauline; Brand, Andrea H.

2014-01-01

Summary Neural stem cells in the adult brain exist primarily in a quiescent state but are reactivated in response to changing physiological conditions. How do stem cells sense and respond to metabolic changes? In the Drosophila CNS, quiescent neural stem cells are reactivated synchronously in response to a nutritional stimulus. Feeding triggers insulin production by blood-brain barrier glial cells, activating the insulin/insulin-like growth factor pathway in underlying neural stem cells and stimulating their growth and proliferation. Here we show that gap junctions in the blood-brain barrier glia mediate the influence of metabolic changes on stem cell behavior, enabling glia to respond to nutritional signals and reactivate quiescent stem cells. We propose that gap junctions in the blood-brain barrier are required to translate metabolic signals into synchronized calcium pulses and insulin secretion. PMID:25065772

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

PubMed

Ross, Stuart A

2013-09-01

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

General Protein Diffusion Barriers create Compartments within Bacterial Cells

PubMed Central

Schlimpert, Susan; Klein, Eric A.; Briegel, Ariane; Hughes, Velocity; Kahnt, Jörg; Bolte, Kathrin; Maier, Uwe G.; Brun, Yves V.; Jensen, Grant J.; Gitai, Zemer; Thanbichler, Martin

2013-01-01

SUMMARY In eukaryotes, the differentiation of cellular extensions such as cilia or neuronal axons depends on the partitioning of proteins to distinct plasma membrane domains by specialized diffusion barriers. However, examples of this compartmentalization strategy are still missing for prokaryotes, although complex cellular architectures are widespread among this group of organisms. This study reveals the existence of a protein-mediated membrane diffusion barrier in the stalked bacterium Caulobacter crescentus. We show that the Caulobacter cell envelope is compartmentalized by macromolecular complexes that prevent the exchange of both membrane and soluble proteins between the polar stalk extension and the cell body. The barrier structures span the cross-sectional area of the stalk and comprise at least four proteins that assemble in a cell cycle-dependent manner. Their presence is critical for cellular fitness, as they minimize the effective cell volume, allowing faster adaptation to environmental changes that require de novo synthesis of envelope proteins. PMID:23201141

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

Norrin/Frizzled4 signaling in retinal vascular development and blood brain barrier plasticity.

PubMed

Wang, Yanshu; Rattner, Amir; Zhou, Yulian; Williams, John; Smallwood, Philip M; Nathans, Jeremy

2012-12-07

Norrin/Frizzled4 (Fz4) signaling activates the canonical Wnt pathway to control retinal vascular development. Using genetically engineered mice, we show that precocious Norrin production leads to premature retinal vascular invasion and delayed Norrin production leads to characteristic defects in intraretinal vascular architecture. In genetic mosaics, wild-type endothelial cells (ECs) instruct neighboring Fz4(-/-) ECs to produce an architecturally normal mosaic vasculature, a cell nonautonomous effect. However, over the ensuing weeks, Fz4(-/-) ECs are selectively eliminated from the mosaic vasculature, implying the existence of a quality control program that targets defective ECs. In the adult retina and cerebellum, gain or loss of Norrin/Fz4 signaling results in a cell-autonomous gain or loss, respectively, of blood retina barrier and blood brain barrier function, indicating an ongoing requirement for Frizzled signaling in barrier maintenance and substantial plasticity in mature CNS vascular structure. Copyright © 2012 Elsevier Inc. All rights reserved.

Reaction front barriers in time aperiodic fluid flows

NASA Astrophysics Data System (ADS)

Locke, Rory; Mitchell, Kevin

2016-11-01

Many chemical and biological systems can be characterized by the propagation of a front that separates different phases or species. One approach to formalizing a general theory is to apply frameworks developed in nonlinear dynamics. It has been shown that invariant manifolds form barriers to passive transport in time-dependent or time-periodic fluid flows. More recently, analogous manifolds termed burning- invariant-manifolds (BIMs), have been shown to form one-sided barriers to reaction fronts in advection-reaction-diffusion (ARD) systems. To model more realistic time-aperiodic systems, recent theoretical work has suggested that similar one-sided barriers, termed burning Lagrangian coherent structures (bLCSs), exist for fluid velocity data prescribed over a finite time interval. In this presentation, we use a stochastic "wind" to generate time dependence in a double-vortex channel flow and demonstrate the (locally) most attracting or repelling curves are the bLCSs.

Degradation of organic pollutants and microorganisms from wastewater using different dielectric barrier discharge configurations--a critical review.

PubMed

Mouele, Emile S Massima; Tijani, Jimoh O; Fatoba, Ojo O; Petrik, Leslie F

2015-12-01

The growing global drinking water crisis requires the development of novel advanced, sustainable, and cost-effective water treatment technologies to supplement the existing conventional methods. One such technology is advanced oxidation based on dielectric barrier discharge (DBD). DBD such as single and double planar and single and double cylindrical dielectric barrier configurations have been utilized for efficient degradation of recalcitrant organic pollutants. The overall performance of the different DBD system varies and depends on several factors. Therefore, this review was compiled to give an overview of different DBD configurations vis-a-viz their applications and the in situ mechanism of generation of free reactive species for water and wastewater treatment. Our survey of the literature indicated that application of double cylindrical dielectric barrier configuration represents an ideal and viable route for achieving greater water and wastewater purification efficiency.

Use of vegetable oil in a pilot-scale denitrifying barrier

NASA Astrophysics Data System (ADS)

Hunter, William J.

2001-12-01

Nitrate in drinking water is a hazard to both humans and animals. Contaminated water can cause methemoglobinemia and may pose a cancer risk. Permeable barriers containing innocuous oils, which stimulate denitrification, can remove nitrate from flowing groundwater. For this study, a sand tank (1.1×2.0×0.085 m in size) containing sand was used as a one-dimensional open-top scale model of an aquifer. A meter-long area near the center of the tank contained sand coated with soybean oil. This region served as a permeable denitrifying barrier. Water containing 20 mg l -1 nitrate-N was pumped through the barrier at a high flow rate, 1112 l week -1, for 30 weeks. During the 30-week study, the barrier removed 39% of the total nitrate-N present in the water. The barrier was most efficient during the first 10 weeks of the study when almost all of the nitrate and nitrogen was removed. Efficiency declined with time so that by week 30 almost no nitrate was removed by the system. Nitrite levels in the effluent water remained low throughout the study. Barriers could be used to protect groundwater from nitrate contamination or for the in situ treatment of contaminated water. At the low flow rates that exist in most aquifers, such barriers should be effective at removing nitrate from groundwater for a much longer period of time.

A permeability barrier surrounds taste buds in lingual epithelia

PubMed Central

Dando, Robin; Pereira, Elizabeth; Kurian, Mani; Barro-Soria, Rene; Chaudhari, Nirupa

2014-01-01

Epithelial tissues are characterized by specialized cell-cell junctions, typically localized to the apical regions of cells. These junctions are formed by interacting membrane proteins and by cytoskeletal and extracellular matrix components. Within the lingual epithelium, tight junctions join the apical tips of the gustatory sensory cells in taste buds. These junctions constitute a selective barrier that limits penetration of chemosensory stimuli into taste buds (Michlig et al. J Comp Neurol 502: 1003–1011, 2007). We tested the ability of chemical compounds to permeate into sensory end organs in the lingual epithelium. Our findings reveal a robust barrier that surrounds the entire body of taste buds, not limited to the apical tight junctions. This barrier prevents penetration of many, but not all, compounds, whether they are applied topically, injected into the parenchyma of the tongue, or circulating in the blood supply, into taste buds. Enzymatic treatments indicate that this barrier likely includes glycosaminoglycans, as it was disrupted by chondroitinase but, less effectively, by proteases. The barrier surrounding taste buds could also be disrupted by brief treatment of lingual tissue samples with DMSO. Brief exposure of lingual slices to DMSO did not affect the ability of taste buds within the slice to respond to chemical stimulation. The existence of a highly impermeable barrier surrounding taste buds and methods to break through this barrier may be relevant to basic research and to clinical treatments of taste. PMID:25209263

[Do organizational barriers to pneumococcal and influenza vaccine access exist?].

PubMed

Rousseau, Louise; Guay, Maryse; Archambault, Denis; El m'ala, Zahra; Abdelaziz, Nadia

2007-01-01

Despite the implementation of a Quebec immunization program against influenza and pneumococcal disease (PQIIP), vaccine coverage has remained low. There have been many studies on personal barriers to vaccination, but few have explored other kinds of barriers. To explore the presence of barriers in relation to the organization of the health care system and to propose recommendations for increasing vaccine coverage. Within a mixed protocol, a phone survey of 996 people in the target population and a case study implicating the follow-up of the PQIIP with all the site and actor categories via 43 semistructured interviews and 4 focus groups were realized. Survey data underwent a descriptive statistical analysis. Qualitative analysis followed the Miles and Huberman approach. The results indicate the presence of barriers with regard to information accessibility. These include access to: the physicians' recommendation, knowledge of the efficacy or the security of vaccines, and admissibility of clients to the PQIIP. Organizational barriers were also found to limit access to vaccination, especially in terms of restricted choices of time and location. Coordination and incentives mechanisms are not optimal. Removal of organizational barriers depends more on strategic rather than structural factors. Addressing organizational barriers should be an important component of strategies aimed at improving vaccine coverage. Public health authorities should focus on strategic management of the information and inter-organizational environment.

Barriers and Enablers to the Implementation of School Wellness Policies: An Economic Perspective.

PubMed

Schuler, Brittany R; Saksvig, Brit I; Nduka, Joy; Beckerman, Susannah; Jaspers, Lea; Black, Maureen M; Hager, Erin R

2018-01-01

Local wellness policies (LWPs) are mandated among school systems to enhance nutrition/physical activity opportunities in schools. Prior research notes disparities in LWP implementation. This study uses mixed methods to examine barriers/enablers to LWP implementation, comparing responses by student body income. Schools ( n = 744, 24 systems) completed an LWP implementation barriers/enablers survey. Semistructured interviews ( n = 20 random subsample) described barriers/enablers. Responses were compared by majority of lower (≥50% free/reduced-price meals; lower income [LI]) versus higher income (HI) student body. In surveys, LI and HI schools identified common barriers (parents/families, federal/state regulations, students, time, funding) and enablers (school system, teachers, food service, physical education curriculum/resources, and staff). Interviews further elucidated how staffing and funding served as enablers for all schools, and provide context for how and why barriers differed by income: time, food service (HI schools), and parents/families (LI schools). Findings support commonalities in barriers and enablers among all schools, suggesting that regardless of economic context, schools would benefit from additional supports, such as physical education and nutrition education resources integrated into existing curricula, additional funding, and personnel time dedicated to wellness programming. LI schools may benefit from additional funding to support parent and community involvement.

Biological-Physical Feedbacks Determine Coastal Environmental Response to Climate Change

NASA Astrophysics Data System (ADS)

Moore, L. J.; Duran Vinent, O.; Walters, D.; Fagherazzi, S.; Mariotti, G.; Young, D.; Wolner, C. V.

2012-12-01

As low-lying coastal landforms, transitional between marine and terrestrial realms, barrier islands are especially sensitive to changing environmental conditions. Interactions among biological and physical processes appear to play a critical role in determining how these landscapes will evolve in the future as sea level rises, storm intensity increases and plant species composition changes. Within a new conceptual framework, barrier islands tend to exist in one of two primary states. "Low" islands have little relief above sea level and are dominated by external processes, responding quickly on short time scales to changes in forcing (e.g., storms, sea level rise, etc.), migrating rapidly and generally being low in ecological diversity and productivity. In contrast, "high" islands are less vulnerable to storms, tend to be dominated by internal processes (e.g., sand trapping by vegetation), require long time periods to respond to changes in forcing, migrate slowly (if at all) and host a range of plant species and morphological environments including shrubs, small trees and vegetated secondary and tertiary dunes with intervening swales. The continued existence of barrier island landforms will depend on the degree to which islands can maintain elevation above sea level while also responding to changes in forcing by migrating landward. A long-term morphological-behavior model exploring coupled barrier-marsh evolution and a new ecomorphodynamic model representing the formation/recovery of dunes as a function of storms, shed light on the role of interactions among biological and physical processes on barrier island response to climate change. Results suggest that connections between the marsh and barrier realms, which are mediated by biological processes in the marsh environment, are highly sensitive to factors such as sea level rise rate, antecedent morphology and marsh composition. Results also suggest that feedbacks between sediment transport and vegetation involved in dune building may allow small, gradual changes in storms to cause abrupt, nonlinear transitions from the high to low island state.

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

PubMed

Corriero, Rosemary; Redmon, Ginger

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

Provider perceptions of barriers to the emergency use of tPA for acute ischemic stroke: a qualitative study.

PubMed

Meurer, William J; Majersik, Jennifer J; Frederiksen, Shirley M; Kade, Allison M; Sandretto, Annette M; Scott, Phillip A

2011-05-06

Only 1-3% of ischemic stroke patients receive thrombolytic therapy. Provider barriers to adhering with guidelines recommending tPA delivery in acute stroke are not well known. The main objective of this study was to describe barriers to thrombolytic use in acute stroke care. Twenty-four hospitals were randomly selected and matched into 12 pairs. Barrier assessment occurred at intervention sites only, and utilized focus groups and structured interviews. A pre-specified taxonomy was employed to characterize barriers. Two investigators independently assigned themes to transcribed responses. Seven facilitators (three emergency physicians, two nurses, and two study coordinators) conducted focus groups and interviews of emergency physicians (65), nurses (62), neurologists (15), radiologists (12), hospital administrators (12), and three others (hospitalists and pharmacist). The following themes represented the most important external barriers: environmental and patient factors. Important barriers internal to the clinician included familiarity with and motivation to adhere to the guidelines, lack of self-efficacy and outcome expectancy. The following themes were not substantial barriers: lack of awareness of the existence of acute stroke guidelines, presence of conflicting guidelines, and lack of agreement with the guidelines. Healthcare providers perceive environmental and patient-related factors as the primary barriers to adherence with acute stroke treatment guidelines. Interventions focused on increasing physician familiarity with and motivation to follow guidelines may be of highest yield in improving adherence. Improving self-efficacy in performing guideline concordant care may also be useful.

Barriers reported among patients with breast and cervical abnormalities in the patient navigation research program: impact on timely care.

PubMed

Katz, Mira L; Young, Gregory S; Reiter, Paul L; Battaglia, Tracy A; Wells, Kristen J; Sanders, Mechelle; Simon, Melissa; Dudley, Donald J; Patierno, Steven R; Paskett, Electra D

2014-01-01

Patient navigation (PN) is a system-level strategy to decrease cancer mortality rates by reducing barriers to cancer care. Barriers to resolution among participants in the PN intervention arm with a breast or cervical abnormality in the Patient Navigation Research Program and navigators' actions to address those barriers were examined. Data from seven institutions (2005-2010) included 1,995 breast and 1,194 cervical patients. A stratified Cox proportional hazards regression model was used to examine the effects of barriers on time to resolution of an abnormal screening test or clinical finding. The range of unique barriers was 0 to 12 and 0 to 7 among participants with breast and cervical abnormalities, respectively. About two thirds of breast and one half of cervical participants had at least one barrier resulting in longer time to diagnostic resolution among breast (adjusted hazard ratio [HR], 0.744; p < .001) and cervical (adjusted HR, 0.792; p < .001) participants. Patient- and system-level barriers were most common. Frequent navigator actions were making arrangements, scheduling appointments, referrals, and education. Having a barrier resulted in a delay in diagnostic resolution of an abnormal screening test or clinical finding. Health care systems can use these findings to improve existing PN programs or when developing new programs. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Barriers to lifestyle changes for prevention of cardiovascular disease - a survey among 40-60-year old Danes.

PubMed

Nielsen, Jesper Bo; Leppin, Anja; Gyrd-Hansen, Dort E; Jarbøl, Dorte Ejg; Søndergaard, Jens; Larsen, Pia Veldt

2017-09-12

Elimination of modifiable risk factors including unhealthy lifestyle has the potential for prevention of 80% of cardiovascular disease cases. The present study focuses on disclosing barriers for maintaining specific lifestyle changes by exploring associations between perceiving these barriers and various sociodemographic and health-related characteristics. Data were collected through a web-based questionnaire survey and included 962 respondents who initially accepted treatment for a hypothetical cardiovascular risk, and who subsequently stated that they preferred lifestyle changes to medication. Logistic regression was used to analyse associations between barriers to lifestyle changes and relevant covariates. A total of 45% of respondents were identified with at least one barrier to introducing 30 min extra exercise daily, 30% of respondents reported at least one barrier to dietary change, and among smokers at least one barrier to smoking cessation was reported by 62% of the respondents. The perception of specific barriers to lifestyle change depended on sociodemographic and health-related characteristics. We observed a considerable heterogeneity between different social groups in the population regarding a number of barriers to lifestyle change. Our study demonstrates that social inequality exists in the ability to take appropriate preventive measures through lifestyle changes to stay healthy. This finding underlines the challenge of social inequality even in populations with equal and cost-free access to health care. Our study suggests supplementing traditional public campaigns to counter cardiovascular disease by using individualized and targeted initiatives.

Low-head sea lamprey barrier effects on stream habitat and fish communities in the Great Lakes basin

USGS Publications Warehouse

Dodd, H.R.; Hayes, D.B.; Baylis, J.R.; Carl, L.M.; Goldstein, J.D.; McLaughlin, R.L.; Noakes, D.L.G.; Porto, L.M.; Jones, M.L.

2003-01-01

Low-head barriers are used to block adult sea lamprey (Petromyzon marinus) from upstream spawning habitat. However, these barriers may impact stream fish communities through restriction of fish movement and habitat alteration. During the summer of 1996, the fish community and habitat conditions in twenty-four stream pairs were sampled across the Great Lakes basin. Seven of these stream pairs were re-sampled in 1997. Each pair consisted of a barrier stream with a low-head barrier and a reference stream without a low-head barrier. On average, barrier streams were significantly deeper (df = 179, P = 0.0018) and wider (df = 179, P = 0.0236) than reference streams, but temperature and substrate were similar (df = 183, P = 0.9027; df = 179, P = 0.999). Barrier streams contained approximately four more fish species on average than reference streams. However, streams with low-head barriers showed a greater upstream decline in species richness compared to reference streams with a net loss of 2.4 species. Barrier streams also showed a peak in richness directly downstream of the barriers, indicating that these barriers block fish movement upstream. Using S??renson's similarity index (based on presence/absence), a comparison of fish community assemblages above and below low-head barriers was not significantly different than upstream and downstream sites on reference streams (n = 96, P > 0.05), implying they have relatively little effect on overall fish assemblage composition. Differences in the frequency of occurrence and abundance between barrier and reference streams was apparent for some species, suggesting their sensitivity to barriers.

Nurses' attitudes, behaviours and perceived barriers towards pressure ulcer prevention.

PubMed

Moore, Zena; Price, Patricia

2004-11-01

Pressure ulcers are not a plague of modern man; they have been known to exist since ancient Egyptian times. However, despite the increasing expenditure on pressure ulcer prevention, pressure ulcers remain a major health care problem. Although nurses do not have the sole responsibility for pressure ulcer prevention, nurses have a unique opportunity to have a significant impact on this problem. The specific aims of the study were to identify: * Staff nurses' attitudes towards pressure ulcer prevention. * The behaviour of staff nurses' in relation to pressure ulcer prevention. * Staff nurses' perceived barriers towards pressure ulcer prevention. A cross-sectional survey method was used. A randomly selected sample of staff nurses (n = 300) working in an acute care setting in an urban location was invited to participate. Data were collected using a prepiloted questionnaire. Data analysis was carried out using SPSS version 10 and SPSS Text Smart version 1.1. The nurses surveyed demonstrated a positive attitude towards pressure ulcer prevention. However, prevention practices were demonstrated to be haphazard and erratic and were negatively affected by lack of time and staff. These barriers prevented the nurses' positive attitude from being reflected into effective clinical practice. Education, although poorly accessed, or made available, was rarely cited as impeding practice in this area. This study suggests that positive attitudes are not enough to ensure that practice change takes place, reinforcing the complex nature of behavioural change. Implementation strategies should introduce ways in which key staff can be empowered to overcome barriers to change. This study provides a unique exploration of Irish nurses' attitudes, behaviours and perceived barriers towards pressure ulcer prevention, thereby contributing to the body of knowledge on this subject. As tissue viability is a new and emerging speciality, this information will contribute to evidence based practice in this area of patient care and will form the basis for the development of an educational strategy for pressure ulcer prevention and management.

Differences in HIV vaccine acceptability between genders

PubMed Central

Kakinami, Lisa; Newman, Peter A.; Lee, Sung-Jae; Duan, Naihua

2010-01-01

The development of safe and efficacious preventive HIV vaccines offers the best long-term hope of controlling the AIDS pandemic. Nevertheless, suboptimal uptake of safe and efficacious vaccines that already exist suggest that HIV vaccine acceptability cannot be assumed, particularly among communities most vulnerable to HIV. The present study aimed to identify barriers and motivators to future HIV vaccine acceptability among low socioeconomic, ethnically diverse men and women in Los Angeles County. Participants completed a cross-sectional survey assessing their attitudes and beliefs regarding future HIV vaccines. Hypothetical HIV vaccine scenarios were administered to determine HIV vaccine acceptability. Two-sided t-tests were performed, stratified by gender, to examine the association between vaccine acceptability and potential barriers and motivators. Barriers to HIV vaccine acceptability differed between men and women. For women, barriers to HIV vaccine acceptability were related to their intimate relationships (p <0.05), negative experiences with health care providers (p <0.05) and anticipated difficulties procuring insurance (p <0.01). Men were concerned that the vaccine would weaken the immune system (p <0.005) or would affect their HIV test results (p <0.05). Motivators for women included the ability to conceive a child without worrying about contracting HIV (p <0.10) and support from their spouse/significant other for being vaccinated (p <0.10). Motivators for men included feeling safer with sex partners (p <0.05) and social influence from friends to get vaccinated (p <0.005). Family support for HIV immunization was a motivator for both men and women (p <0.10). Gender-specific interventions may increase vaccine acceptability among men and women at elevated risk for HIV infection. Among women, interventions need to focus on addressing barriers due to gendered power dynamics in relationships and discrimination in health care. Among men, education that addresses fears and misconceptions about adverse effects of HIV vaccination on health and the importance of vaccination as one component of integrated HIV prevention may increase vaccine acceptability. PMID:18484322

Measuring and Advancing Experimental Design Ability in an Introductory Course without Altering Existing Lab Curriculum†

PubMed Central

Shanks, Ryan A.; Robertson, Chuck L.; Haygood, Christian S.; Herdliksa, Anna M.; Herdliska, Heather R.; Lloyd, Steven A.

2017-01-01

Introductory biology courses provide an important opportunity to prepare students for future courses, yet existing cookbook labs, although important in their own way, fail to provide many of the advantages of semester-long research experiences. Engaging, authentic research experiences aid biology students in meeting many learning goals. Therefore, overlaying a research experience onto the existing lab structure allows faculty to overcome barriers involving curricular change. Here we propose a working model for this overlay design in an introductory biology course and detail a means to conduct this lab with minimal increases in student and faculty workloads. Furthermore, we conducted exploratory factor analysis of the Experimental Design Ability Test (EDAT) and uncovered two latent factors which provide valid means to assess this overlay model’s ability to increase advanced experimental design abilities. In a pre-test/post-test design, we demonstrate significant increases in both basic and advanced experimental design abilities in an experimental and comparison group. We measured significantly higher gains in advanced experimental design understanding in students in the experimental group. We believe this overlay model and EDAT factor analysis contribute a novel means to conduct and assess the effectiveness of authentic research experiences in an introductory course without major changes to the course curriculum and with minimal increases in faculty and student workloads. PMID:28904647

Dispersal Limitations on Fish Community Recovery Following Long-term Water Quality Remediation

DOE PAGES

McManamay, Ryan A.; Jett, Robert T.; Ryon, Michael G.; ...

2016-02-22

Holistic restoration approaches, such as water quality remediation, are likely to meet conservation objectives because they are typically implemented at watershed scales, as opposed to individual stream reaches. However, habitat fragmentation may impose constraints on the ecological effectiveness of holistic restoration strategies by limiting colonization following remediation. We questioned the importance of dispersal limitations to fish community recovery following long-term water quality remediation and species reintroductions across the White Oak Creek (WOC) watershed near Oak Ridge, Tennessee (USA). Long-term (26 years) responses in fish species richness and biomass to water quality remediation were evaluated in light of habitat fragmentation andmore » population isolation from instream barriers, which varied in their passage potential. In addition, ordination techniques were used to determine the relative importance of habitat connectivity and water quality, in explaining variation fish communities relative to environmental fluctuations, i.e. streamflow. Ecological recovery (changes in richness) at each site was negatively related to barrier index, a measure of community isolation by barriers relative to stream distance. Following species reintroductions, dispersal by fish species was consistently in the downstream direction and upstream passage above barriers was non-existent. The importance of barrier index in explaining variation in fish communities was stronger during higher flow conditions, but decreased over time an indication of increasing community stability and loss of seasonal migrants. Compared to habitat fragmentation, existing water quality concerns (i.e., outfalls, point source discharges) were unrelated to ecological recovery, but explained relatively high variation in community dynamics. Our results suggest that habitat fragmentation limited the ecological effectiveness of intensive water quality remediation efforts and fish reintroduction efforts by impeding recolonization at isolated stream reaches.« less

What are specialist mental health clinician attitudes to guideline recommendations for the treatment of depression in young people?

PubMed

Hetrick, Sarah E; Simmons, Magenta; Thompson, Andrew; Parker, Alexandra G

2011-11-01

We sought to examine potential barriers to the use of evidence-based guidelines for youth depression in a tertiary specialist mental health service, as part of an initiative to implement evidence based practice within the service. This was a qualitative study adopting a social constructionist perspective using focus groups. The focus groups, conducted with all clinicians (medical and allied health), were audiotaped, transcribed and thematic analysis was undertaken. Clinicians were asked about the barriers to implementing four key recommendations from the National Institute for Health and Clinical Excellence (NICE) guidelines. Barriers existed at (i) the individual clinician level; (ii) the clinical level in terms of the presentation of young people; and (iii) the service level. The key individual clinician level barrier was a stated belief that the guidelines were not relevant to the young people presenting to the service, with little evidence to guide practice. Related, the main barrier with regard to the clinical presentation was the severity and complexity of this presentation, often making the delivery of interventions like cognitive behavioural therapy (CBT) difficult. At the service level, a lack of integration with primary and secondary level care meant sequencing interventions according to guideline recommendations was difficult. There is a clear imperative to develop the evidence base to ensure that effective treatments for young people aged up to 25 years with severe and complex disorders that include comorbid conditions, suicide risk and psychosocial difficulties are investigated and disseminated. Furthermore, this work has highlighted the need for greater investment in models of care that ensure integration between existing primary and secondary care and enhanced specialist early intervention mental health services for young people.

Dispersal Limitations on Fish Community Recovery Following Long-term Water Quality Remediation

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

McManamay, Ryan A.; Jett, Robert T.; Ryon, Michael G.

Holistic restoration approaches, such as water quality remediation, are likely to meet conservation objectives because they are typically implemented at watershed scales, as opposed to individual stream reaches. However, habitat fragmentation may impose constraints on the ecological effectiveness of holistic restoration strategies by limiting colonization following remediation. We questioned the importance of dispersal limitations to fish community recovery following long-term water quality remediation and species reintroductions across the White Oak Creek (WOC) watershed near Oak Ridge, Tennessee (USA). Long-term (26 years) responses in fish species richness and biomass to water quality remediation were evaluated in light of habitat fragmentation andmore » population isolation from instream barriers, which varied in their passage potential. In addition, ordination techniques were used to determine the relative importance of habitat connectivity and water quality, in explaining variation fish communities relative to environmental fluctuations, i.e. streamflow. Ecological recovery (changes in richness) at each site was negatively related to barrier index, a measure of community isolation by barriers relative to stream distance. Following species reintroductions, dispersal by fish species was consistently in the downstream direction and upstream passage above barriers was non-existent. The importance of barrier index in explaining variation in fish communities was stronger during higher flow conditions, but decreased over time an indication of increasing community stability and loss of seasonal migrants. Compared to habitat fragmentation, existing water quality concerns (i.e., outfalls, point source discharges) were unrelated to ecological recovery, but explained relatively high variation in community dynamics. Our results suggest that habitat fragmentation limited the ecological effectiveness of intensive water quality remediation efforts and fish reintroduction efforts by impeding recolonization at isolated stream reaches.« less

Preconception care for women with type 1 or type 2 diabetes mellitus: a mixed-methods study exploring uptake of preconception care.

PubMed

Earle, Sarah; Tariq, Anisah; Komaromy, Carol; Lloyd, Cathy E; Karamat, M Ali; Webb, Jackie; Gill, Paramjit S

2017-03-01

Diabetes mellitus is a global health problem and one of the most common medical conditions in pregnancy. A wide range of modifiable risk factors are associated with diabetes mellitus in pregnancy, and it is widely acknowledged that preconception care (PCC) is beneficial for women with pre-existing diabetes mellitus. However, uptake of PCC services is low. To systematically review qualitative research on PCC for women with pre-existing diabetes mellitus of childbearing age, identify facilitators of and barriers to uptake of PCC and establish themes and gaps in knowledge. Through qualitative interviews explore views on the provision of, and facilitators of and barriers to the uptake of, PCC. Mixed methods encompassing a systematic review and qualitative interviews. Two secondary care sites and 11 primary care sites. Women of childbearing age with pre-existing type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) of white British or Pakistani origin. None. A narrative synthesis of the literature using thematic analysis and a thematic analysis of the qualitative interview data using the method of constant comparison. Eighteen qualitative studies were included in the systematic review and a quality appraisal was carried out using relevant criteria for qualitative research appraisal, including a narrative summary of study quality. Twelve interviews with women with pre-existing T1DM or T2DM were carried out. This fell short of the original aim of interviewing 48 women owing to challenges in recruitment, especially in primary care. A synthesis of these data shows that uptake of PCC is influenced by a range of factors, including the complexity of pregnancy planning, the skill and expertise of health professionals who provide care to women with diabetes mellitus, the role of health professionals in the delivery of PCC, and the quality of relationships between women and health professionals. Owing to significant challenges with recruitment of participants, particularly in primary care, 12 interviews with women with pre-existing T1DM or T2DM were carried out, which fell short of the a priori sample size. Reconceptualising PCC to place greater emphasis on pregnancy planning, fertility and contraception would lower some of the existing barriers to uptake of care. It is important to clarify who is responsible for the delivery of PCC to women with pre-existing diabetes mellitus and to ensure that the correct expertise is available so that opportunities for advice giving are maximised. Relationships between women and health professionals should be based on a partnership approach that encourages mutual trust and respect, focusing on positive change rather than negative outcomes. Further research is needed to investigate the views and experiences of stakeholders that commission, design and deliver PCC services for women with pre-existing diabetes mellitus; to explore experiences of women from minority or ethnically diverse backgrounds; to investigate the role of family support in contraception, pregnancy planning and PCC; and to investigate the management of diabetes mellitus in neonatal care and its role in breastfeeding. This study is registered as PROSPERO CRD42014015592 and ISRCTN12983949. The National Institute for Health Research Health Technology Assessment programme.

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

PubMed

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

2016-12-01

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

Barriers and Facilitators to Central Venous Catheter Insertion: A Qualitative Study.

PubMed

Cameron, Kenzie A; Cohen, Elaine R; Hertz, Joelle R; Wayne, Diane B; Mitra, Debi; Barsuk, Jeffrey H

2018-03-14

The aims of the study were to identify perceived barriers and facilitators to central venous catheter (CVC) insertion among healthcare providers and to understand the extent to which an existing Simulation-Based Mastery Learning (SBML) program may address barriers and leverage facilitators. Providers participating in a CVC insertion SBML train-the-trainer program, in addition to intensive care unit nurse managers, were purposively sampled from Veterans Administration Medical Centers located in geographically diverse areas. We conducted semistructured interviews to assess perceptions of barriers and facilitators to CVC insertion. Deidentified transcripts were analyzed using a grounded theory approach and the constant comparative method. We subsequently mapped identified barriers and facilitators to our SBML curriculum to determine whether or not the curriculum addresses these factors. We interviewed 28 providers at six Veterans Administration Medical Centers, identifying the following five overarching factors of perceived barriers to CVC insertion: (1) equipment, (2) personnel/staff, (3) setting or organizational context, (4) patient or provider, and (5) time-related barriers. Three overarching factors of facilitators emerged: (1) equipment, (2) personnel, and (3) setting or organizational context facilitators. The SBML curriculum seems to address most identified barriers, while leveraging many facilitators; building on the commonly identified facilitator of nursing staff contribution by expanding the curriculum to explicitly include nurse involvement could improve team efficiency and organizational culture of safety. Many identified facilitators (e.g., ability to use ultrasound, personnel confidence/competence) were also identified as barriers. Evidence-based SBML programs have the potential to amplify these facilitators while addressing the barriers by providing an opportunity to practice and master CVC insertion skills.

Evaluating the long-term hydrology of an evapotranspiration-capillary barrier with a 1000 year design life

NASA Astrophysics Data System (ADS)

Zhang, Z. Fred

2016-06-01

A surface barrier is a commonly used technology for isolation of subsurface contaminants. Surface barriers for isolating radioactive waste are expected to perform for centuries to millennia, yet there are very few data for field-scale surface barriers for periods approaching a decade or longer. The Prototype Hanford Barrier (PHB) with a design life of 1000 years was constructed over an existing radioactive waste site in 1994 to demonstrate its long-term performance. The primary element of the PHB is an evapotranspiration-capillary (ETC) barrier in which precipitation water is stored in a fine-textured soil layer and later released to the atmosphere via evapotranspiration. To address the barrier performance under extreme conditions, this study included an enhanced precipitation stress test from 1995 to 1997 to determine barrier response to extreme precipitation events. During this period a 1000 year 24 h return rainstorm was simulated in March every year. The loss of vegetation on barrier hydrology was tested with a controlled fire test in 2008. The 19 year monitoring record shows that the store-and-release mechanism worked as well as or better than the design criterion. Average drainage from the ETC barrier amounted to an average of 0.005 mm yr-1, which is well below the design criterion of 0.5 mm yr-1. After a simulated wildfire, the naturally reestablished vegetation and increased evaporation combined to release the stored water and summer precipitation to the atmosphere such that drainage did not occur in the 5 years subsequent to the fire.

Collective Phenomena In Volume And Surface Barrier Discharges

NASA Astrophysics Data System (ADS)

Kogelschatz, U.

2010-07-01

Barrier discharges are increasingly used as a cost-effective means to produce non-equilibrium plasmas at atmospheric pressure. This way, copious amounts of electrons, ions, free radicals and excited species can be generated without appreciable gas heating. In most applications the barrier is made of dielectric material. In laboratory experiments also the use of resistive, ferroelectric and semiconducting materials has been investigated, also porous ceramic layers and dielectric barriers with controlled surface conductivity. Major applications utilizing mainly dielectric barriers include ozone generation, surface cleaning and modification, polymer and textile treatment, sterilization, pollution control, CO2 lasers, excimer lamps, plasma display panels (flat TV screens). More recent research efforts are also devoted to biomedical applications and to plasma actuators for flow control. Sinu- soidal feeding voltages at various frequencies as well as pulsed excitation schemes are used. Volume as well as surface barrier discharges can exist in the form of filamentary, regularly patterned or laterally homogeneous discharges. Reviews of the subject and the older literature on barrier discharges were published by Kogelschatz (2002, 2003), by Wagner et al. (2003) and by Fridman et al. (2005). A detailed discussion of various properties of barrier discharges can also be found in the recent book "Non-Equilibrium Air Plasmas at Atmospheric Pressure" by Becker et al. (2005). The physical effects leading to collective phenomena in volume and surface barrier discharges will be discussed in detail. Special attention will be given to self-organization of current filaments. Main similarities and differences of the two types of barrier discharges will be elaborated.

Chasing boundaries and cascade effects in a coupled barrier-marsh-lagoon system

NASA Astrophysics Data System (ADS)

Lorenzo-Trueba, Jorge; Mariotti, Giulio

2017-08-01

The long-term dynamic evolution of an idealized barrier-marsh-lagoon system experiencing sea-level rise is studied by coupling two existing numerical models. The barrier model accounts for the interaction between shoreface dynamics and overwash flux, which allows the occurrence of barrier drowning. The marsh-lagoon model includes both a backbarrier marsh and an interior marsh, and accounts for the modification of the wave regime associated with changes in lagoon width and depth. Overwash, the key process that connects the barrier shoreface with the marsh-lagoon ecosystems, is formulated to account for the role of the backbarrier marsh. Model results show that a number of factors that are not typically associated with the dynamics of coastal barriers can enhance the rate of overwash-driven landward migration by increasing backbarrier accommodation space. For instance, lagoon deepening could be triggered by marsh edge retreat and consequent export of fine sediment via tidal dispersion, as well as by an expansion of inland marshes and consequent increase in accommodation space to be filled in with sediment. A deeper lagoon results in a larger fraction of sediment overwash being subaqueous, which coupled with a slow shoreface response sending sediment onshore can trigger barrier drowning. We therefore conclude that the supply of fine sediments to the back-barrier and the dynamics of both the interior and backbarrier marsh can be essential for maintaining the barrier system under elevated rates of sea-level rise. Our results highlight the importance of considering barriers and their associated backbarriers as part of an integrated system in which sediment is exchanged.

36 CFR 406.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... accessibility requirements to the extent compelled by the Architectural Barriers Act of 1968, as amended (42 U.S.C. 4151-4157), and any regulations implementing it. In choosing among available methods for meeting...

11 CFR 9420.5 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the extent compelled by the Architectural Barriers Act of 1968, as amended, 42 U.S.C. 4151-4157, and any regulations implementing it. In choosing among available methods for meeting the requirements of...

11 CFR 6.150 - Program accessibility; Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the extent compelled by the Architectural Barriers Act of 1968, as amended (42 U.S.C. 4151-4157) and any regulations implementing it. In choosing among available methods for meeting the requirements of...

13 CFR 136.150 - Program accessibility: Existing facilities.

Code of Federal Regulations, 2010 CFR

2010-01-01

... the extent compelled by the Architectural Barriers Act of 1968, as amended (42 U.S.C. 4151-4157), and any regulations implementing it. In choosing among available methods for meeting the requirements of...

The Birthday of Organic Chemistry.

ERIC Educational Resources Information Center

Benfey, Otto Theodor; Kaufman, George B.

1979-01-01

Describes how the synthesis of urea, 150 years ago, was a major factor in breaking the artificial barrier that existed between organic and inorganic chemistry, and this contributed to the rapid growth of organic chemistry. (GA)

Hybrid Viability and Fertility in Co-occuring Plant Species

NASA Astrophysics Data System (ADS)

Hernandez, E.; Garcia, C.; Yost, J.

2012-12-01

Similar species of plants can co-exist due to reproductive barriers that keep them from hybridizing. In the case of Lasthenia gracilis and L. californica, certain reproductive barriers allow them to co-exist at Jasper Ridge without hybridization. The two species are locally adapted to different regions of the same hillside, and have slight differences in flowering time but hybrids can be created at low rate in the green house. We tested the viability and fertility of green house produced hybrids to quantify post-zygotic reproductive isolation at Jasper Ridge. We planted 10 hybrid seeds and 10 control seeds from 11 different families. We measured the percent germination, survival to flowering and pollen fertility of the seeds. We expect lower germination, lower survival to flowering, and lower pollen viability of hybrid seeds as compared to control seeds.

Load Measurement on Foundations of Rockfall Protection Systems

PubMed Central

Volkwein, Axel; Kummer, Peter; Bitnel, Hueseyin; Campana, Lorenzo

2016-01-01

Rockfall protection barriers are connected to the ground using steel cables fixed with anchors and foundations for the steel posts. It is common practice to measure the forces in the cables, while to date measurements of forces in the foundations have been inadequately resolved. An overview is presented of existing methods to measure the loads on the post foundations of rockfall protection barriers. Addressing some of the inadequacies of existing approaches, a novel sensor unit is presented that is able to capture the forces acting on post foundations in all six degrees of freedom. The sensor unit consists of four triaxial force sensors placed between two steel plates. To correctly convert the measurements into the directional forces acting on the foundation a special in-situ calibration procedure is proposed that delivers a corresponding conversion matrix. PMID:26840315

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

PubMed Central

2010-01-01

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

Service provision and quality outcomes in home health for rural Medicare beneficiaries at high risk for unplanned care.

PubMed

Mroz, Tracy M; Andrilla, C Holly A; Garberson, Lisa A; Skillman, Susan M; Patterson, Davis G; Larson, Eric H

2018-06-11

Multiple barriers exist to providing home health care in rural areas. This study examined relationships between service provision and quality outcomes among rural, fee-for-service Medicare beneficiaries who received home health care between 2011 and 2013 for conditions associated with high-risk for unplanned care. More skilled nursing visits, visits by more types of providers, more timely care, and shorter lengths of stay were associated with significantly higher odds of hospital readmission and emergency department use and significantly lower odds of community discharge. Results may indicate unmeasured clinical severity and care needs among this population. Additional research regarding the accuracy of current severity measures and adequacy of case-mix adjustment for quality metrics is warranted, especially given the continued focus on value-based payment policies.

Influence of solid noise barriers on near-road and on-road air quality

NASA Astrophysics Data System (ADS)

Baldauf, Richard W.; Isakov, Vlad; Deshmukh, Parikshit; Venkatram, Akula; Yang, Bo; Zhang, K. Max

2016-03-01

Public health concerns regarding adverse health effects for populations spending significant amounts of time near high traffic roadways has increased substantially in recent years. Roadside features, including solid noise barriers, have been investigated as potential methods that can be implemented in a relatively short time period to reduce air pollution exposures from nearby traffic. A field study was conducted to determine the influence of noise barriers on both on-road and downwind pollutant concentrations near a large highway in Phoenix, Arizona, USA. Concentrations of nitrogen dioxide, carbon monoxide, ultrafine particles, and black carbon were measured using a mobile platform and fixed sites along two limited-access stretches of highway that contained a section of noise barrier and a section with no noise barrier at-grade with the surrounding terrain. Results of the study showed that pollutant concentrations behind the roadside barriers were significantly lower relative to those measured in the absence of barriers. The reductions ranged from 50% within 50 m from the barrier to about 30% as far as 300 m from the barrier. Reductions in pollutant concentrations generally began within the first 50 m of the barrier edge; however, concentrations were highly variable due to vehicle activity behind the barrier and along nearby urban arterial roadways. The concentrations on the highway, upwind of the barrier, varied depending on wind direction. Overall, the on-road concentrations in front of the noise barrier were similar to those measured in the absence of the barrier, contradicting previous modeling results that suggested roadside barriers increase pollutant levels on the road. Thus, this study suggests that noise barriers do reduce potential pollutant exposures for populations downwind of the road, and do not likely increase exposures to traffic-related pollutants for vehicle passengers on the highway.

Crossing the Barriers: An Analysis of Permitting Barriers to Geothermal Development and Potential Improvement Scenarios

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

Levine, Aaron L; Young, Katherine R

Developers have identified many non-technical barriers to geothermal power development, including permitting. Activities required for permitting, such as the associated environmental reviews, can take a considerable amount of time and delay project development. This paper discusses the impacts to geothermal development timelines due to the permitting challenges, including the regulatory framework, environmental review process, and ancillary permits. We identified barriers that have the potential to prevent geothermal development or delay timelines and defined improvement scenarios that could assist in expediting geothermal development and permitting timelines and lead to the deployment of additional geothermal resources by 2030 and 2050: (1) themore » creation of a centralized federal geothermal permitting office and utilization of state permit coordination offices as well as (2) an expansion of existing categorical exclusions applicable to geothermal development on Bureau of Land Management public lands to include the oil and gas categorical exclusions passed as part of the Energy Policy Act of 2005. We utilized the Regional Energy Deployment System (ReEDS) and the Geothermal Electricity Technology Evaluation Model (GETEM) to forecast baseline geothermal deployment based on previous analysis of geothermal project development and permitting timelines. The model results forecast that reductions in geothermal project timelines can have a significant impact on geothermal deployment. For example, using the ReEDS model, we estimated that reducing timelines by two years, perhaps due to the creation of a centralized federal geothermal permitting office and utilization of state permit coordination offices, could result in deployment of an additional 204 MW by 2030 and 768 MW by 2050 - a 13% improvement when compared to the business as usual scenario. The model results forecast that a timeline improvement of four years - for example with an expansion of existing categorical exclusions coupled with the creation of a centralized federal geothermal permitting office and utilization of state permit coordination offices - could result in deployment of an additional 2,529 MW of geothermal capacity by 2030 and 6,917 MW of geothermal capacity by 2050 - an improvement of 116% when compared to the business as usual scenario. These results suggest that reducing development timelines could be a large driver in the deployment of geothermal resources.« less

Effect of stratum corneum heterogeneity, anisotropy, asymmetry and follicular pathway on transdermal penetration.

PubMed

Barbero, Ana M; Frasch, H Frederick

2017-08-28

The impact of the complex structure of the stratum corneum on transdermal penetration is not yet fully described by existing models. A quantitative and thorough study of skin permeation is essential for chemical exposure assessment and transdermal delivery of drugs. The objective of this study is to analyze the effects of heterogeneity, anisotropy, asymmetry, follicular diffusion, and location of the main barrier of diffusion on percutaneous permeation. In the current study, the solution of the transient diffusion through a two-dimensional-anisotropic brick-and-mortar geometry of the stratum corneum is obtained using the commercial finite element program COMSOL Multiphysics. First, analytical solutions of an equivalent multilayer geometry are used to determine whether the lipids or corneocytes constitute the main permeation barrier. Also these analytical solutions are applied for validations of the finite element solutions. Three illustrative compounds are analyzed in these sections: diethyl phthalate, caffeine and nicotine. Then, asymmetry with depth and follicular diffusion are studied using caffeine as an illustrative compound. The following findings are drawn from this study: the main permeation barrier is located in the lipid layers; the flux and lag time of diffusion through a brick-and-mortar geometry are almost identical to the values corresponding to a multilayer geometry; the flux and lag time are affected when the lipid transbilayer diffusivity or the partition coefficients vary with depth, but are not affected by depth-dependent corneocyte diffusivity; and the follicular contribution has significance for low transbilayer lipid diffusivity, especially when flux between the follicle and the surrounding stratum corneum is involved. This study demonstrates that the diffusion is primarily transcellular and the main barrier is located in the lipid layers. Published by Elsevier B.V.